Imogen N. Clark

Psychosocial outcomes of active singing interventions for therapeutic purposes: a systematic review of the literature

Meaningful interventions that enhance psychosocial factors, such as improving mood, reducing anxiety or increasing motivation, have the potential to ameliorate therapeutic outcomes for individuals in therapeutic programs. Singing, with its capacity for social, emotional, cognitive, and physical engagement, demonstrates potential as an accessible intervention that could facilitate such benefits. A systematic review of the literature was conducted to investigate the effectiveness of active singing as an intervention for improving psychosocial measures for people in therapeutic programs. Literature was searched through databases Medline, PsycInfo, Embase, Cinahl, Amed, and PubMed. Key concepts included populations in therapeutic programs, active singing as an intervention and psychosocial outcomes. Fourteen articles were identified that met the inclusion and exclusion criteria. These studies were assessed against quality criteria and data were tabulated for analysis and synthesis of results. Of the 11 quantitative studies, three demonstrated significantly improved psychosocial measures following the active singing intervention, and three further studies showed significant effects for both active singing and a comparison intervention. These findings are inconclusive and indicate that a variety of interventions including active singing demonstrate a capacity to improve psychosocial measures in the populations examined. Evidence from three qualitative papers, however, suggests that active singing may have some less tangible benefits that were not captured in the quantitative data. Further research with random group allocation, validated measurement tools, larger sample sizes and mixed quantitative and qualitative designs might increase the potential for results that capture the psychosocial effects of active singing for therapeutic purposes.

The modulating effects of music listening on health-related exercise and physical activity in adults: a systematic review and narrative synthesis

A systematic review and narrative synthesis of theories was conducted to examine the modulating effects of music listening on health-related exercise and physical activity. Searches were conducted on multiple bibliographic databases from the earliest available date until April 2013 using the key terms of music, physical activity and theory and related synonyms. Two reviewers independently screened retrieved texts using the inclusion and exclusion criteria. The quality of included texts was appraised using a checklist, and key concepts were recorded and synthesised using inductive thematic analysis. The narrative synthesis comprised 23 theoretical texts representing three contexts: therapeutic outcomes, sports and exercise performance, and auditory-motor processing. The quality appraisal demonstrated some limitations in the reporting of evidence informing theories. Analysis across all texts identified a main theme, cortical and subcortical stimulation and response, and two sub-themes, physiological arousal and subjective experience. These themes contributed to a common hypothesis that music could promote behavioural change with increased exercise adherence and participation. A meta-theory is presented, offering a framework for clinical practice and research. Music therapists might use the meta-theory to inform music listening interventions in programmes that aim to increase levels of physical activity.

Music interventions and physical activity in older adults: A systematic literature review and meta-analysis

OBJECTIVE To determine the effectiveness of music interventions in increasing physical activity in older adults. METHODS Searches until March 2011 were conducted through CINAHL, MEDLINE, EMBASE, PubMED, AMED, PsychINFO, AUSPORT, PEDro, OTseeker, Expanded Academic ASAP, SPORTDiscus, and The Cochrane Library. Selection criteria included older adults, music interventions, physical activity outcomes, and quantitative designs. Two reviewers independently screened records. Study details included objectives, designs, participants, music interventions, physical activity outcomes, and results. Risk of bias was assessed using the PEDro scale. RESULTS The review included 12 low to moderate quality studies with 309 participants. Three meta-analyses conducted for the review (4 trials and 99 participants) did not demonstrate any within-session differences in comparisons between music and no-music interventions. Two individual trials of moderate quality demonstrated increased capacity to perform physical activity following exercise programs with music over 4 and 8 weeks compared with no-music. There was no evidence that any particular music intervention was superior to another. CONCLUSION Evidence from a small number of low to moderate quality trials did not demonstrate within-session improvements for older adults who listen to music during exercise. However, there may be cumulative benefits following programs with music over several weeks.

