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Effectiveness of music therapy: a summary

of systematic reviews based on randomized
controlled trials of music interventions

Hiroharu Kamioka 1 Objective: The objective of this review was to summarize evidence for the effectiveness of
Kiichiro Tsutani 2 music therapy (MT) and to assess the quality of systematic reviews (SRs) based on randomized
Minoru Yamada 3 controlled trials (RCTs).
Hyuntae Park 4 Study design: An SR of SRs based on RCTs.
Hiroyasu Okuizumi 5 Methods: Studies were eligible if they were RCTs. Studies included were those with at least
Koki Tsuruoka 6 one treatment group in which MT was applied. We searched the following databases from
Takuya Honda 7 1995 to October 1, 2012: MEDLINE via PubMed, CINAHL (Cumulative Index of Nursing
Shinpei Okada 8 and Allied Health Literature), Web of Science, Global Health Library, and Ichushi-Web. We
Sang-Jun Park 8 also searched all Cochrane Database and Campbell Systematic Reviews up to October 1, 2012.
Jun Kitayuguchi 9 Based on the International Classification of Diseases, 10th revision, we identified a disease
Takafumi Abe 9 targeted for each article.
Shuichi Handa 5 Results: Twenty-one studies met all inclusion criteria. This study included 16 Cochrane reviews.
Takuya Oshio 10 As a whole, the quality of the articles was very good. Eight studies were about “Mental and
Yoshiteru Mutoh 11 behavioural disorders (F00-99)”; there were two studies on “Diseases of the nervous system
1
Faculty of Regional Environment Science,
(G00-99)” and “Diseases of the respiratory system (J00-99)”; and there was one study each for
Tokyo University of Agriculture, Tokyo, “Endocrine, nutritional and metabolic diseases (E00-90)”, “Diseases of the circulatory system
Japan; 2Department of Drug Policy
and Management, Graduate School of (I00-99)”, and “Pregnancy, childbirth and the puerperium (O60)”. MT treatment improved the
Pharmaceutical Sciences, The University following: global and social functioning in schizophrenia and/or serious mental disorders, gait
of Tokyo, Tokyo, Japan; 3Kyoto University
Graduate School Research, Kyoto, Japan; and related activities in Parkinson’s disease, depressive symptoms, and sleep quality.
4
Department of Functioning Activation, Conclusion: This comprehensive summary of SRs demonstrated that MT treatment improved
National Center for Geriatrics and
Gerontology, Aichi, Japan; 5Mimaki Onsen the following: global and social functioning in schizophrenia and/or serious mental disorders,
(Spa) Clinic, Tomi, Nagano, Japan; 6Graduate gait and related activities in Parkinson’s disease, depressive symptoms, and sleep quality. MT
School of Social Services, Japan College of
Social Work, Tokyo, Japan; 7Japanese Society may have the potential for improving other diseases, but there is not enough evidence at present.
for the Promotion of Science, Tokyo, Most importantly, no specific adverse effect or harmful phenomenon occurred in any of the
Japan; 8Physical Education and Medicine
Research Foundation, Tomi, Nagano, Japan; studies, and MT was well tolerated by almost all patients.
9
Physical Education and Medicine Research Keywords: ICD-10, schizophrenia, mental disorders, Parkinson’s disease, depression, sleep
Center Unnan, Shimane, Japan; 10Social
Welfare Service Corporation CARE-
PORT MIMAKI, Tomi, Nagano, Japan; 11The
Research Institute of Nippon Sport Science Article focus
University, Tokyo, Japan
Although many studies have reported the effects of music therapy (MT), there is no
review of systematic reviews (SRs) based on randomized controlled trials (RCTs).
Correspondence: Hiroharu Kamioka
Faculty of Regional Environment Science,
Tokyo University of Agriculture, Key messages
1-1-1 Sakuragaoka, Setagaya-ku, The key messages of this paper are as follows.
Tokyo 156-8502, Japan
Tel/fax +81 3 5477 2587
1. This is the first SR of SRs of the effectiveness of cure based on music interventions
Email h1kamiok@nodai.ac.jp in studies with RCT designs.

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2. Our study is unique because it summarizes the evidence feeding ability, and music as a basis for pacification during
for each target disease according to the International multilayered, multimodal stimulation.4
Classification of Diseases, revision 10 (ICD-10). Examining the curative effects of MT has unique chal-
3. We propose the future research agenda for studies on the lenges. A review article by Nilsson5 described how nurses
treatment effect of MT. face many challenges as they care for the needs of hospital-
ized patients, and that they often have to prioritize physical
Strength and limitation of this study care over the patient’s emotional, spiritual, and psychologi-
The strengths of this study are as follows: 1) the methods and cal needs. In clinical practice, music intervention can be a
implementation registered high on the PROSPERO database; tool to support these needs by creating an environment that
2) it was a comprehensive search strategy across multiple stimulates and maintains relaxation, wellbeing, and comfort.
databases with no data restrictions; and 3) there were high Furthermore, the Nilsson article5 presented a concrete rec-
agreement levels for quality assessment of articles. ommendation for music interventions in clinical practice,
This study has three limitations. Firstly, some selection such as “slow and flowing music, approximately 60 to 80
criteria were common across studies; however, the bias beats per minute”, “nonlyrical”, “maximum volume level
remained due to differences in eligibility for participation at 60 dB”, “patient’s own choice, with guidance”, “suitable
in each original RCT. Secondly, publication bias was a equipment chosen for the specific situation”, “a minimum
limitation. Lastly, since this review focused on summarizing duration of 30 minutes in length”, and “measurement, fol-
the effects of MT for each disease, we did not describe all low up, and documentation of the effects”. In addition, MT
details on quality and quantity, such as type of MT, frequency has been variably applied as both a primary and accessory
of MT, and time on MT. treatment for persons with addictions to alcohol, tobacco,
and other drugs of abuse. However, an SR6 described that no
Introduction consensus exists regarding the efficacy of MT as treatment
MT is widely utilized for treatment of and assistance in for patients with addictions.
various diseases. In one literature review, the authors found On the other hand, music may be considered an adjunc-
seven case reports/series and seven studies on MT for mul- tive therapy in clinical situations. Music is effective in
tiple sclerosis patients. The results of these studies as well reducing anxiety and pain in children undergoing medical
as the case reports demonstrated patients’ improvements in and dental procedures.7 A meta-analysis confirmed that
the domains of self-acceptance, anxiety, and depression.1 patients listening to music during colonoscopy, which is
Another review examined the overall efficacy of MT in chil- now the recommended method for screening colon can-
dren and adolescents with psychopathology, and examined cer, was an effective method for reducing procedure time,
how the size of the effect of MT is influenced by the type of anxiety, and the amount of sedation. More importantly, no
pathology, the subject’s age, the MT approach, and the type harmful effects were observed for all the target studies.8
of outcome.2 The analysis revealed that MT had a medium to The usual practice following a cervical cancer abnormal
large positive effect (effect size =0.61) on clinically relevant cervical smear is to perform a colposcopy. However, women
outcomes that was statistically highly significant (P,0.001) experience high levels of anxiety and negative emotional
and statistically homogeneous. A more recent SR assessed responses at all stages of cervical screening. An SR of
the effects of musical elements in the treatment of individu- RCTs evaluated interventions designed to reduce anxiety
als with acquired neurological disorder.3 The results showed levels during colposcopic examination. Psychosexual
that mechanisms of recovery remained unclear: two of the dysfunction (ie, anxiety) was reduced by playing music
three studies that examined mechanisms of recovery via during colposcopy.9
neuro-imaging techniques supported the role of the right The definition of musical intervention is complex,
hemisphere, but reports were contradictory, and exact mecha- but the literature describes two broad categories of music
nisms of recovery remained indefinable. An interesting meta- interventions: music medicine and MT.10 Music medicine is
analysis described results that justified strong consideration the use of passive listening (usually involving prerecorded
for the inclusion of neonatal intensive care unit (NICU) MT music) as implemented by medical personnel. In music
protocols in best practice standards for NICU treatment of medicine studies, the subject’s preference for the music
preterm infants: examples of these therapies were listening used may be considered by having him or her select from
to music for pacification, music reinforcement of sucking/ a variety of tapes. Alternately, some studies use predefined

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Dovepress Effectiveness of music therapy

music stimuli that do not take the subject’s preferences into Search methods for studies identification
account. Furthermore, there is generally no attempt by the Bibliographic database
researcher to form a therapeutic relationship with the subject, We searched the following databases from 1995 to
and there is no process involved in the music treatment. In October 1, 2012: MEDLINE via PubMed, Cumulative
essence, music medicine studies usually allow one to assess Index of Nursing and Allied Health Literature (CINAHL),
the effects of music alone as a therapeutic intervention. In Web of Science, Ichushi Web (in Japanese), the Global
contrast, MT interventions most often involve a relationship Health Library (GHL), and the Western Pacific Region
between the therapist and the subject, the use of live music Index Medicus (WPRIM). The International Committee of
(performed or created by the therapist and/or patient), and a Medical Journal Editors (ICMJE) recommended uniform
process that includes assessment, treatment, and evaluation. requirements for manuscripts submitted to biomedical
Patient preference for the music is usually a consideration journals in 1993. We selected articles published (that
in MT studies. included a protocol) since 1995, because it appeared that
We were interested in evaluating the curative effect of the ICMJE recommendation had been adopted by the
MT according to diseases because many of the primary stud- relevant researchers and had strengthened the quality of
ies and review articles of much MT have reported results in the reports.
this way. In particular, we wanted to focus on all cure and We also searched the Cochrane Database of Systematic
rehabilitation effects using the ICD-10. It is well known in Reviews (Cochrane Reviews), the Database of Abstracts
research design that evidence grading is highest for an SR of Reviews of Effects (Other Reviews), the Cochrane Central
with meta-analysis of RCTs. Although many studies have Register of Controlled Trials (Clinical Trials or CENTRAL),
reported the effects of MT, there is no review of SRs based the Cochrane Methodology Register (Methods Studies),
on RCTs. The objective of this review was to summarize the Health Technology Assessment Database (Technology
evidence for the effectiveness of MT and to assess the quality Assessments), the NHS Economic Evaluation Database
of SRs based on RCTs of these therapies. (Economic Evaluations), About The Cochrane Collaboration
databases (Cochrane Groups), the Campbell Systematic
Methods Reviews (the Campbell Collaboration), and the All Cochrane,
Criteria for considering studies up to October 1, 2012.
included in this review All searches were performed by two specific searchers
Types of studies (hospital librarians) who were qualified in medical infor-
Studies were eligible if they were SRs (with or without a mation handling, and who were experienced in searches of
meta-analysis) based on RCTs. clinical trials.

Types of participants Search strategies

There was no restriction on patients. The special search strategies contained the elements and
terms for MEDLINE, CINAHL, Web of Science, Ichushi
Types of intervention and language Web, GHL, WPRIM, and All Cochrane databases (Figure 1
Studies included were those with at least one treatment group and Table 1). Only keywords about intervention were used for
in which MT was applied. The definition of MT is complex, the searches. First, titles and abstracts of identified published
but in this study, any kind of MT (not only music apprecia- articles were reviewed in order to determine the relevance of
tion but also musical instrument performance and singing, the articles. Next, references in relevant studies and identified
for example) was permitted and defined as an intervention. SRs were screened.
Studies had to include information on the use of medication,
alternative therapies, and lifestyle changes, and these had to Registry checking
be comparable among groups. There was no restriction on We searched the International Clinical Trials Registry
the basis of language. Platform (ICTRP), Clinical Trials.gov, and the University
Hospital Medical Information Network – Clinical Trials
Types of outcome measures Registry (UMIN-CTR), up to October 1, 2012.
We focused on all cure and rehabilitation effects using the ICTRP in the WHO Registry Network meet specific cri-
ICD-10. teria for content, quality and validity, accessibility, unique

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Manuscripts based on databases Clinical registries

Potentially relevant abstracts International Prospective Register of Systematic Reviews (n=46)

MEDLINE (n=278) International Clinical Trials Registry Platform (n=195)
CINAHL (n=215) Clinical Trials.gov (n=163)
Web of science (n=169) University Hospital Medical Information Network – Clinical Trials Registry (n=2)
Ichushi-web (n=89)
Global health library (n=126 )
Western pacific regional index medicus (n=17)
Cochrane reviews (n=211)
Cochrane other reviews (n=68)
Cochrane clinical trials or CENTRAL (n=0)
Cochrane method studies (n=26)
Technology assessments (n=3)
NHS economic evaluations (n=1)
Cochrane groups (n=5)
Campbell systematic review (n=5)

Retrieved for detail evaluation by articles* (n=63 )

Appendix (references to studies excluded)

Excluded (n=42) • Updated or replacement SR (n=4)
• Not treatment or rehabilitation (n=11)
• Not SR based on RCTs (n=22)
• Not music therapy (n=2)
• Protocol (n=1)
Articles meeting inclusion criteria (n=21) • Reduplication study/error of selection (n=2)

Figure 1 Flowchart of trial process.

