Joke Bradt

Music therapy for end-of-life care

Reason for withdrawal from publication At March 2014, the Cochrane Pain, Palliative and Supportive Care Review Group withdrew this review as the authors were no longer available to complete the update. For more information, please contact Managing Editor Anna Hobson, anna.hobson@ndcn.ox.ac.uk,

Vocal Music Therapy for Chronic Pain Management in Inner-City African Americans: A Mixed Methods Feasibility Study

BACKGROUND To date, research on music for pain management has focused primarily on listening to prerecorded music for acute pain. Research is needed on the impact of active music therapy interventions on chronic pain management. OBJECTIVE The aim of this mixed methods research study was to determine feasibility and estimates of effect of vocal music therapy for chronic pain management. METHODS Fifty-five inner-city adults, predominantly African Americans, with chronic pain were randomized to an 8-week vocal music therapy treatment group or waitlist control group. Consent and attrition rates, treatment compliance, and instrument appropriateness/burden were tracked. Physical functioning (pain interference and general activities), self-efficacy, emotional functioning, pain intensity, pain coping, and participant perception of change were measured at baseline, 4, 8, and 12 weeks. Focus groups were conducted at the 12-week follow-up. RESULTS The consent rate was 77%. The attrition rate was 27% at follow-up. We established acceptability of the intervention. Large effect sizes were obtained for self-efficacy at weeks 8 and 12; a moderate effect size was found for pain interference at week 8; no improvements were found for general activities and emotional functioning. Moderate effect sizes were obtained for pain intensity and small effect sizes for coping, albeit not statistically significant. Qualitative findings suggested that the treatment resulted in enhanced self-management, motivation, empowerment, a sense of belonging, and reduced isolation. CONCLUSIONS This study suggests that vocal music therapy may be effective in building essential stepping-stones for effective chronic pain management, namely enhanced self-efficacy, motivation, empowerment, and social engagement.

Guidelines for publishing mixed methods research studies in the Nordic Journal of Music Therapy

The Nordic Journal of Music Therapy (NJMT) accepts manuscripts of empirical research, literature-based research, as well as other genres such as essays, perspectives on practice, and dialogues and ...

Reducing Opioid Use for Patients With Chronic Pain: An Evidence-Based Perspective

&NA; The implementation of recent Centers for Disease Control and Prevention recommendations to move away from opioids and toward nonpharmacological therapies for the treatment of chronic pain could involve a difficult transition period for patients and practitioners. The focus of treatment should shift from eliminating pain completely to minimizing the impact of pain on quality of life. Many patients with chronic pain take opioids either because opioids were previously prescribed as a first‐line treatment for chronic pain, on the basis of old standards of care, or because opioids were initially prescribed for acute pain. Patients currently taking opioids will need a tapering period during which they transition their pain management to interdisciplinary care and nonpharmacological treatments. To provide useful treatment options, physical therapists need to have a good understanding of the neuroscientific mechanisms of chronic pain, biopsychosocial components of chronic pain management, issues related to opioid use, and pain management strategies used by other health care professionals. Armed with knowledge and good communication skills, physical therapists can work within an interdisciplinary team to adapt care to each patients needs and abilities. This perspective article provides guidance for physical therapists to effectively treat patients with chronic pain during the opioid tapering process. A framework has been created to help health care providers structure their reasoning as they collaborate to develop a unique approach for each patient.

NIH/Kennedy Center Workshop on Music and the Brain: Finding Harmony

The National Institutes of Health and John F. Kennedy Center for the Performing Arts convened a panel of experts to discuss the current state of research on music and the brain. The panel generated research recommendations to accelerate the study of musics effects on the brain and the implications for human health.