The Brunel Music Rating Inventory-2 is a reliable and valid instrument for older cardiac rehabilitation patients selecting music for exercise

Music with motivating qualities might support exercise adherence in older adults with cardiac disease. The Brunel Music Rating Inventory-2 (BMRI-2), a 6-item scale with motivational quotients ranging from 6 to 42 developed to facilitate music selection for exercise, has been validated with young adults. However, the suitability of the BMRI-2 for older adults is unknown. We tested reliability (internal consistency, test-retest reliability, and measurement error) and validity (content and construct) of the BMRI-2 with older adults in cardiac rehabilitation. Eleven men and 9 women (M age = 71.6 years, SD = 8.9) selected two pieces of music and used the BMRI-2 to rate the motivational quality of these for a walking task. BMRI-2 ratings demonstrated high internal consistency. Test-retest reliability and levels of measurement error were acceptable. Content was evaluated as relevant and comprehensive. There was convergence with flow scales, and discrimination between music selections with differing motivational quotients (p < .01). The BMRI-2 demonstrates acceptable psychometric properties for older adult cardiac rehabilitation patients.

Participant-selected music and physical activity in older adults following cardiac rehabilitation: A randomized controlled trial

Objective: To evaluate effects of participant-selected music on older adults’ achievement of activity levels recommended in the physical activity guidelines following cardiac rehabilitation. Design: A parallel group randomized controlled trial with measurements at Weeks 0, 6 and 26. Setting: A multisite outpatient rehabilitation programme of a publicly funded metropolitan health service. Subjects: Adults aged 60 years and older who had completed a cardiac rehabilitation programme. Interventions: Experimental participants selected music to support walking with guidance from a music therapist. Control participants received usual care only. Main measures: The primary outcome was the proportion of participants achieving activity levels recommended in physical activity guidelines. Secondary outcomes compared amounts of physical activity, exercise capacity, cardiac risk factors, and exercise self-efficacy. Results: A total of 56 participants, mean age 68.2 years (SD = 6.5), were randomized to the experimental (n = 28) and control groups (n = 28). There were no differences between groups in proportions of participants achieving activity recommended in physical activity guidelines at Week 6 or 26. Secondary outcomes demonstrated between-group differences in male waist circumference at both measurements (Week 6 difference −2.0 cm, 95% CI −4.0 to 0; Week 26 difference −2.8 cm, 95% CI −5.4 to −0.1), and observed effect sizes favoured the experimental group for amounts of physical activity (d = 0.30), exercise capacity (d = 0.48), and blood pressure (d = −0.32). Conclusions: Participant-selected music did not increase the proportion of participants achieving recommended amounts of physical activity, but may have contributed to exercise-related benefits.

Remini-Sing: A Feasibility Study of Therapeutic Group Singing to Support Relationship Quality and Wellbeing for Community-Dwelling People Living With Dementia and Their Family Caregivers

Background: Living at home following a diagnosis of dementia can be difficult for both the person living with dementia (PwD) and their family caregivers (FCG). Active group music participation may provide an avenue for emotional release, offer psychosocial support to caregivers and stimulate meaningful interaction between caregivers and loved ones with dementia. Therapeutic music interventions also have the capacity to facilitate reminiscence and social engagement and can help to manage challenging symptoms associated with dementia, such as anxiety, apathy, and agitation. Method: This feasibility study examined the acceptability of a 20-week therapeutic group singing intervention (Remini-Sing) and quantitative research assessments for PwD/FCG dyads living in the community. Quantitative measures for the following outcomes were tested for sensitivity and acceptability: relationship quality (PwD and FCG); life satisfaction, caregiver satisfaction, flourishing, and depression for FCGs; and anxiety, apathy, agitation, and quality of life for PwD. Quantitative assessments were conducted before, during (midway) and after 20 weeks of participation in a therapeutic singing group attended by the PwD and FCG together. The Remini-Sing intervention incorporated vocal warm ups, singing familiar songs, learning new songs, and opportunities for social interaction. Qualitative interviews were conducted with all dyads that completed the intervention. Results: Twelve PWD/FCG dyads were recruited and enrolled in the study. High participation and retention rates indicated that the intervention was received favorably by participants. There were no statistically significant changes on measures from pre to post intervention. However, favorable baseline scores on relationship quality and wellbeing measures were sustained over the 20-week intervention. The testing of these measures for feasibility also revealed that some were too difficult for PwD and thus yielded questionable results, some were potentially less relevant, and there were likely floor and ceiling effects on several of the measures utilized. Conclusions: This study demonstrated good feasibility for a research protocol and therapeutic group singing intervention for community-dwelling PwD and their FCGs. Participant reflections and researcher observations yielded useful information guiding the selection of quantitative outcome measures for future research in this area.