Note: *Reduplication.
Abbreviations: CINAHL, Cumulative Index of Nursing and Allied Health Literature; CENTRAL, Cochrane Central Register of Controlled Trials; RCT, randomized
controlled trial; SR, systematic review.

identification, technical capacity, and administration. Primary only completed studies. Cure and rehabilitation effects were
registries meet the requirements of the ICMJE. Clinical used as a primary outcome measure. Trials that were excluded
Trials.gov is a registry of federally and privately supported are presented with reasons for exclusion (Table S1).
clinical trials conducted in the US and around the world.
UMIN-CTR is a registry of clinical trials conducted in Japan Quality assessment of included studies
and around the world. To ensure that variation was not caused by systematic errors
in the study design or execution, eleven review authors (HP,
Handsearching and reference checking MY, HO, SO, SJP, TO, KT, TH, SH, JK, and HK) indepen-
We handsearched abstracts published on MT in relevant dently assessed the quality of the articles. A full quality
journals in Japan. We checked the references of included appraisal of these papers was made using the combined tool
studies for further relevant literature. based on the AMSTAR checklist11 developed to assess the
methodological quality of SRs.
Review methods Each item was scored as “present” (Yes), “absent” (No),
Selection of trials “unclear or inadequately described” (Can not answer), or
To make the final selection of studies for the review, all “not applicable” (n/a). Depending on the study design, some
criteria were applied independently by four authors (ie, TH, items were not applicable. The “n/a” was excluded from cal-
JK, SJP, and TA) to the full text of articles that had passed culation for quality assessment. We displayed the percentage
the first eligibility screening (Figure 1). Disagreements and of descriptions that were present on all items for the quality
uncertainties were resolved by discussion with other authors assessment of articles. Then, based on the percentage of risk of
(ie, HK, KT, and YM). poor methodology and/or bias, each item was assigned to one
Studies were selected when 1) the design was an SR based of the following categories: good description (80%–100%),
on RCTs and 2) one of the interventions was a form of MT. poor description (50%–79%), or very poor description
Protocols without results were excluded, and we included (0%–49%).

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Dovepress Effectiveness of music therapy

Table 1 The special search strategies Table 1 (Continued)

1. MEDLINE #5 Keywords:song? or singing
#1 Search music[all] #6 #5 or #4 or #3 or #2 or #1
#2 Search musical[all] #7 MeSH Heading:Meta-Analysis/All Categories/All Subheadings
#3 Search music[MeSH] #8 MeSH Heading:Meta-Analysis as Topic/All Categories/All Subheadings
#4 Search “Music Therapy”[Mesh] #9 All:meta-analy% or “meta analy%” or metaanaly%
#5 Search song[Text Word] #10 All:“sistematic review” or “systematic review%”
#6 Search songs[Text Word] #11All:review%
#7 Search singing[Text Word] #12 #11 or # 10 or #9 or #8 or #7
#8 Search ((((((#1) OR #2) OR #3) OR #4) OR #5) OR #6) OR #7 #13 #12 and #6
#9 Search systematic[sb] #14 #12 and #6 -Limits:1995-2012
#10 Search Meta-Analysis[Publication type] 7. All Cochrane
#11 Search “Meta-Analysis as Topic”[MeSH Terms] #1 MeSH descriptor: [Music] explode all trees
#12 Search Meta-analysis*[all] #2 MeSH descriptor: [Music Therapy] explode all trees
#13 Search Metaanalysis*[all] #3 music* (Word variations have been searched)
#14 Search systematic review*[all] #4 song* or singing:ti,ab,kw (Word variations have been searched)
#15 Search (((((#9) OR #10) OR #11) OR #12) OR #13) OR #14 #5 #1 or #2 or #3 or #4
#16 Search (#8) AND #15 #6 MeSH descriptor: [Meta-Analysis] explode all trees
#17 Search (#8) AND #15 Filters: Publication date from 1995/01/01 #7 MeSH descriptor: [Meta-Analysis as Topic] explode all trees
2. CINHAL #8 “meta-analysis”:pt (Word variations have been searched)
#1 (TI music OR AB music) OR (TI musical OR AB musical) #9 meta next analy* (Word variations have been searched)
OR TX “music therap*” OR MH music OR MH “music therapy” #10 systematic next review* (Word variations have been searched)
#2 (TI “song” OR AB “song”) OR (TI “songs” OR AB “songs”) #11 #6 or #7 or #8 or #9 or #10
OR (TI “singing” OR AB “singing”) OR MH “singing” #12 #5 and #11 from 1995 (Word variations have been searched)
#3 MH “meta analysis” OR PT “meta analysis” OR TI “meta analy*” 8. Campbell Collaboration
OR AB “meta analysis*” music* in “ALL text”
#4 MH “systematic review” OR PT “systematic review” OR TI 9. ICTRP
“systematic review*” OR AB “systematic review*” music therapy* OR music* OR singing
#5 #1 or #2 10. Internationl Prospective Register of Systematic Review
#6 #3 or #4 music
#7 #5 and #6 11. Clinical Trials. Gov
3. Web of Science #1music OR musical
#1 (music*) OR (music therap*) 12. UMIN-CTR
#2 (song*) OR (singing) NOT (song*) 音楽 in 「自由記載語」
#3 (meta analys*) OR (systematic review*)
#4 #2 OR #1
#5 #4 AND #3
Disagreements and uncertainties were resolved by discus-
#6 #5 Article time span=1995-2012
4. Ichushi Web sion with other authors (ie, KT and HK). Inter-rater reliability
#1 (音楽療法/TH or 音楽療法/AL) or (音楽療法士/TH or 音楽療法 was calculated on a dichotomous scale using percentage
士/AL) or 音楽/TH or 音楽/AL or ミュージック/AL or 歌唱/AL or agreement and Cohen’s kappa coefficient (κ).
(楽器/TH or 楽器/AL) or 演奏/AL
#2 メタアナリシス/TH or メタアナリシス/AL or メタ分析/AL or
(RD=メタアナリシス) Summary of studies and data extraction
#3 システマティックレビュー/TH or システマティックレビュー/ Eleven review authors (HP, MY, HO, SO, SJP, TH, TO, SH,
AL or “systematic review”/AL JK, KT, and HK) described the summary from each article
#4 総説文献/TH or (文献研究/TH or 文献/AL) or レビュー/AL or
(EBM/TH or EBM/AL)
based on the structured abstracts.12,13
#5 #2 or #3 or #4
#6 #1 and #5 Benefit and harm
#7 (#6) and (DT=1995:2012 PT=会議録除く)
The GRADE Working Group14 reported that the balance
5. GHL
(music or musical or singing) AND (“meta analysis” or meta-analysis or between benefit and harm, quality of evidence, applicability,
#systematic and review*#) and the certainty of the baseline risk were all considered in
6. WPRIM judgments about the strength of recommendations. Adverse
#1 All:music or music% or “music therap%”
events for intervention were especially important informa-
#2 Mesh Heading:Music/All Categories/All Subheadings
#3 Mesh Heading:Music Therapy/All Categories/All Subheadings tion for researchers and users of clinical practice guidelines,
#4 Abstract:song? or singing and we presented this information with the description of
(Continued) each article.

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Table 2 A structured abstract of 21 systematic reviews

Study Title Aim/objective Data source/search strategy Study selection/
selection criteria
Sinha Auditory integration To determine the For this update, we searched the following Randomized controlled trials
et al17 training and other effectiveness of auditory databases in September 2010: involving adults or children
sound therapies for integration therapy or CENTRAL (2010, Issue 2), MEDLINE with autism spectrum
autism spectrum other methods of sound (1950 to September week 2, 2010), disorders. Treatment was
disorders (ASD) therapy in individuals EMBASE (1980 to week 38, 2010), auditory integration therapy
with autism spectrum CINAHL (1937 to current), PsycINFO or other sound therapies
disorders. (1887 to current), ERIC (1966 to current), involving listening to music
LILACS (September 2010) and the modified by filtering and
reference lists of published papers. modulation. Control groups
One new study was found for inclusion. could involve no treatment,
a waiting list, usual therapy,
or a placebo equivalent. The
outcomes were changes in
core and associated features
of autism spectrum disorders,
auditory processing, QoL, and
adverse events.

Mossler Music therapy for To review the effects of We searched the Cochrane Schizophrenia All RCTs that compared
et al18 people with music therapy, or music Group Trials Register (December 2010) music therapy with standard
schizophrenia and therapy added to and supplemented this by contacting care, placebo therapy, or no
schizophrenia-like standard care, compared relevant study authors, handsearching treatment.
disorders with “placebo” therapy, of music therapy journals, and manual
standard care or no searches of reference lists.
treatment for people
with serious mental
disorders such as
schizophrenia.

Table 2 (Continued)

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Dovepress Effectiveness of music therapy

Data extraction/data Main results The authors’ conclusions

collection and analysis
Two independent review authors We identified six RCTs of auditory integration There is no evidence that auditory
performed data extraction. therapy and one of Tomatis therapy, involving a integration therapy or other sound
All outcome data in the included total of 182 individuals aged 3–39 years. Two were therapies are effective as treatments for
papers were continuous. cross-over trials. Five trials had fewer than 20 autism spectrum disorders. As synthesis
We calculated point estimates participants. Allocation concealment was inadequate of existing data has been limited by the
and standard errors from for all studies. Twenty different outcome measures disparate outcome measures used between
paired t-test scores and post- were used, and only two outcomes were used studies, there is not sufficient evidence to
intervention means. Meta- by three or more studies. Meta-analysis was not prove that this treatment is not effective.
analysis was inappropriate for possible due to very high heterogeneity or the However, of the seven studies including
the available data. presentation of data in unusable forms. Three 182 participants that have been reported to
studies did not demonstrate any benefit of auditory date, only two (with an author in common),
integration therapy over control conditions. Three involving a total of 35 participants, report
studies reported improvements at 3 months for statistically significant improvements in the
the auditory integration therapy group based on auditory integration therapy group and for
the Aberrant Behavior Checklist, but they used a only two outcome measures (Aberrant
total score rather than subgroup scores, which is of Behavior Checklist and Fisher’s Auditory
questionable validity, and Veale’s results did not reach Problems Checklist). As such, there is no
statistical significance. Rimland 1995 also reported evidence to support the use of auditory
improvements at 3 months in the auditory integration integration therapy at this time.
therapy group for the Aberrant Behavior Checklist
subgroup scores. The study addressing Tomatis
therapy described an improvement in language
with no difference between treatment and control
conditions and did not report on the behavioral
outcomes that were used in the auditory integration
therapy trials.
Studies were reliably selected, We included eight studies (total 483 participants). Music therapy as an addition to standard
quality assessed, and data These examined effects of music therapy over the short- care helps people with schizophrenia
extracted. We excluded to medium-term (1–4 months), with treatment “dosage” to improve their global state, mental
data where more than 30% varying from seven to 78 sessions. Music therapy added state (including negative symptoms), and
of participants in any group to standard care was superior to standard care for social functioning if a sufficient number of
were lost to follow-up. global state (medium-term, one RCT, n=72, RR 0.10, music therapy sessions are provided by
We synthesized non-skewed 95% CI 0.03–0.31; NNT 2, 95% CI 1.2–2.2). Continuous qualified music therapists. Further research
continuous endpoint data from data identified good effects on negative symptoms should especially address the long-term
valid scales using an SMD. (four RCTs, n=240, SMD average endpoint SANS −0.74, effects of music therapy, dose–response
If statistical heterogeneity was 95% CI −1.00 to −0.47); general mental state relationships, as well as the relevance of
found, we examined treatment (one RCT, n=69, SMD average endpoint PANSS −0.36, outcomes measures in relation to music
“dosage” and treatment 95% CI −0.85 to 0.12; two RCTs, n=100, SMD average therapy.
approach as possible sources endpoint. BPRS −0.73, 95% CI −1.16 to −0.31);
of heterogeneity. depression (two RCTs, n=90, SMD average endpoint.
SDS −0.63, 95% CI −1.06 to −0.21; one RCT, n=30,
SMD average endpoint Ham-D −0.52, 95% CI −1.25
to −0.12); and anxiety (one RCT, n=60, SMD average
endpoint SAS −0.61, 95% CI −1.13 to −0.09).
Positive effects were also found for social functioning
(one RCT, n=70, SMD average endpoint. SDSI
score −0.78, 95% CI −1.27 to −0.28). Furthermore,
some aspects of cognitive functioning and behavior
seem to develop positively through music therapy.
Effects, however, were inconsistent across studies and
depended on the number of music therapy sessions as
well as the quality of music therapy provided.
(Continued)

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Study Title Aim/objective Data source/search strategy Study selection/

selection criteria
Bradt Music interventions for To compare the effects We searched CENTRAL (The Cochrane We included all RCTs
et al19 improving psychological of music therapy or music Library 2010, Issue 10), MEDLINE, EMBASE, and quasi-RCTs of music
and physical outcomes medicine interventions CINAHL, PsycINFO, LILACS, Science interventions for improving
in cancer patients and standard care with Citation Index, CancerLit, http://www. psychological and physical
standard care alone, or musictherapyworld.net, CAIRSS, Pro Quest outcomes in patients
standard care and other Digital Dissertations, ClinicalTrials.gov, with cancer. Participants
interventions in patients Current Controlled Trials, and the undergoing biopsy and
with cancer. National Research Register. All databases aspiration for diagnostic
were searched from their start date to purposes were excluded.
September 2010. We handsearched music
therapy journals and reference lists and
contacted experts. There was no language
restriction.