Involving services users in music therapy evaluation

Service users’ perspectives on music therapy services can play a powerful role in examining and enhancing the impact and quality of music therapy services, securing continued funding for music therapy services, enhancing understanding of music therapy as a healthcare service and formulating recommendations for future research. In this issue, several articles focus on music therapy service evaluation and the importance of gaining experiential knowledge from service users. Giorgos Tsiris, Neta Spiro and Mercédès Pavlicevic (p. 3) discuss how music therapy service evaluations can contribute an important form of evidence to music therapy practice and play an essential role in the development of music therapy research agendas. They report on the analysis of five service evaluations of Nordoff–Robbins Music Therapy services in different neurorehabilitation contexts as perceived by clients, their families, music therapists and staff. Triona McCaffrey reports on an evaluation study of adult service users of music therapy in statutory mental health services in Ireland (p. 28). Through semi-structured interviews, she sought to obtain experiential knowledge from service users in order to enhance understanding of what music therapy services can offer to service users in mental health care contexts. McCaffrey argues that as recovery-oriented services become more prominent in mental healthcare, it is necessary for music therapists to actively engage service users in research endeavors. One way to accomplish this is by conducting service user evaluation studies. Monique van Bruggen-Rufi, Annemieke Vink, Wilco Achterberg and Raymund Roos conducted focus groups with healthcare professionals about their perceptions of music therapy services with people with Huntington’s disease (p. 44). The focus groups helped to identify the role music therapy could play in improving the quality of life of people with Huntington’s disease. The findings of this qualitative exploratory study were subsequentially used for the development of a largemusic therapy trial to examine the effects of music therapy on quality-of-life outcomes in this patient population. Finally, Bolette Daniels Beck and colleagues reported on a feasibility study of trauma-focused guided imagery and music with adult refugees diagnosed with PTSD in preparation of a large-scale randomized controlled trial (RCT) (p. 76). An important aspect of this feasibility study was the evaluation of acceptance of the music therapy intervention by the refugees. Although RCTs are aimed at measuring treatment efficacy and may not (always) incorporate service user perspectives on the intervention, the preparatory work for a high quality RCT typically includes feasibility studies. Such studies often include obtaining user experiences of the intervention to determine if the intervention is perceived as meaningful and acceptable. Feasibility studies may lead to further refinement of the intervention and additional preliminary studies before an RCT is conducted. Increasingly, clinical trials of behavioral interventions use mixed methods research designs so that study participants’ experiences of the interventions can be captured, analyzed and integrated with quantitative outcome data (Creswell & Plano Clark, 2018).

Innovation, excitement and perseverance

An interdisciplinary approach to research greatly augments the potential for innovation as it typically brings a new lens to the study of a phenomenon. Innovation, new knowledge and the ability to challenge existing knowledge fuels research teams. My PhD students often ask me: How do you do it? Subsequent discussions clarify that what they really are asking is: What keeps you going? How do you persevere? Where do you find the energy and motivation to submit grant applications given the low success rate for funding? What powers you to manage multiple research studies, teach, mentor students, be an editor for a journal and continue to write grants? For me, it is the excitement for innovative research that makes me persevere, whether my own research, my students’ research, or that of scholars who submit to our journal. Vice versa, perseverance leads to the possibility of actually implementing innovative research through funding. Several studies in this issue filled me with excitement because of their innovation. The studies by Johns (p. 197) and Marom, Gilboa and Bodner (p. 175) both used micro-analysis. This, in and of itself, may not be innovative but what made these studies unique is that they used micro-analysis to examine the musical parameters of phenomena that have not previously been studied through a musical lens. Unni Tanum Johns used micro-analysis to study, through a musical framework, the microactions in child psychotherapeutic encounters. I was surprised to read that even though micro-analysis has been used plenty in infant development research and even in the field of adult psychotherapy, careful analysis of therapeutic interactions at the micro-level has been absent in child psychotherapy. Yet, understanding the micro-shifts that take place in the therapeutic process can offer important insights into the child’s individual therapeutic development. This is furthermore the first study to bring greater understanding of the musical parameters of the intersubjective encounter between the psychotherapist and the child and the implications of this for therapeutic growth. Maya Marom and colleagues micro-analyzed the intersubjective and musical characteristics of echolalia in children with autism. Although echolalia has been studied for years, the innovation of their work lies in the fact that they meticulously analyzed the musical characteristics of each child’s echolalic expressions with the aim to better understand the purpose of the echolalic speech. This enabled them to identify various interactive functions of echolalia characterized by distinct musical parameters for each child. Their findings are most intriguing as they hold great potential for helping clinicians and caregivers understand why a child may use echolalia. This, in turn, may contribute to a more accurate identification of the child’s in-the-moment needs. Jennifer Bibb and Katrina Skewes McFerran’s grounded theory study (p. 235) focused on uncovering conditions and contextual factors of group singing that

Music therapy applied to complex blast injury in interdisciplinary care: a case report

Abstract Purpose: Music therapy has a long history of treating the physiological, psychological, and neurological injuries of war. Recently, there has been an increase in the use of music therapy and other creative arts therapies in the care of combat injured service members returning to the United States from Iraq and Afghanistan, especially those with complex blast-related injuries. This case report describes the role of music therapy in the interdisciplinary rehabilitation of a severely injured service member. Methods: Music therapy was provided as stand-alone treatment and in co-treatment with speech language pathology, physical therapy, and occupational therapy. The report is based on clinical notes, self-reports by the patient and his wife, and interviews with rehabilitation team members. Results: In collaboration with other treatment disciplines, music therapy contributed to improvements in range of motion, functional use of bilateral upper extremities, strength endurance, breath support, articulation, task-attention, compensatory strategies, social integration, quality of life, and overall motivation in the recovery process. The inclusion of music therapy in rehabilitation was highly valued by the patient, his family, and the treatment team. Conclusions: Music therapy has optimized the rehabilitation of a service member through assisting the recovery process on a continuum from clinic to community. Implications for Rehabilitation Music therapy in stand-alone sessions and in co-treatment with traditional disciplines can enhance treatment outcomes in functional domains of motor, speech, cognition, social integration, and quality of life for military populations. Music therapists can help ease discomfort and difficulty associated with rehabilitation activities, thereby enhancing patient motivation and participation in interdisciplinary care. Music therapy assists treatment processes from clinic to community, making it highly valued by the patient, family, and interdisciplinary team members in military healthcare. Music therapy provides a platform to prevent social isolation by promoting community integration through music performance.