Community-Dwelling People Living With Dementia and Their Family Caregivers Experience Enhanced Relationships and Feelings of Well-Being Following Therapeutic Group Singing: A Qualitative Thematic Analysis

The progression of dementia can severely compromise interpersonal connection and relationship quality between people living with dementia (PwD) and their family caregivers (FCG), leading to social isolation and poor quality of life for both. Therapeutic group singing (TGS) is a socially engaging, stimulating, and supportive pursuit that community-dwelling PwD and their FCG can participate in together. This study aimed to build on the findings from previous research by undertaking a thematic analysis of interviews with nine PwD (five women, four men; mean age = 79.1 years) and nine FCG (five women, four men; mean age = 75.7 years). The interviews explored participants’ perspectives and experiences of a 20-week TGS intervention, underpinned by Kitwood’s model of person-centered care. Inductive thematic analysis resulted in the emergence of five themes which described how TGS for PwD and their FCG: (1) included supportive therapeutic facilitation and design features; (2) made group singing more accessible; (3) fostered new empathic friendships; (4) enhanced relationships between PwD and FCG; and (5) led to personal feelings of wellbeing for both PwD and FCG. Affinity with others who had similar life experiences and challenges created a sense of mutual understanding and camaraderie, which made group singing accessible without fear of judgment and social stigmas. For some PwD/FCG dyads, TGS meant they could continue a lifelong passion for singing together, while others enjoyed participating in singing together for the first time. Both PwD and FCG participants described personal feelings of acceptance, improved social confidence, mood, and purpose. Further, participants valued mental stimulation from TGS such as learning new skills and memory support. A model explaining relationships between themes suggests that TGS with person-centered facilitation features for PwD/FCG dyads led to affinity among group members with ripple effects, which enhanced accessibility to group singing, the formation of empathic friendships, PwD/FCG relationship quality, and personal wellbeing for both PwD and FCG. Psychoemotional, social and cognitive benefits from TGS described by participants in this study are known to promote self-identity, healthy relationships, and quality of life. This research highlights a need for improved availability of TGS for community-dwelling PwD/FCG dyads.

Music therapy research in dementia: Fostering a global approach

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Authors’ roundtable: scientific writing, peer review, and publication across journals

Background: Preparing a manuscript for submission and moving through the peer review process can be a challenging task. Authors may benefit from learning about the peer review process and understanding common pitfalls.Objective: Editors from music therapy journals across the globe will facilitate discussion with attendees about the process of peer review and scientific publication, offering cross-journal perspectives and examples from the vantage point of editor, reviewer, and author.Methods: Editors will present topics across six key areas: (1) overview of the review process, (2) strategies for preparing a strong manuscript, (3) common reasons manuscripts are declined publication, (4) how to respond to reviewer comments, (5) citation metrics and impact factor, and (6) ways editors/editorial boards can improve the peer review process for authors/reviewers. Emphasis is on facilitating dialogue among editors and session participants.Conclusions: This roundtable will provide transparency about the peer revie...