Bradt and Music therapy for To examine effects of We searched CENTRAL, MEDLINE, We included all RCTs and
Dileo20 end-of-life care music therapy with CINAHL, EMBASE, PsycINFO, LILACS, quasi-RCTs that compared
standard care versus CancerLit, Science Citation Index, music interventions and
standard care alone or http://www.musictherapyworld.de, standard care with standard
standard care combined CAIRSS for Music, Pro Quest Digital care alone or combined
with other therapies on Dissertations, ClinicalTrials.gov, Current with other therapies in any
psychological, Controlled Trials, and the National care setting with a diagnosis
physiological, and Research Register to September 2009. of advanced life-limiting
social responses in We handsearched music therapy journals illness being treated with
end-of-life care. and reference lists, and contacted experts palliative intent and with a life
to identify unpublished manuscripts. expectancy of less than
There was no language restriction. 2 years.

Vink Music therapy for To assess the effects ALOIS, the specialized Register of the Randomized controlled
et al21 people with dementia of music therapy in the CDCIG was searched on April 14, 2010 trials that reported clinically
treatment of behavioral, using the terms: music therapy, music singing, relevant outcomes associated
social, cognitive and sing, and auditory stimulation. Additional with music therapy in
emotional problems of searches were also carried out on April 14, treatment of behavioral,
older people with 2010 in the major health care databases social, cognitive, and
dementia, in relation MEDLINE, EMBASE, PsycINFO, CINAHL, emotional problems of older
to the type of music and LILACS, trial registers and grey people with dementia.
therapy intervention. literature sources to ensure the search
was as up-to-date and as comprehensive
as possible.

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Dovepress Effectiveness of music therapy

Data extraction/data Main results The authors’ conclusions

collection and analysis
Two review authors We included 30 trials with a total of 1,891 participants. This systematic review indicates that music
independently extracted the data We included music therapy interventions offered interventions may have beneficial effects
and assessed the risk of bias. by trained music therapists, as well as listening to on anxiety, pain, mood, and QoL in people
Where possible, results were prerecorded music offered by medical staff. The results with cancer. Furthermore, music may have
presented in meta-analyses using suggest that music interventions may have a beneficial a small effect on heart rate, respiratory
MDs and SMDs. Post-test scores effect on anxiety in people with cancer, with rate, and blood pressure. Most trials were
were used. In cases of significant a reported average anxiety reduction of 11.20 units at high risk of bias, and therefore, these
baseline difference, we used (95% CI −19.59 to −2.82, P=0.009) on the STAI-S scale results need to be interpreted with caution.
change scores. and −0.61 standardized units, (95% CI −0.97
to −0.26, P=0.0007) on other anxiety scales. Results
also suggested a positive impact on mood
(SMD =0.42, 95% CI 0.03–0.81, P=0.03), but no support
was found for depression. Music interventions may
lead to small reductions in heart rate, respiratory
rate, and blood pressure. A moderate pain-reducing
effect was found (SMD =−0.59, 95% CI −0.92 to −0.27,
P=0.0003), but no strong evidence was found for
enhancement of fatigue or physical status. The pooled
estimate of two trials suggested a beneficial effect of
music therapy on patients’ QoL (SMD =1.02, 95% CI
0.58–1.47, P=0.00001). No conclusions could be drawn
regarding the effect of music interventions on distress,
body image, oxygen saturation level, immunologic
functioning, spirituality, and communication outcomes.
Seventeen trials used listening to prerecorded music,
and 13 trials used music therapy interventions that
actively engaged the patients. Not all studies included
the same outcomes, and due to the small number
of studies per outcome, we could not compare the
effectiveness of music medicine interventions with that
of music therapy interventions.
Data were extracted, and Five studies (175 participants) were included. A limited number of studies suggest
methodological quality was There is insufficient evidence of high quality to support there may be a benefit of music therapy
assessed, independently by the effect of music therapy on QoL of people in end- on the QoL of people in end-of-life care.
review authors. Additional of-life care. Given the limited number of studies and However, the results stem from studies
information was sought from small sample sizes, more research is needed. No strong with a high risk of bias. More research is
study authors when necessary. evidence was found for the effect of music therapy on needed.
Results are presented using pain or anxiety. These results were based on two small
weighted MDs for outcomes studies. There were insufficient data to examine the
measured by the same scale and effect of music therapy on other physical, psychological,
SMDs for outcomes measured by or social outcomes.
different scales. Post-test scores
were used. In cases of statistically
significant baseline difference, we
used change scores.
Two reviewers screened the Ten studies were included. The methodological quality The methodological quality and the
retrieved studies independently of the studies was generally poor, and the study results reporting of the included studies were too
for methodological quality. Data could not be validated or pooled for further analyses. poor to draw any useful conclusions.
from accepted studies were
independently extracted by the
reviewers.

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Table 2 (Continued)
Study Title Aim/objective Data source/search strategy Study selection/
selection criteria
Bradt Music interventions To examine the effects We searched CENTRAL (The Cochrane We included all RCTs and
et al22 for mechanically of music interventions Library 2010, Issue 1) MEDLINE, CINAHL, quasi-RCTs that compared
ventilated patients with standard care AMED, EMBASE, PsycINFO, LILACS, music interventions and
versus standard care Science Citation Index, http://www. standard care with standard
alone on anxiety and musictherapyworld.net, CAIRSS for Music, care alone for mechanically
physiological responses Pro Quest Digital Dissertations, ventilated patients.
in mechanically ClinicalTrials.gov, Current Controlled Trials,
ventilated patients. the National Research Register, and NIH
RePORTer (formerly CRISP)
(all to January 2010). We
handsearched music therapy journals
and reference lists and contacted relevant
experts to identify unpublished manuscripts.
There was no language restriction.

Cepeda Music for pain relief To evaluate the effects of We searched the Cochrane Library, We included RCTs that
et al23 music on acute, chronic, MEDLINE, EMBASE, PsycINFO, LILACS, evaluated the effect of
or cancer pain intensity, and the references in retrieved manuscripts. music on any type of pain
pain relief, and analgesic There was no language restriction. in children or adults. We
requirements. excluded trials that reported
results of concurrent non-
pharmacological therapies.

Bradt Music therapy To examine the effects We searched the Cochrane Stroke RCTs and quasi-RCTs that
et al24 for acquired brain of music therapy with Group Trials Register (February 2010), compared music therapy
injury standard care versus the Cochrane Central Register of Controlled interventions and standard
standard care alone or Trials (the Cochrane Library Issue 2, 2009), care with standard care alone
standard care combined MEDLINE (July 2009), EMBASE (August 2009), or combined with other
with other therapies on CINAHL (July 2010) PsycINFO (July 2009), therapies for people older
gait, upper extremity LILACS (August 2009), AMED (August 2009), than 16 years of age who
function, communication, and Science Citation Index (August 2009). had acquired brain damage
mood and emotions, We handsearched music therapy journals and of a non-degenerative nature
social skills, pain, conference proceedings, searched dissertation and were participating in
behavioral outcomes, and specialist music databases, trials and treatment programs offered
activities of daily living, research reference lists, and contacted in hospital, outpatient, or
and adverse events. experts and music therapy associations. community settings.
There was no language restriction.

736 submit your manuscript | www.dovepress.com Patient Preference and Adherence 2014:8
Dovepress
Dovepress Effectiveness of music therapy

Data extraction/data Main results The authors’ conclusions

collection and analysis
Two authors independently We included eight trials (213 participants). Listening Listening to music may have a beneficial
extracted the data and to music was the main intervention used, and effect on heart rate, respiratory rate, and
assessed the methodological seven of the studies did not include a trained music anxiety in mechanically ventilated patients.
quality. Additional information therapist. Results indicated that listening to music may However, the quality of the evidence is not
was sought from the trial be beneficial for anxiety reduction in mechanically strong. Most studies examined the effects
researchers, when necessary. ventilated patients; however, these results need to be of listening to prerecorded music. More
Results were presented using interpreted with caution due to the small sample size. research is needed on the effects of music
MDs for outcomes measured Findings indicated that listening to music consistently offered by a trained music therapist.
by the same scale and SMDs for reduced heart rate and respiratory rate, suggesting a
outcomes measured by different relaxation response. No strong evidence was found for
scales. Post-test scores were blood pressure reduction. Listening to music did not
used. In cases of significant improve oxygen saturation level. No studies could be
baseline difference, we used found that examined the effects of music interventions
change scores. on QoL, patient satisfaction, post-discharge outcomes,
mortality, or cost-effectiveness.
Data was extracted by two Fifty-one studies involving 1,867 subjects exposed Listening to music reduces pain intensity
independent review authors. to music and 1,796 controls met inclusion criteria. levels and opioid requirements, but the
We calculated the MD in pain In the 31 studies evaluating mean pain intensity there magnitude of these benefits is small and,
intensity levels, percentage of was a considerable variation in the effect of music, therefore, its clinical importance unclear.
patients with at least 50% pain indicating statistical heterogeneity (I2 =85.3%).
relief, and opioid requirements. After grouping the studies according to the pain model,
We converted opioid this heterogeneity remained, with the exception of
consumption to morphine the studies that evaluated acute postoperative pain.
equivalents. To explore In this last group, patients exposed to music had pain
heterogeneity, studies that intensity that was 0.5 units lower on a 0–10 scale than
evaluated adults, children, unexposed subjects (95% CI −0.9 to −0.2). Studies that
acute, chronic, malignant, labor, permitted patients to select the music did not reveal
procedural, or experimental pain a benefit from music; the decline in pain intensity was
were evaluated separately, 0.2 units, 95% CI (−0.7 to 0.2). Four studies reported
as well as those studies in which the proportion of subjects with at least 50% pain relief;
patients chose the type of music. subjects exposed to music had a 70% higher likelihood
of having pain relief than unexposed subjects
(95% CI 1.21–2.37). NNT =5 (95% CI 4–13).
Three studies evaluated opioid requirements two hours
after surgery: subjects exposed to music required
1.0 mg (18.4%) less morphine (95% CI −2.0 to −0.2)
than unexposed subjects. Five studies assessed
requirements 24 hours after surgery: the music group
required 5.7 mg (15.4%) less morphine than the
unexposed group (95% CI -−8.8 to −2.6). Five studies
evaluated requirements during painful procedures: the
difference in requirements showed a trend towards
favoring the music group (−0.7 mg, 95% CI −1.8 to 0.4).
Two review authors We included seven studies (184 participants). RAS may be beneficial for gait improvement
independently assessed The results suggest that RAS may be beneficial for in people with stroke. These results are
methodological quality and improving gait parameters in stroke patients, including encouraging, but more RCTs are needed
extracted data. We present gait velocity, cadence, stride length, and gait symmetry. before recommendations can be made for
results using MDs (using post- These results were based on two studies that received clinical practice. More research is needed
test scores), as all outcomes a low risk of bias score. There were insufficient data to examine the effects of music therapy on
were measured with the same to examine the effect of music therapy on other other outcomes in people with acquired
scale. outcomes. brain injury.