Threats to legitimacy

What influences people’s perceptions of music therapy? What kind of things lead to misunderstandings of who we are and what we do? I was left pondering these questions after reading the findings of a survey by Gioros Tsiris (p. 293) about music therapists’ perceptions of spirituality and its relevance to their music therapy practice. Whereas the majority of the survey respondents indicated that spirituality is important to their work, others expressed concern about associating music therapy with spirituality. This concern appeared to be fueled by a fear that associating music therapy with such an “esoteric” term (p. 312) may threaten the legitimacy of our profession. One survey respondent suggested that we should not be talking about “non-scientific” (p. 312) words such as spirituality until music therapy is better established as a field. I find these responses very intriguing; they made me wonder about things music therapists possibly avoid doing or discussing to “safeguard” the credibility of our profession. Do some avoid engaging clients in group drumming experiences because these may be viewed as just “beating on drums” and do not seem to address “real” client issues? Are there music therapists who shun the use of prerecorded music because it potentially threatens the credibility of the need for trained music therapists? Are certain instruments avoided in sessions because they make the intervention appear too new age like (e.g. Tibetan singing bowls)? Should all qualitative research or arts-based research be halted because the dominant medical research paradigm values objective and unbiased measures of treatment outcomes? It is certainly important that we work toward enhancing the credibility and legitimacy of music therapy. However, avoiding discussion, reflection, training, and research in areas that are of importance to our work due to fear of misrepresentation and potential delegitimization does not seem acceptable to me. So what can we do to enhance the legitimacy of our profession? It is important that we 1) continue to develop and test music therapy theories, 2) produce and publish high-quality research that elucidates music therapy processes, demonstrates impact of treatment, and examines underlying mechanisms, 3) grow research capacity in our field as an increase in research output is urgently needed, 4) engage in practice that is supported by multiple types of evidence and is responsive to current needs and evolving healthcare practices, 5) collaborate with other healthcare professionals in research and practice, and 6) engage consumers as stakeholders in our research endeavors. The articles in this issue of the Nordic Journal of Music Therapy contribute to several of these areas. Suvi Saarikallio and colleagues (p. 376) examined mechanisms involved in music relaxation in adolescents, enhancing understanding of affective processes involved in music relaxation in adolescents. Susan Gardstrom and

Research that contributes to evidence-based practice

Evidence-based practice dominates healthcare practices and decision-making in many countries across the world. Evidence-based practice includes the integration of the best available research with the music therapist’s clinical expertise, including the ability to individualize treatment based on specific patient needs and preferences (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). Evidence-based practice decision-making typically involves use of a hierarchy of evidence where the best evidence is presumed to be provided by metaanalyses of randomized controlled trials (RCTs) or single RCTs in the absence of meta-analysis. But for many music therapy clinicians, using published evidence of systematic reviews and RCTs presents challenges. First, many published clinical trials lack a detailed description of the music therapy intervention, making it difficult to understand what the intervention actually entailed (Potvin, Bradt, & Kesslick, 2015). This is problematic. For example, studies that limit intervention description to “this study used receptive music therapy” do not offer meaningful contributions to evidence-based practice. In addition, many music therapy efficacy studies do not yet use manualized protocols. This makes it impossible for clinicians to either replicate the intervention in their practice or to understand what revisions to the treatment may be needed for their particular clinical population. Second, many music therapy trials measure the effects of one or very few music therapy session. This choice is often driven by research protocol demands, limited study time frame and fear of participant attrition. However, it does not represent the reality of most music therapy practice. Third, little attention is given in publications of efficacy trials to description of the therapeutic relationship or the musical interactions within the music therapy session. Of course, analysis of these important clinical components is not the focus of efficacy trials. However, this issue illustrates the necessity for inclusion of other types of evidence in music therapy evidencebased practice. This issue of the Nordic Journal of Music Therapy contains four articles that demonstrate how different types of research can contribute to evidence-based practice. The article by Jeanette Tamplin and colleagues (p. 111) offer clinicians a therapeutic song writing protocol that was developed for individuals with acquired neurological injuries. The authors provide a sound theoretical framework for the intervention, a detailed description of each intervention session, and a case study example. Systematic reviews and narrative synthesis are useful to clinicians as they summarize the available evidence on a given topic. The Nordic Journal of Music Therapy, 2016 Vol. 25, No. 2, 109–110, http://dx.doi.org/10.1080/08098131.2016.1143176