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Table 2 (Continued)
Study Title Aim/objective Data source/search strategy Study selection/
selection criteria
Gold Music therapy for To review the effects The following databases were searched: All RCTs or controlled
et al25 autistic spectrum of music therapy for CENTRAL, 2005 (issue 3); MEDLINE (1966 clinical trials comparing music
disorder individuals with autistic to July 2004); EMBASE (1980 to July 2004); therapy added to standard
spectrum disorders. LILACS (1982 to July 2004); PsycINFO care to “placebo” therapy, no
(1872 to July 2004); CINAHL, (1872 to July treatment, or standard care.
2004); ERIC (1966 to July 2004); ASSIA
(1987 to July 2004); Sociofile (1963 to July
2004); Dissertation Abstracts International
(late 1960s to July 2004). These searches
were supplemented by searching specific
sources for music therapy literature and
manual searches of reference lists. Personal
contacts to some investigators were made.
Laopaiboon Music during To evaluate the We searched the Cochrane Pregnancy We included randomized
et al26 caesarean section effectiveness of music and Childbirth Group’s Trials Register controlled trials comparing
under regional during cesarean section (30 September 2008). music added to standard
anesthesia for under regional anesthesia care during cesarean section
improving maternal for improving clinical and under regional anesthesia to
and infant outcomes psychological outcomes standard care alone.
for mothers and infants.

Bradt and Music for stress and To examine the effects We searched CENTRAL, MEDLINE, We included all RCTs that
Dileo27 anxiety reduction of music interventions CINAHL, EMBASE, PsycINFO, LILACS, compared music interventions
in coronary heart with standard care versus Science Citation Index, http://www. and standard care with
disease patients standard care alone musictherapyworld.net, CAIRSS for standard care alone for
on psychological and Music, Pro Quest Digital Dissertations, persons with CHD.
physiological responses ClinicalTrials.gov, Current Controlled
in persons with CHD. Trials, and the National Research Register
(all to May 2008). We handsearched music
therapy journals and reference lists, and
contacted relevant experts to identify
unpublished manuscripts. There was no
language restriction.

Maratos Music therapy for To examine the efficacy CCDANCTR studies and CCDANCTR All RCTs comparing music
et al28 depression of music therapy with references were searched on November 7, therapy with standard care
standard care compared 2007, and MEDLINE, PsycINFO, EMBASE, or other interventions for
with standard care PsycLIT, PSYindex, and other relevant depression.
alone among people sites were searched in November 2006.
with depression and to Reference lists of retrieved articles were
compare the effects of handsearched, as well as specialist music
music therapy for people and arts therapies journals.
with depression against
other psychological or
pharmacological therapies.

738 submit your manuscript | www.dovepress.com Patient Preference and Adherence 2014:8
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Dovepress Effectiveness of music therapy

Data extraction/data Main results The authors’ conclusions

collection and analysis
Studies were independently Three small studies were included (total n=24). The included studies were of limited
selected, quality assessed, and These examined the short-term effect of brief music applicability to clinical practice. However,
data extracted by two authors. therapy interventions (daily sessions over 1 week) the findings indicate that music therapy
Continuous outcomes were for autistic children. Music therapy was superior to may help children with autistic spectrum
synthesized using an SMD to “placebo” therapy with respect to verbal and gestural disorder to improve their communicative
enable a meta-analysis combining communicative skills (verbal, two RCTs, n=20, skills. More research is needed to examine
different scales, and to facilitate SMD 0.36, 95% CI 0.15–0.57; gestyrak, 2 RCTs, n=20, whether the effects of music therapy are
the interpretation of effect sizes. SMD 0.50, 95% CI 0.22–0.79). Effects on behavioral enduring, and to investigate the effects of
Heterogeneity was assessed problems were not significant. music therapy in typical clinical practice.
using the I2 statistic.

Two review authors, Malinee One trial involving 76 women who planned to have The findings indicate that music during
Laopaiboon and Ruth Martis, their babies delivered by cesarean section met the planned cesarean section under regional
independently assessed eligibility, inclusion criteria, but data were available for only anesthesia may improve pulse rate and
risk of bias in included trials and 64 women. This trial was of low quality with unclear birth satisfaction score. However, the
extracted data. We analyzed allocation concealment, and only a few main clinical magnitude of these benefits is small and the
continuous outcomes using an outcomes reported for the women. The trial did not methodological quality of the one included
MD with a 95% CI. report any infant outcomes. It appears that music trial is questionable. Therefore, the clinical
added to standard care during cesarean section under significance of music is unclear. More
regional anesthesia had some impact on pulse rate at research is needed to investigate the effects
the end of maternal contact with the neonate in the of music during cesarean section under
intra-operative period (MD −7.50 fewer beats per regional anesthesia on both maternal and
minute, 95% CI 14.08 to −0.92) and after completion infant outcomes, in various ethnic pregnant
of skin suture for the cesarean section (MD −7.37 women, and with adequate sample sizes.
fewer beats per minute, 95% CI 13.37–1.37). There
was also an improvement in the birth satisfaction score
(maximum possible score of 35) (MD of 3.38, 95% CI
1.59–5.17). Effects on other outcomes were either not
significant or not reported in the one included trial.
Data were extracted and Twenty-three trials (1,461 participants) were included. Listening to music may have a beneficial
methodological quality was Listening to music was the main intervention used, and effect on blood pressure, heart rate,
assessed, independently by 21 of the studies did not include a trained music therapist. respiratory rate, anxiety, and pain in
the two reviewers. Additional Results indicated that listening to music has a moderate persons with CHD. However, the quality
information was sought from the effect on anxiety in patients with CHD; however, results of the evidence is not strong and the
trial researchers when necessary. were inconsistent across studies. This review did not find clinical significance unclear. Most studies
Results are presented using strong evidence for reduction of psychological distress. examined the effects of listening to
weighted MDs for outcomes Findings indicated that listening to music reduces heart prerecorded music. More research is
measured by the same scale and rate, respiratory rate, and blood pressure. Studies that needed on the effect of music offered by a
SMDs for outcomes measured included two or more music sessions led to a small and trained music therapist.
by different scales. Post-test consistent pain-reducing effect. No strong evidence was
scores were used. In cases found for peripheral skin temperature. None of the
of significant baseline difference, studies considered hormone levels, and only one study
we used change scores. considered QoL as an outcome variable.
Data on participants, Five studies met the inclusion criteria of the review. Findings from individual randomized
interventions, and outcomes Marked variations in the interventions offered and trials suggest that music therapy is
were extracted and entered the populations studied meant that meta-analysis was accepted by people with depression and
into a database independently not appropriate. Four of the five studies individually is associated with improvements in mood.
by two review authors. The reported greater reduction in symptoms of depression However, the small number and low
methodological quality of among those randomized to music therapy than to methodological quality of studies mean that
each study was also assessed those in standard care conditions. The fifth study, it is not possible to be confident about its
independently by two review in which music therapy was used as an active control effectiveness. High quality trials evaluating
authors. The primary outcome treatment, reported no significant change in mental the effects of music therapy on depression
was reduction in symptoms state for music therapy compared with standard care. are required.
of depression, based on a Dropout rates from music therapy conditions appeared
continuous scale. to be low in all studies.
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Table 2 (Continued)
Study Title Aim/objective Data source/search strategy Study selection/
selection criteria
de Dreu Rehabilitation, To study that people with We searched PubMed, EMBASE, Cochrane, The following selection
et al29 exercise therapy and PD benefit from MbM CINAHL, and SPORTDiscus for articles criteria were applied: 1)
music in patients with therapy when compared published until 1st August, 2011. people with PD were
Parkinson’s disease: with conventional targeted, 2) the study was
a meta-analysis of the therapy or no therapy an RCT of high quality
effects of music-based in terms of standing (PEDro score of .4), 3) the
movement therapy on balance, transfers, gait intervention contained MbM,
walking ability, balance performance, severity of and 4) the rhythmic cues
and quality of life freezing, and QoL. were embedded in music.

Cogo- Music education for To study the effectiveness We searched the following electronic We planned to include RCTs.
Moreira improving reading of music education on databases in June 2012: CENTRAL (2012, We looked for studies that
et al30 skills in children and reading skills (ie, oral Issue 5), MEDLINE (1948 to May week 4 included at least one of our
adolescents with reading skills, reading 2012), EMBASE (1980 to 2012 week 22), primary outcomes. The
dyslexia comprehension, reading CINAHL (searched June 7, 2012), LILACS primary outcomes were
fluency, phonological (searched June 7, 2012), PsycINFO (1887 to related to the main domain
awareness, and spelling) May week 5 2012), ERIC (searched June 7, of reading: oral reading skills,
in children and 2012), Arts and Humanities Citation reading comprehension,
adolescents with dyslexia. Index (1970 to 6 June 2012), Conference reading fluency, phonological
Proceedings Citation Index – Social Sciences awareness, and spelling
and Humanities (1990 to June 2012), measured through validated
and WorldCat (searched June 7, 2012). instruments. The secondary
We also searched the WHO ICTRP and outcomes were self-esteem
reference lists of studies. We did not apply and academic achievement.
any date or language limits.
Drahota Sensory environment To assess the effect of We searched: CENTRAL (last searched RCTs and non-randomized
et al31 on health-related hospital environments January 2006); MEDLINE (1902 to controlled trials, before-and-
outcomes of hospital on adult patient health- December 2006); EMBASE (January 1980 after studies, and interrupted
patients related outcomes. to February 2006); 14 other databases times series of environmental
covering health, psychology, and the interventions in adult hospital
built environment; reference lists; and patients reporting health-
organization websites. This review is related outcomes.
currently ongoing (MEDLINE last search
October 2010), see Studies awaiting
classification.

740 submit your manuscript | www.dovepress.com Patient Preference and Adherence 2014:8
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Dovepress Effectiveness of music therapy

Data extraction/data Main results The authors’ conclusions

collection and analysis
Two reviewers extracted Studies were generally small (total N=168). Significant MbM therapy appears promising for the
relevant data from the included homogeneous SESs were found for the Berg Balance improvement of gait and gait-related
studies. A meta-analysis of RCTs Scale, Timed Up and Go test, and stride length activities in PD. Future studies should
on the efficacy of MbM therapy, (SESs, 4.1, 2.2, and 0.11; P-values ,0.01; I2, 0%, 0%, incorporate larger groups and focus on
including individual rhythmic and 7%, respectively). A sensitivity analysis on type long-term compliance and follow-up.
music training and partnered of MbM therapy (dance- or gait-related interventions)
dance classes, was performed. revealed a significant improvement in walking velocity
Identified studies (N=6) were for gait-related MbM therapy but not for dance-related
evaluated on methodological MbM therapy. No significant effects were found for
quality, and SESs were calculated. UPDRS-motor score, freezing of gait, and QoL.
Two authors (HCM and RBA) We retrieved 851 references via the search strategy. There is no evidence available from RCTs
independently screened all titles No RCTs testing music education for the improvement on which to base a judgment about the
and abstracts identified through of reading skills in children with dyslexia could be effectiveness of music education for the
the search strategy to determine included in this review. improvement of reading skills in children
their eligibility. For our analysis and adolescents with dyslexia. This
we had planned to use MD for uncertainty warrants further research via
continuous data, with 95% CIs, RCTs, involving an interdisciplinary team:
and to use the random-effects musicians, hearing and speech therapists,
statistical model when the effect psychologists, and physicians.
estimates of two or more studies
could be combined in a meta-
analysis.

Two review authors Overall, 102 studies were included in this review. Music may improve patient-reported
independently undertook data Interventions explored were: “positive distracters”, outcomes in certain circumstances, so
extraction and “risk of bias” to include aromas (two studies), audiovisual distractions support for this relatively inexpensive
assessment. We contacted (five studies), decoration (one study), and music intervention may be justified. For some
authors to obtain missing (85 studies); interventions to reduce environmental environmental interventions, well designed
information. For continuous stressors through physical changes, to include air quality research studies have yet to take place.
variables, we calculated an (three studies), bedroom type (one study), flooring
MD or SMD, and 95% CIs for (two studies), furniture and furnishings (one study),
each study. For dichotomous lighting (one study), and temperature (one study);
variables, we calculated RR with and multifaceted interventions (two studies). We did
95% CI. When appropriate, not find any studies meeting the inclusion criteria to
we used a random-effects model evaluate: art, access to nature for example through
of meta-analysis. Heterogeneity hospital gardens, atriums, flowers, and plants, ceilings,
was explored qualitatively and interventions to reduce hospital noise, patient controls,
quantitatively based on risk technologies, way-finding aids, or the provision of
of bias, case mix, hospital visit windows. Overall, it appears that music may improve
characteristics, and country of patient-reported outcomes such as anxiety; however,
study. the benefit for physiological outcomes, and medication
consumption has less support.
There are few studies to support or refute
the implementation of physical changes,
and except for air quality, the included studies
demonstrated that physical changes in the hospital
environment at least did no harm.
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Table 2 (Continued)
Study Title Aim/objective Data source/search strategy Study selection/
selection criteria
Chan The effectiveness To review trials of the A comprehensive search strategy was We searched the published
et al32 of music listening in effectiveness of listening employed to identify all published papers in literature for RCTs and
reducing depressive to music in reducing English language between January 1989 and quasi-experimental trials that
symptoms in adults: depressive symptoms in March 2010. We searched nine databases included an intervention with
a systematic review adults, and identify areas with initial search terms including “music”, music listening designed to
requiring further study. “depression”, or “depressive symptoms”. reduce the depression level,
compared with a control
group. The intervention was
music listening, it is defined as
listening to music via any form
of music device or live music,
without the active involvement
of a music therapist.

Naylor The effectiveness of To systematically review The following international electronic Studies were included if they
et al33 music in pediatric the effectiveness of music databases were searched on March 4, met the following six criteria:
healthcare: a systematic on pediatric health- 2009: Ovid Medline (Medical Literature 1) examined the effectiveness
review of randomized related outcomes. Analysis and Retrieval System Online), of a music intervention;
controlled trials 1950 to February, week 3, 2009; EMBASE, 2) involved a clinical population
1980–2009 week 9; PsycINFO, 1967 to in a health care, research, or
February, week 4, 2009; AMED (Allied and education setting; 3) involved
Complementary Medicine), 1985–February children and adolescents
2009; and CINAHL, 1983–2008. between 1 and 18 years of
age (or reported a mean age
within this range); 4) used
an RCT design (parallel or
crossover); 5) reported at
least one quantifiable outcome
measure; and 6) was published
between 1984 and 2009.
Irons Singing for children To evaluate the effects of We searched the Group’s Cystic Fibrosis RCTs in which singing (as an
et al34 and adults with cystic a singing intervention in Trials Register, the CENTRAL, major allied adjunctive intervention) is
fibrosis addition to usual therapy complementary databases, and clinical compared with either a sham
on the QoL, morbidity, trial registers. Handsearching for relevant intervention or no singing in
respiratory muscle conference proceedings and journals was people with cystic fibrosis.
strength, and pulmonary also carried out. Date of search of trials
function of children and register: September 2, 2009. Date of
adults with cystic fibrosis. additional searches: September 17, 2009.
Irons Singing for children To evaluate the effects We searched the CAG trial register, RCTs in which singing
et al35 and adults with of a singing intervention CENTRAL, major allied complementary (as an intervention) is
bronchiectasis as a therapy on the QoL, databases, and clinical trials registers. compared with either a sham
morbidity, respiratory Professional organizations and individuals intervention or no singing in
muscle strength, and were also contacted. CAG performed patients with bronchiectasis.
pulmonary function of searches in February 2011, and additional
children and adults with searches were carried out in February
bronchiectasis. 2011.
de Niet Music-assisted To evaluate the efficacy We conducted searches in EMBASE We included published RCTs
et al36 relaxation to improve of music-assisted (1997–July 2008), Medline (1950–July performed in an adult
sleep quality: meta- relaxation for sleep 2008), Cochrane (2000–July 2008), (18–60 years) or elderly
analysis quality in adults and PsycINFO (1987–July 2008) and CINAHL (60 years or older) population
elders with sleep (1982–July 2008) for studies published in with primary sleep complaints
complaints with or English, German, French, or Dutch. or sleep complaints comorbid
without a comorbid with a medical condition.
medical condition. Studies involving active use
of music, such as playing
instruments, were excluded.

742 submit your manuscript | www.dovepress.com Patient Preference and Adherence 2014:8
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Dovepress Effectiveness of music therapy

Data extraction/data Main results The authors’ conclusions

collection and analysis
The data extracted included Listening to music over a period of time helps to All types of music can be used as listening
specific details about the reduce depressive symptoms in the adult population. material, depending on the preferences of
interventions, populations, Daily intervention does not seem to be superior over the listener. It is recommended that the
study methods, and outcomes weekly intervention, and it is recommended that music listeners are given choices over the kind
of significance to the review listening sessions be conducted repeatedly over a time of music they listen to. There is a need
question and specific objectives. span of more than 3 weeks to allow an accumulative to conduct more studies, which replicate
Two studies were pooled effect to occur. the designs used in the existing studies
together for meta-analysis due to that met the inclusion criteria, on the level
similarity in outcome measures of efficacy of music listening and on the
and intervention time points. reduction of depressive symptoms for a
more accurate meta-analysis of the findings
and which would reflect with greater
accuracy the significant effects that music
has on the level of depressive symptoms.
Data extraction includes Qualitative synthesis revealed significant improvements These findings offer limited qualitative
information about each study in one or more health outcomes within four evidence to support the effectiveness
(authorship, year of publication, of seven trials involving children with learning and of music on health-related outcomes
country, recruitment setting, and developmental disorders; two of three trials involving for children and adolescents with
experimental design), participants children experiencing stressful life events; and four of clinical diagnoses. Recommendations
(sample size, sex, population, and five trials involving children with acute and/or chronic for establishing a consensus on research
age), intervention (treatment, physical illness. No significant effects were found priorities and addressing methodological
delivery, participant involvement, for two trials involving children with mood disorders limitations are put forth to support the
and dosage), and quality rating. and related psychopathology. continued advancement of this popular
Because of heterogeneity in the intervention.
study populations, interventions
used, and outcome measures
applied, it was neither feasible
nor appropriate to conduct a
meta-analysis.

No trials were found that met No meta-analysis could be performed. As no studies that met the criteria were
the selection criteria. found, this review is unable to support or
refute the benefits of singing as a therapy
for people with cystic fibrosis. Future RCTs
are required to evaluate singing therapy for
people with cystic fibrosis.

Two authors independently No meta-analysis could be performed. In the absence of data, we cannot draw
reviewed the titles, abstracts, any conclusion to support or refute the
and citations to assess potential adoption of singing as an intervention
relevance for full review. for people with bronchiectasis. Given
No eligible trials were identified the simplicity of the potentially beneficial
and thus no data were available intervention, future RCTs are required to
for analysis. evaluate singing therapy for people with
bronchiectasis.
Pre and post-test means Five RCTs with six treatment conditions and a total Music-assisted relaxation can be used
and standard deviations, of 170 participants in intervention groups and without intensive investment in training
demographic data, and condition 138 controls met our inclusion criteria. Music-assisted and materials and is therefore cheap,
properties were extracted from relaxation had a moderate effect on the sleep quality easily available, and can be used by nurses
each included study. Review of patients with sleep complaints (SMD −0.74; to promote music-assisted relaxation to
Manager 5.0.12 (The Cochrane 95% CI −0.96 to −0.46). Subgroup analysis revealed improve sleep quality.
Collaboration, Oxford, UK) was no statistically significant contribution of accompanying
used to calculate the effect sizes measures.
of the individual studies and for
calculation of the pooled MD.
(Continued)

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Table 2 (Continued)
Study Title Aim/objective Data source/search strategy Study selection/
selection criteria
Gold Dose–response To examine the benefits A comprehensive search strategy was Study participants eligible for
et al37 relationship in music of music therapy for applied to identify all relevant studies. this review were adults with
therapy for people people with serious The trial database PsiTri, which contains serious mental disorders
with serious mental mental disorders. structured information on published and diagnosed by an international
disorders: systematic unpublished clinical trials in mental health, classification system. This
review and meta- based on multiple database searches as included psychotic disorders
analysis well as handsearches by several Cochrane as well as some non-psychotic
groups, was searched for entries containing disorders such as borderline
the word “music” in any field. PubMed was personality disorder,
searched using its “Clinical Queries” search depression, bipolar disorder,
strategy designed to identify scientifically and suicidality connected to a
strong studies of therapy outcome, mental disorder. Studies were
which was expanded with the MeSH included only if participants
term “Evaluation Studies”, and crossed were offered music therapy,
with the MeSH terms “Music Therapy” according to the definition
and “Mentally Ill Persons” or “Mental above. Most importantly, this
Disorders”. excluded interventions of the
“music medicine” type, where
music alone is provided as a
treatment, rather than using
music as a medium within a
psychotherapeutic process
and relationship. Secondly,
it had to be possible to
disentangle music therapy
from other therapies.
Abbreviations: ASSIA, Applied Social Sciences Index and Abstracts; BPRS, Brief Psychiatric Rating Scale; CAG, Cochrane Airways Group; CAIRSS, Computer-Assisted
Information Retrieval System; CCDANCTR, Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register; CDCIG, Cochrane Dementia and
Cognitive Improvement Group; CENTRAL, Cochrane Central Register of Controlled Trials; CHD, coronary heart disease; CI, confidence interval; CINAHL, Cumulative
Index of Nursing and Allied Health Literature; ERIC, Education Resource Information Centre; Ham-D, Hamilton Depression Scale; ICTRP, International Clinical Trials
Registry Platform; LILACS, Latin American and Caribbean Health Sciences Literature; MbM, music-based movement; MD, mean difference; MeSH, Medical Subject Headings;
NIH, National Institutes of Health; NNT, number needed to treat; PANSS, Positive and Negative Symptoms Scale; PD, Parkinson’s disease; PEDro, Physiotherapy Evidence
Database; QoL, quality of life; RAS, rhythmic auditory stimulation; RCT, randomized controlled trial; RR, risk ratio; SANS, Scale for the Assessment of Negative Symptoms;
SDS, Self-rating Depression Scale; SDSI, Social Disability Schedule for Inpatients; SES, summary effect size; SMD, standardized mean difference; STAI-S, State-Trait Anxiety
Inventory – State; UPDRS, Unified Parkinson’s Disease Rating Scale; WHO, World Health Organization.

Research protocol registration 63 papers were retrieved for further evaluation (checks for
We submitted and registered our research protocol to the relevant literature). Forty-two publications were excluded
PROSPERO (no 42012002950). PROSPERO is an inter- because they did not meet the eligibility criteria (Table S1).
national database of prospectively registered SRs in health A total of 21 studies17–37 met all inclusion criteria (Table 1).
and social care.15 Key features from the review protocol are The language of all eligible publications was English.
recorded and maintained as a permanent record in PROS-
PERO. This provides a comprehensive listing of SRs regis- Study characteristics
tered at inception, and enables comparison of reported review The contents of all articles were summarized as structured
findings with what was planned in the protocol. PROSPERO abstracts (Table 2). Sinha et al17 reported that there was no
is managed by UK Centre for Reviews and Dissemination evidence that auditory integration therapy or other sound thera-
(CRD) and funded by the UK National Institute for Health pies are effective as treatments for autism spectrum disorders.
Research. Registration was recommended because it encour- Mossler et al18 concluded that MT as an addition to standard
age full publication of the review’s findings and transparency care helps people with schizophrenia to improve their global
in changes to methods that could bias findings.16 state, mental state (including negative symptoms), and social
functioning if a sufficient number of MT sessions are provided
Results by qualified music therapists. Bradt et al19 indicated that music
Study selection interventions may have beneficial effects on anxiety, pain,
The literature searches included potentially relevant articles mood, and quality of life (QoL) in people with cancer. Bradt
(Figure 1). Abstracts from those articles were assessed, and and Dileo20 reported that there may be a benefit of MT on QoL

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Dovepress Effectiveness of music therapy

Data extraction/data Main results The authors’ conclusions

collection and analysis
Results for the same type of Results showed that music therapy, when added to The findings suggest that music therapy
outcome were combined across standard care, has strong and significant effects on is an effective treatment which helps
studies in a meta-analysis. Results global state, general symptoms, negative symptoms, people with psychotic and non-psychotic
of different outcomes were not depression, anxiety, functioning, and musical severe mental disorders to improve global
combined. If the same outcome engagement. Significant dose–effect relationships state, symptoms, and functioning. Slight
was measured with different were identified for general, negative, and depressive improvements can be seen with a few
scales in the same study, both symptoms, as well as functioning, with explained therapy sessions, but longer courses or
using equally valid methods variance ranging from 73% to 78%. Small effect sizes for more frequent sessions are needed to
(in terms of rater blinding and these outcomes are achieved after 3–10, large effects achieve more substantial benefits.
standardization and validity of after 16–51 sessions.
instrument), the average effect
size of these measures was used.

of people in end-of-life care. Vink et al21 reported that the meth- heart disease. Maratos et al28 suggested that MT is accepted by
odological quality and the reporting of the included studies on people with depression and is associated with improvements in
dementia were too poor to draw any useful conclusions. Bradt mood, but the small number and low methodological quality
et al22 indicated that listening to music may have a beneficial of studies meant that it is not possible to be confident about its
effect on heart rate, respiratory rate, and anxiety in mechani- effectiveness. de Dreu et al29 reported that music-based move-
cally ventilated patients. Cepeda et al23 reported that listening ment therapy appeared promising for the improvement of gait
to music reduces pain intensity levels and opioid requirements and gait-related activities in Parkinson’s disease. Cogo-Moreira
on patients with chronic, acute, neuropathic, and cancer pain et al30 concluded that there is no evidence available on which
or experimental pain, but the magnitude of these benefits is to base a judgment about the effectiveness of music education
small and therefore its clinical importance unclear. Bradt et al24 for the improvement of reading skills in children and adoles-
reported that rhythmic auditory stimulation might be benefi- cents with dyslexia. Drahota et al31 reported that music may
cial for gait improvement in people with stroke. Gold et al25 improve patient-reported outcomes in certain circumstances
indicated that MT may help children with autistic spectrum such as anxiety for hospital patients. Chan et al32 concluded
disorder to improve their communicative skills. Laopaiboon that listening to music over a period of time helps to reduce
et al26 indicated that music during planned cesarean section depressive symptoms in the adult population. Naylor et al33
under regional anesthesia may improve pulse rate and birth reported that there is limited qualitative evidence to support the
satisfaction score. Bradt and Dileo27 reported that listening to effectiveness of music on health-related outcomes for children
music may have a beneficial effect on blood pressure, heart and adolescents with clinical diagnoses. Irons et al34 concluded
rate, respiratory rate, anxiety, and pain in persons with coronary that because no studies that met the criteria were found, their

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review was unable to support or refute the benefits of singing “Pregnancy, childbirth and the puerperium (O60)”. Because
as a therapy for people with cystic fibrosis. Irons et al35 reported there were a variety of target diseases, there were six articles
that they could not draw any conclusion to support or refute in which we could not identify a single disease.
the adoption of singing as an intervention for people with
bronchiectasis because of the absence of data. de Niet et al36 Evidence of effectiveness
concluded that music-assisted relaxation could be without Table 4 presents a brief summary of 21 SRs. Five studies
intensive investment in training and materials and is therefore (ie, schizophrenia for global and mental state and social
cheap, easily available and can be used by nurses to promote functioning,18 Parkinson’s disease for gait and related
music-assisted relaxation to improve sleep quality. Gold et al37 activities,29 depressive symptoms,32 sleep quality,36 and
reported that MT is an effective treatment which helps people serious mental disorders for global and social functioning37)
with psychotic and nonpsychotic severe mental disorders to concluded that there are effects of the intervention.
improve global state, symptoms, and functioning. Ten studies with a meta-analysis (ie, cancer for anxi-
Based on ICD-10, we identified a disease targeted in each ety, pain, mood, and QoL,19 advanced life-limiting illness
article (Table 3). Among 21 studies, eight studies were about for QoL,20 mechanically ventilated patients for heart rate,
“Mental and behavioural disorders (F00-99)”. There were respiratory rate, and anxiety,22 multiple pain for intensity
two studies in “Diseases of the nervous system (G00-99)” level and opioid requirement,23 acquired brain injury for
and “Diseases of the respiratory system (J00-99)”, and one gait parameters,24 autistic spectrum disorders for commu-
study in “Endocrine, nutritional and metabolic diseases nicative skills,25 cesarean section for heart rate and birth
(E00-90)”, “Diseases of the circulatory system (I00-99)”, and satisfaction,26 coronary heart disease for blood pressure,

Table 3 International classification of target diseases in each article

Chapter ICD code Classification Study (detail ICD code)
1 A00–B99 Certain infectious and parasitic diseases
2 C00–D48 Neoplasms Bradt et al19 (unidentification about neoplasm type)
3 D50–D89 Diseases of the blood and blood-forming organs and certain
disorders involving the immune mechanism
4 E00–E90 Endocrine, nutritional and metabolic diseases Irons et al34 (E84.9)
5 F00–F99 Mental and behavioral disorders Sinha et al17 and Gold et al25 (F84.0); Mossler et al18
(F21, F22); Vink et al21 (F00–03); Maratos et al28
(F30–33); Cogo-Moreira et al30 (F81.0); Chan et al32
(F30–33); and de Niet et al36 (G47)
6 G00–G99 Diseases of the nervous system Bradt et al24 (G46) and de Dreu et al29 (G20–21)
7 H00–H59 Diseases of the eye and adnexa
8 H60–H95 Diseases of the ear and mastoid process
9 I00–I99 Diseases of the circulatory system Bradt and Dileo27 (I20–25)
10 J00–J99 Diseases of the respiratory system Bradt et al22 (J44) and Irons et al35 (J47)
11 K00–K93 Diseases of the digestive system
12 L00–L99 Diseases of the skin and subcutaneous tissue
13 M00–M99 Diseases of the musculoskeletal system and connective tissue
14 N00–N99 Diseases of the genitourinary system
15 O00–O99 Pregnancy, childbirth and the puerperium Laopaiboon et al26 (O60)
16 P00–P96 Certain conditions originating in the perinatal period
17 Q00–Q99 Congenital malformations, deformations and chromosomal
abnormalities
18 R00–R99 Symptoms, signs and abnormal clinical and laboratory
finding not elsewhere classified
19 S00–T98 Injury, positioning and certain other consequences
of external causes
20 V00–Y98 External causes of morbidity and mortality
21 Z00–Z99 Factors influencing health status and contact with health services
22 U00–U99 Code for special purpose
– Unidentification Because many illnesses were mixed, we could not identify it Bradt and Dileo,20 Cepeda et al,23 Drahota et al,31
Naylor et al,33 and Gold et al37
Abbreviation: ICD, International Classification of Diseases.

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 Table 4 Brief summary of 21 systematic reviews
Study Published Intervention type Meta- Object disease Having effect or not Adverse events
year analysis or symptom
Dovepress

Sinha et al17 2011 Auditory integration therapy and other sound therapies Not Autism spectrum Unclear No study reported specific
that involved listening to music modified by filtering performed disorders deterioration.
(attenuating sounds at selected frequencies) and
modulating (random alternating high and low sound)
Mossler et al18 2011 Music therapy (a systematic process of intervention Performed Schizophrenia and Effective; improving their No study reported specific
wherein the therapist helps the client to promote schizophrenia-like global state, mental state deterioration.
health, using music experiences and the relationships disorders (including negative symptoms),
that develop through them as dynamic forces of change) and social functioning

Patient Preference and Adherence 2014:8

Bradt et al19 2011 All types of music therapy or music medicine Performed Cancer May be effective; improving No study reported specific
anxiety, pain, mood, and QoL deterioration.
Bradt and 2010 All types of music therapy or music medicine Performed Advanced life- May be effective; improving QoL No study reported specific
Dileo20 limiting illness deterioration.
Vink et al21 2003 All types of music therapy or music medicine Performed Dementia Unclear No study reported specific
deterioration.
Bradt et al22 2010 All types of music therapy or music medicine Performed Mechanically May be effective; improving No study reported specific
ventilated heart rate, respiratory rate, deterioration.
patients and anxiety
Cepeda et al23 2006 Listening to music (as defined by the investigator) Performed Acute, chronic, May be effective; reducing No study reported specific
neuropathic, cancer, pain intensity levels and deterioration.
or experimental pain opioid requirements
Bradt et al24 2010 All types of music therapy or music medicine Performed Acquired brain May be effective; No study reported specific
injury improving gait parameters deterioration.
Gold et al25 2006 Music therapy delivered by a professional Performed Autistic spectrum May be effective; improving No study reported specific
disorders in children communicative skills deterioration.
Laopaiboon 2009 All types of music therapy or music medicine Performed Cesarean section May be effective; improving heart No study reported specific
et al26 rate and birth satisfaction score deterioration.
Bradt and 2009 Any form of participation in music (eg, listening Performed Coronary heart May be effective; improving blood No study reported specific
Dileo27 to music, singing, and playing music) disease pressure, heart rate, respiratory deterioration.
rate, anxiety, and pain
Maratos et al28 2008 Music therapy provided by a certificated professional Not Depression May be effective; accepted No study reported specific
performed by people with depression deterioration.
and improving mood
de Dreu 2012 Music-based movement therapy (the form of individual Performed Parkinson’s disease Effective; improving gait No study reported specific
et al29 gait training or in a group, partnered dance) and gait-related activities deterioration.
Cogo-Moreira 2012 Music education (individual or group music lessons No Dyslexia No evidence Non-information due to no
et al30 or musical training) studies studies included in the review
Drahota 2012 Music listening Performed Hospital patients May be effective; improving No study reported specific

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et al31 patient-reported outcomes deterioration.
such as anxiety
(Continued)

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Effectiveness of music therapy
 Kamioka et al Dovepress

heart rate, respiratory rate, anxiety, and pain, 27 hospital

studies included in the review

studies included in the review

Non information due to no

Non information due to no

No study reported specific

No study reported specific

No study reported specific

No study reported specific

patients for self-reported outcomes such as anxiety,31 and
various clinical conditions for health outcomes in children
Adverse events

with learning and developmental disorder33) concluded that

deterioration.

deterioration.

deterioration.

deterioration.
there might be an effect of the intervention. An SR without
a meta-analysis of depression reported that there might be
an effect of the intervention.28
Two studies (ie, autism spectrum17 and dementia21)
outcomes in children with learning

described that the effect of intervention is unclear. There was

May be effective; improving health

Effective; improving sleep quality

Effective; improve global state,

no evidence for three studies (ie, dyslexia,30 cystic fibrosis,34
Effective; reducing depressive

and developmental disorder

symptoms, and functioning

and bronchiectasis35) because they were not RCTs.
Having effect or not

Adverse events
No evidence

No evidence

There were no specif ic adverse events in any of the

symptoms

studies.

Quality assessment
We evaluated eleven items from the AMSTAR checklist in
Object disease

Sleep complaints

more detail (Table 5). Inter-rater reliability metrics for the

Various clinical

Serious mental
Bronchiectasis
or symptom

Cystic fibrosis

quality assessment indicated substantial agreement for all

Depressive
symptoms

disorders
condition

231 items (percentage agreement 95.3% and κ=0.825). As

a whole, the quality of the articles was very good.
No studies

No studies

Discussion
Performed

Performed

Performed

Performed
analysis
Meta-

This is the first SR of SRs of the effectiveness of cure based

on music interventions in studies with RCT designs. Our
study is unique because it summarized the evidence for each
that develop through them as dynamic forces of change)
music, without the active involvement of a music therapist

target disease according to ICD-10 classification. We assume

health, using music experiences and the relationships
Listening to music via any form of music device or live

Music therapy (a systematic process of intervention

of delivery mode (ie, by a trained music therapist)

wherein the therapist helps the client to promote

that this study will be helpful to researchers who want to

Music as an intervention or therapy, regardless

All types of music therapy or music medicine

grasp an effect of MT comprehensively and could provide

information that is indispensable for the organization that is
going to make the guidelines according to each disease.
Twenty-one SRs based on RCTs were identified, and
Listening to music (CD/DVD)
All types of singing programs

music intervention was clearly effective for five diseases

(ie, schizophrenia for global and mental state and social
Intervention type

functioning, Parkinson’s disease for gait and related activi-

ties, depressive symptoms, sleep quality, and serious mental
disorders for global and social functioning).
A review of all SRs showed that there was no special
adverse effect or harm associated with MT.
Abbreviation: QoL, quality of life
Published

Tendency of target disease and outcome

year
2011

2011

2010

2010

2009

2009

The most commonly reported target diseases were “Mental

Table 4 (Continued)

and behavioural disorders (F00-99)”,17,18,21,25,28,30,32,36 and the

effect of MT on these diseases was improved mental health (eg,
de Niet et al36
Naylor et al33
Chan et al32

Irons et al34

Irons et al35

Gold et al37

anxiety and mood), pain, QoL, and communication skills. The

Study

main reason given in these articles for improved mental health

was that the beauty and rhythm of the music tone allowed the

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Dovepress Effectiveness of music therapy

Table 5 AMSTAR is a measurement tool created to assess the methodological quality of systematic reviews
Total evaluation N (%)
1. Was an “a priori” design provided?  Yes 20 (95%)
The research question and inclusion criteria should be established before the conduct of the review.  No 0 (0%)
 Can’t answer 1 (5%)
 Not applicable 0 (0%)
2. Was there duplicate study selection and data extraction?  Yes 21 (100%)
There should be at least two independent data extractors and a consensus procedure for disagreements  No 0 (0%)
should be in place.  Can’t answer 0 (0%)
 Not applicable 0 (0%)
3. Was a comprehensive literature search performed?  Yes 21 (100%)
At least two electronic sources should be searched. The report must include years and databases used  No 0 (0%)
(eg, CENTRAL, EMBASE, and MEDLINE). Keywords and/or MeSH terms must be stated and where feasible  Can’t answer 0 (0%)
the search strategy should be provided. All searches should be supplemented by consulting current contents,  Not applicable 0 (0%)
reviews, textbooks, specialized registers, or experts in the particular field of study, and by reviewing
the references in the studies found.
4. Was the status of publication (ie, grey literature) used as an inclusion criterion?  Yes 14 (67%)
The authors should state that they searched for reports regardless of their publication type.  No 6 (28%)
The authors should state whether or not they excluded any reports (from the systematic review),  Can’t answer 0 (0%)
based on their publication status, language etc.  Not applicable 1 (5%)
5. Was a list of studies (included and excluded) provided?  Yes 17 (81%)
A list of included and excluded studies should be provided.  No 4 (19%)
 Can’t answer 0 (0%)
 Not applicable 0 (0%)
6. Were the characteristics of the included studies provided?  Yes 18 (85%)
In an aggregated form such as a table, data from the original studies should be provided on the participants,  No 1 (5%)
interventions and outcomes. The ranges of characteristics in all the studies analyzed, eg, age, race, sex,  Can’t answer 0 (0%)
relevant socioeconomic data, disease status, duration, severity, or other diseases should be reported.  Not applicable 2 (10%)
7. Was the scientific quality of the included studies assessed and documented?  Yes 19 (90%)
“A priori” methods of assessment should be provided (eg, for effectiveness studies if the author(s)  No 0 (0%)
chose to include only randomized, double-blind, placebo controlled studies, or allocation concealment  Can’t answer 0 (0%)
as inclusion criteria); for other types of studies alternative items will be relevant.  Not applicable 2 (10%)
8. Was the scientific quality of the included studies used appropriately in formulating conclusions?  Yes 18 (85%)
The results of the methodological rigor and scientific quality should be considered in the analysis  No 2 (10%)
and the conclusions of the review, and explicitly stated in formulating recommendations.  Can’t answer 0 (0%)
 Not applicable 1 (5%)
9. Were the methods used to combine the findings of studies appropriate?  Yes 16 (76%)
For the pooled results, a test should be done to ensure the studies were combinable, to assess their homogeneity  No 0 (0%)
(ie, chi-squared test for homogeneity, I2). If heterogeneity exists a random effects model should be used and/or  Can’t answer 0 (0%)
the clinical appropriateness of combining should be taken into consideration (ie, is it sensible to combine?).  Not applicable 5 (24%)
10. Was the likelihood of publication bias assessed?  Yes 15 (71%)
An assessment of publication bias should include a combination of graphical aids  No 0 (0%)
(eg, funnel plot, other available tests) and/or statistical tests (eg, Egger regression test).  Can’t answer 0 (0%)
 Not applicable 6 (29%)
11. Was the conflict of interest stated?  Yes 20 (95%)
Potential sources of support should be clearly acknowledged in both the systematic review  No 0 (0%)
and the included studies.  Can’t answer 0 (0%)
 Not applicable 1 (5%)
Abbreviations: CENTRAL, Cochrane Central Register of Controlled Trials; MeSH, Medical Subject Headings; Can’t, can not.

patient to be comfortable. In studies about the effects of MT The second most frequently reported target diseases
on anxiety, discomfort, fear, and pain, MT has been variably were “Diseases of the nervous system (G00-99)”, 24,29
applied as an accessory treatment for persons with addictions,6 and the effects of MT on these diseases showed com-
and as evasion of direct discomfort for undergoing medical monly gait parameters. MT is expected to improve gait
device procedures such as colonoscopy,8 colposcopy9 and and related activities such as rehabilitation in diseases
dental procedures.7 of the central nervous system. There were also several

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studies that identified “Diseases of the respiratory system Table 6 Future research agenda to build evidence of music
(J00-99).”22,35 Improvements seen in these studies were therapy
mainly due to effects of singing on breathing function, Item

such as respiratory rate, and on the circulation function, 1. Long-term effect

2. Consensus of the intervention framework such as type, frequency,
such as heart rate. time for each disease*
3. Dose–response relationship
Validity of overall evidence based 4. Description of cost
5. Development of the original checklist for music therapy**
on quality assessment
Notes: *Reporting guidelines for intervention on each disease; **reporting guideline
We performed an evaluation of all SRs by the AMSTAR for research methodology on study plan, implementation, and description.
checklist developed to assess the methodological quality
of SRs. There were no serious problems with the conduct
and reporting of all target studies. This study included 16 included in this study, their characteristic study designs
Cochrane Reviews.17–28,30,31,34,35 In the Cochrane Reviews, the limited our results to the assessment of short-term effects.
eligibility criteria for a meta-analysis are strict, and for each Even if a study is not an RCT design, it is necessary to evalu-
article, heterogeneity and low quality of reporting are to first ate the long-term effects.
be excluded. Therefore, we assumed that the conclusion of Because studies of intervention using music vary in
each SR had enough validity. design, a consensus of the framework is necessary. 10 In
this study, examination according to a detailed interven-
Overall evidence tion method was not possible, but it would be important for
Most importantly, a specific adverse effect or harmful future studies to define MT. Furthermore, studies to assess
phenomenon did not occur in any study, and MT was well dose–response relationships according to each disease are
tolerated by almost all patients. MT treatment has positive clearly necessary.18
effects for the following: schizophrenia and/or serious men- Bowen et al38 suggested that public health is moving
tal disorders for global and social functioning, Parkinson’s toward the goal of implementing evidence-based interven-
disease for gait and related activities, depressive symptoms, tion. However, the feasibility of possible interventions and
and sleep quality. We assume that the direct effects of MT whether comprehensive and multilevel evaluations are
are generally improvement of mental health and sense of needed to justify them must be determined. It is at least
rhythm, and reduction of pain. In addition, we assume that necessary to show the cost of such interventions. We must
communication with other people improves through music, introduce an interventional method based on its cost-benefit,
the sense of isolation disappears, and QoL rises. cost-effectiveness, and cost-utility.
Although further accumulation of RCT data is necessary, In addition, MT as an intervention is unique and com-
MT may be effective treatment for the following diseases pletely different than pharmacological or traditional rehabili-
and symptoms: cancer and/or advanced life-limiting illnesses tation methods. Therefore, it may be necessary to add some
affecting mental state and QoL, mechanically ventilated original items like herbal intervention,39 aquatic exercise,40
patients with impaired respiratory function and mental state, and balneotherapy41 to the CONSORT 2010 checklist as
chronic pain requiring opioid treatment, acquired brain alternative or complementary medicines.
injury affecting gait parameters, autistic spectrum disorders
involving communicative skills, cesarean section effects Strength and limitations
on heart rate and birth satisfaction, coronary heart disease This review has several strengths: 1) the methods and imple-
effects on circulatory, respiratory function, and mental state, mentation registered high on the PROSPERO database; 2) it
and self-reported outcomes for hospitalized patients and was a comprehensive search strategy across multiple data-
other patients with various clinical conditions. These SRs bases with no data restrictions; 3) there were high agreement
describe the need for additional high quality RCTs to assess levels for quality assessment of articles; and 4) it involved
the effect of MT. detailed data extraction to allow for collecting all articles’
content into a recommended structured abstract.
Future research agenda to build evidence This review also had several limitations that should
Table 6 shows the future research agenda for studies on the be acknowledged. Firstly, some selection criteria were
treatment effect of MT. Because only SRs of RCTs were common across studies, as described above; however, bias

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Dovepress Effectiveness of music therapy

remained due to differences in eligibility for participation data. All authors took part in drafting the article or revising
in each original RCT. Secondly, publication bias was a it critically for important intellectual content.
limitation. Although there was no linguistic restriction in
the eligibility criteria, we searched studies with only English Ethical approval
and Japanese keywords. Thirdly, in order to be specific to No ethical approval was required.
SRs based on RCTs, it ignores some excellent results of
primary research by other research designs. Fourthly, as a Data sharing
point of terminology for MT, because we applied a broad No additional data are available.
definition to the use of music in medicine, it may be more
confusing or a bit misleading in the cultural context of Funding
Western health care. This study was supported by the Health and Labour Sciences
In addition, since this review focused on summaries Research Grants (Research on Health Security Control
of effects of MT for each disease, we did not describe ID No H24-021; representative Dr K Tsutani) from the
all details on quality and quantity such as type of MT, Japanese Ministry of Health, Labour and Welfare of Japan
frequency of MT, and time on MT. Moreover, we could in 2012.
not follow standard procedures as estimates of the effects
of moderating variables. Finally, because we broadly Disclosure
defined MT as music appreciation, musical instrument The authors report no conflicts of interest in this work.
performance, and singing, we could not assess a specific
intervention. References
1. Ostermann T, Schmid W. Music therapy in the treatment of multiple
sclerosis: a comprehensive literature review. Expert Rev Neurother.
Conclusion 2006;6:469–477.
This comprehensive summary of SRs demonstrates that MT 2. Gold C, Voracek M, Wigram T. Effects of music therapy for children
and adolescents with psychopathology: a meta-analysis. J Child Psychol
treatment improved the following: global and social func-
Psychiatry. 2004;45:1054–1063.
tioning in schizophrenia and/or serious mental disorders, 3. Hurkmans J, de Bruijn M, Boonstra AM, et al. Music in the treatment
gait and related activities in Parkinson’s disease, depressive of neurological language and speech disorder: a systematic review.
Aphasiology. 2012;26:1–19.
symptoms, and sleep quality. MT may have the potential for 4. Standley J. Music therapy research in the NICU: an updated meta-
improving other diseases, but there is not enough evidence at analysis. Neonatal Network. 2012;31:311–316.
5. Nilsson U. The anxiety- and pain-reducing effects of music interven-
present. Most importantly, a specific adverse effect or harm-
tions: a systematic review. AORN J. 2008;87:780–807.
ful phenomenon did not occur in any of the studies, and MT 6. Mays KL, Clark DL, Gordon AJ. Treating addiction with tunes: a
was well tolerated by almost all patients. systematic review of music therapy for the treatment of patients with
addictions. Substance Abuse. 2008;29:51–59.
To most effectively assess the potential benefits of MT, 7. Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L. Music for
it will be important for future research to explore 1) long- pain and anxiety in children undergoing medical procedures: a system-
atic review of randomized controlled trials. Ambul Pediatr. 2008;8:
term effects, 2) a consensus of the framework of music
117–128.
intervention, 3) dose–response relationships, 4) the cost of 8. Tam WWS, Wong ELY, Twinn SF. Effect of music on procedure
the intervention, and 5) development of the original check time and sedation during colonoscopy: a meta-analysis. World J
Gastroenterol. 2008;14:5336–5343.
item in MT. 9. Galaal K, Bryant A, Deane KH, Al-Khaduri M, Lopes AD. Interventions
for reducing anxiety in women undergoing colposcopy. Cochrane
Acknowledgments Database Syst Rev. 2011;(12):CD006013.
10. Dileo C. Effects of music and music therapy on medical patients: a
We would like to express our appreciation to Ms Aya meta-analysis of the research and implications for the future. J Soc
Maruyama (methodology of MT), Ms Rie Higashino, Ms Integr Oncol. 2006;4:67–70.
11. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR:
Yoko Ikezaki, Ms Rinako Kai (paperwork), and Ms Satoko a measurement tool to assess the methodological quality of systematic
Sayama and Ms Mari Makishi (all searches of studies) for reviews. BMC Med Res Methodol. 2007;7:10.
12. Hopewell S, Clarke M, Moher D, et al. CONSORT for reporting ran-
their assistance in this study.
domized trials in journal and conference abstracts. Lancet. 2008;371:
281–283.
Author contributions 13. Hopewell S, Ravaud P, Baron G, et al. Effect of editors’ implementation
of CONSORT guidelines on the reporting of abstracts in high impact
All authors made substantial contributions to conception and medical journals: interrupted time series analysis. BMJ. 2012;344:
design, acquisition of data, or analysis and interpretation of e4178.

Patient Preference and Adherence 2014:8 submit your manuscript | www.dovepress.com

751
Dovepress
Kamioka et al Dovepress

14. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and 30. Cogo-Moreira H, Andriolo RB, Yazigi L, et al. Music education for
strength of recommendations. BMJ. 2004;328:1490–1497. improving reading skills in children and adolescents with dyslexia.
15. International Prospective Register of Systematic Reviews [database on Cochrane Database Syst Rev. 2012;8:CD009133.
the Internet]. York, UK: University of York. Available from: http://www. 31. Drahota A, Ward D, Mackenzie H, et al. Sensory environment on
crd.york.ac.uk/prospero. Accessed June 20, 2012. health-related outcomes of hospital patients. Cochrane Database Syst
16. Booth A, Clarke M, Ghersi D, et al. An international registry of sys- Rev. 2012;3:CD005315.
tematic review protocols. Lancet. 2011;377:108–109. 32. Chan MF, Wong ZY, Thayala NV. The effectiveness of music listen-
17. Sinha Y, Silove N, Hayen A, Williams K. Auditory integration train- ing in reducing depressive symptoms in adults: a systematic review.
ing and other sound therapies for autism spectrum disorders (ASD). Complement Ther Med. 2011;19:332–348.
Cochrane Database Syst Rev. 2011;12:CD003681. 33. Naylor KT, Kingsnorth S, Lamont A, et al. The effectiveness of music
18. Mossler K, Chen X, Heldal TO, et al. Music therapy for people with in pediatric healthcare: a systematic review of randomized controlled
schizophrenia and schizophrenia-like disorders. Cochrane Database trials. Evid Based Complement Alternat Med. 2011;2011:464759.
Syst Rev. 2011;12:CD004025. 34. Irons JY, Kenny DT, Chang AB. Singing for children and adults with
19. Bradt J, Dileo C, Grocke D, et al. Music interventions for autistic cystic fibrosis. Cochrane Database Syst Rev. 2010;5:CD008036.
spectrum disorder. Cochrane Database Syst Rev. 2011;8:CD006911. 35. Irons JY, Kenny DT, Chang AB. Singing for children and adults with
20. Bradt J, Dileo C. Music therapy for end-of-life care. Cochrane Database bronchiectasis. Cochrane Database Syst Rev. 2010;2:CD007729.
Syst Rev. 2010;1:CD007169. 36. de Niet G, Tiemens B, Lendemeijer B, Hutschemaekers G. Music-
21. Vink AC, Birks JS, Bruinsma MS, Scholten RJ. Music therapy assisted relaxation to improve sleep quality: meta-analysis. J Adv Nurs.
for people with dementia. Cochrane Database Syst Rev. 2003;4: 2009;65:1356–1364.
CD003477. 37. Gold C, Solli HP, Kruger V, et al. Dose-response relationship in music
22. Bradt J, Dileo C, Grocke D. Music interventions for mechanically ven- therapy for people with serious mental disorders: systematic review and
tilated patients. Cochrane Database Syst Rev. 2010;12:CD006902. meta-analysis. Clin Psychol Rev. 2009;29:193–207.
23. Cepeda MS, Carr DB, Lau J, et al. Music for pain relief. Cochrane 38. Bowen DJ, Kreuter M, Spring B, et al. How we design feasibility studies.
Database Syst Rev. 2006;2:CD004843. Am J Prev Med. 2009;36:452–457.
24. Bradt J, Magee WL, Dileo C, et al. Music interventions for acquired 39. Gragnier JJ, Boon H, Rochon P, et al. Reporting randomized, controlled
brain injury. Cochrane Database Syst Rev. 2010;7:CD006787. trials of herbal interventions: an elaborated CONSORT statement. Ann
25. Gold C, Wigram T, Elefant C. Music therapy for autistic spectrum Intern Med. 2006;144:364–367.
disorder. Cochrane Database Syst Rev. 2006;2:CD004381. 40. Kamioka H, Tsutani K, Okuizumi H, et al. Effectiveness of aquatic
26. Laopaiboon M, Lumbiganon P, Martis R, et al. Music during caesarean exercise and balneotherapy: a summary of systematic reviews based on
section under regional anaesthesia for improving maternal and infant randomized controlled trials of water immersion therapies. J Epidemiol.
outcomes. Cochrane Database Syst Rev. 2009;2:CD006914. 2010;20:2–12.
27. Bradt J, Dileo C. Music for stress and anxiety reduction in coro- 41. Kamioka K, Kawamura Y, Tsutani K et al. A checklist to assess the
nary heart disease patients. Cochrane Database Syst Rev. 2009;2: quality of reports on spa therapy and balneotherapy trials was developed
CD006577. using the Delphi consensus method: the SPAC checklist. Complement
28. Maratos A, Gold C, Wang X, et al. Music therapy for depression. Ther Med. 2013;21(4):324–332.
Cochrane Database Syst Rev. 2008;1:CD004517.
29. de Dreu MJ, van der Wilk AS, Poppe E, Kwakkel G, van Wegen EE.
Rehabilitation, exercise therapy and music in patients with Parkinson’s
diseases: a meta-analysis of the effects of music-based movement
therapy on walking ability, balance and quality of life. Parkinsonism
Relat Disord. 2012;18 Suppl 1:S114–S119.

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Dovepress Effectiveness of music therapy

Supplementary material

Table S1 References to studies excluded in this review

First author. Journal (Year) Title Reason for exclusion
Standley J. Neonatal Netw (2012) Music therapy research in the NICU: an updated meta-analysis Not SR based on RCTs
Wittwer JE. Disabil Rehabil (2012) Rhythmic auditory cueing to improve walking in patients with neurological Not SR based on RCTs
conditions other than Parkinson’s disease – what is the evidence?
Hurkmans J. Aphasiology (2012) Music in the treatment of neurological language and speech disorders: Not SR based on RCTs
a systematic review
Burns DS. J Music Ther (2012) Theoretical rationale for music selection in oncology intervention Not SR based on RCTs
research: an integrative review
Fredericks S. Clin Nurs Res (2012) Anxiety, depression, and self-management: a systematic review Not SR based on RCTs
Galaal K. Cochrane Database Interventions for reducing anxiety in women undergoing colposcopy Not treatment or
Syst Rev (2011) rehabilitation
Pittman S. Int Nurs Rev (2011) Music intervention and preoperative anxiety: an integrative review Not SR based on RCTs
Cogo-Moreia H. Cochrane Music education for improving reading skills in children Updated or
Database Syst Rev (2011) and adolescents with dyslexia replacement SR
Schmid W. BMC Health Serv Home-based music therapy – a systematic overview Not SR based on RCTs
Res (2010) of settings and conditions for an innovative service in healthcare
Renner RM. Contraception (2010) Pain control in first-trimester surgical abortion: Not music therapy
a systematic review of randomized controlled trials
de Niet GJ. Int J Evid Based Review of systematic reviews about the efficacy of non-pharmacological Not music therapy
Healthc (2009) interventions to improve sleep quality in insomnia
Engwall M. J Perianesth Nurs (2009) Music as a nursing intervention for postoperative pain: Not treatment or
a systematic review rehabilitation
Harting L. Arch Dis Child Music for medical indications in the neonatal period: Not treatment or
Fetal Neonatal Ed (2009) a systematic review of randomised controlled trials rehabilitation
Bechtold ML. Dig Dis Sci (2009) Effect of music on patients undergoing colonoscopy: Not treatment or
a meta-analysis of randomized controlled trials rehabilitation
Klassen JA. Ambul Pediatr (2008) Music for pain and anxiety in children undergoing medical Not treatment or
procedures: a systematic review of randomized controlled trials rehabilitation
Tam WW. World J Gastroenterol Effect of music on procedure time and sedation during Not treatment or
(2008) colonoscopy: a meta-analysis rehabilitation
Gillen E. Int J Evid Based Effects of music listening on adult patients’ pre-procedural Not treatment or
Healthc (2008) state anxiety in hospital rehabilitation
Dileo C. Cochrane Database Music for preoperative anxiety Protocol
Syst Rev (2008)
Mays KL. Subst Abus (2008) Treating addiction with tunes: a systematic review of music Not SR based on RCTs
therapy for the treatment of patients with addictions
Klassen JA. Ambul Pediatr (2008) Music for pain and anxiety in children undergoing medical Not treatment or
procedures: a systematic review of randomized controlled trials rehabilitation
Galaal K. Cochrane Database Interventions for reducing anxiety in women undergoing colposcopy Not treatment or
Syst Rev (2007) rehabilitation
Rudin D. Endoscopy (2007) Music in the endoscopy suite: a meta-analysis of randomized Not treatment or
controlled studies rehabilitation
Richards T. Medsurg Nurs (2007) The effect of music therapy on patients’ perception and manifestation Not SR based on RCTs
of pain, anxiety, and patient satisfaction
Vanderboom T. J Radiol Nurs (2007) Does music reduce anxiety during invasive procedures with procedural Not SR based on RCTs
sedation? An integrative research review
Lim PH. Int Nurs Rev (2006) Music as nursing intervention for pain in five Asian countries Not SR based on RCTs
Ostermann T. Expert Rev Music therapy in the treatment of multiple sclerosis: Not SR based on RCTs
Neurother (2006) a comprehensive literature review
Dileo C. J Soc Integr Oncol (2006) Effects of music and music therapy on medical patients: Not SR based on RCTs
a meta-analysis of the research and implications for the future
Sung HC. J Clin Nurs (2005) Use of preferred music to decrease agitated behaviors Not SR based on RCTs
in older people with dementia: a review of the literature
(Continued)

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Table S1 (Continued)
First author. Journal (Year) Title Reason for exclusion
Pelletier CL. J Music Ther (2004) The effect of music on decreasing arousal due to stress: a meta-analysis Not SR based on RCTs
Whipple J. J Music Ther (2004) Music in intervention for children and adolescents with autism: Not SR based on RCTs
a meta-analysis
Wilkins MK. Evid Based Nurs (2004) Music intervention in the intensive care unit: a complementary Not SR based on RCTs
therapy to improve patient outcomes
Gold C. J Child Psychol Psychiatry (2004) Effects of music therapy for children and adolescents Not SR based on RCTs
with psychopathology: a meta-analysis
Silverman MJ. J Music Ther (2003) The influence of music on the symptoms of psychosis: a meta-analysis Not treatment or
rehabilitation
Standley JM. J Pediatr Nurs (2002) A meta-analysis of the efficacy of music therapy for premature infants Not SR based on RCTs
Evans D. J Adv Nurs (2002) The effectiveness of music as an intervention for hospital patients: Not SR based on RCTs
a systematic review
You ZY. Acta Academiae Meta-analysis of assisted music therapy for chronic schizophrenia Reduplication study/
Med Sinicae (2002) error of selection
You ZY. Zhongguo Yi Xue Ke Meta-analysis of assisted music therapy for chronic schizophrenia Updated or
Xue Yuan Xue Bao (2002) replacement SR
Evans D. Joanna Briggs Institute Evidence Music as an intervention for hospital patients: a systematic review Not SR based on RCTs
Based Nurs Midwifery (2001)
Koger SM. Cochrane Database Music therapy for dementia symptoms Updated or
Syst Rev (2000)* replacement SR
Koger SM. Cochrane Database Music therapy for dementia symptoms Updated or
Syst Rev (2000)* replacement SR
Koger SM. J Music Ther (1999) Is music therapy an effective intervention for dementia? Not SR based on RCTs
A meta-analytic review of literature
Note: *Published and reformed in the same year.
Abbreviations: NICU, neonatal intensive care unit; RCT, randomized controlled trial; SR, systematic review.

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