Music-based intervention in Covid-19 hospitalization: a perspective through Consolidated Framework for Implementation Research (CFIR)
1Department of internal Medicine, ASL2, Savona, Italy
Corresponding Author: Alessio Pesce, MSN, Local Health Authority (ASL2), Piazza Sandro Pertini n. 10, 17100 Savona, Italy, Email: email@example.com
COVID-19 patients survive in isolation with stringent measures of infection containment, leading to anxiety, fear, stress, loneliness, and depression. Music is recognized as useful to promote multiple health outcomes, including anxiolytic effects, pain-relieving, and relaxing effects that favour well-being and social interaction in healthcare settings. The Consolidated Framework for Implementation Research (CFIR) allows to implement music in hospital, restricting methodological weaknesses. The importance of exploring the in-patients’ preferences, usages, and feelings for COVID-19 before initiating a music-based intervention is crucial.
Keywords: Music-Therapy, Covid-19, Patient preference, Nursing
Music represents an interdisciplinary topic, transversal to medicine and human sciences. It constitutes a non-pharmacological intervention aimed at multiple health outcomes, including anxiolytic effects, pain-relieving, and relaxing effects that promote well-being and social interaction in healthcare settings [1,2,3]. Music-based interventions, therefore, can also be used to relieve psycho-social need in COVID-19 patients . Clinical observation has revealed that patients with COVID-19 may experience diarrhea, nausea, decreased appetite, rash, and other adverse reactions during antiviral treatments . Similarly, hospitalized patients survive in isolation with stringent measures of infection containment, leading to anxiety, fear, stress, loneliness, and depression, even to the point of evoking obsessive thoughts; in severe cases these effects compromise prognoses impacting on mortality and adverse events. There is ample evidence of the need for interventions, with greater relevance on health determinants in the community and hospital context, such as loneliness and social isolation that are fundamental for anxiety and depression development. Furthermore, in percentage terms, loneliness is associated with a 50% increase in the risk of developing dementia and a 30% increase in the risk of heart disease and stroke . Since the early 1900s, music has been used as a mean to improve the psychological well-being of people experiencing situations of isolation or detention; this area of interest is currently at the forefront of scientific research.
Music is recognized as useful to promote social interactions and emotional regulation, strongly improving people well-being in a pandemic context . To date, research protocols are available in the hypothesis that music can reduce anxiety, depression or improve quality of life in COVID-19 patients . However, to provide scientific evidence, studies are needed to explore patients’ perspectives and determine the effects of music-based intervention during hospitalization. Some authors  remark how essential is the compatibility between proposed music pieces and people’s preferences, and how these may vary depending on expectations at a specific time, health conditions, or healthcare environment. A crucial aspect in music-based interventions is the proper selection of music pieces. Listening to specific types / genres of favorite music or sounds is likely to have an emotional impact based on patients’ clinical condition. Systematic reviews show that patients’ music background and listening habits were drastically underestimated, reported in only 7.7% of studies conducted . In only about 25% of the studies, patient feedbacks on music interventions were explored . In UK , a scientific framework was used to integrate music in hospital. Through the Consolidated Framework for Implementation Research (CFIR), a protocol has been developed to integrate the patient’s preferred music into the care pathway by providing in-ear music players. The CFIR presents five domains that must be satisfied in order to support the implementation of the intervention. Domains include: Characteristics of intervention, Individuals involved, Outer and Inner setting and Implementation process .
The CFIR constructs starts from the evidence of efficacy in music-based intervention available in literature, proceeding through its feasibility analysis, considering socio-political, organizational and applicability domains in healthcare setting, through systematic surveys among patients and healthcare professionals. Carter et Al , applying CIFR, defined pre-recorded music-based intervention as easy to be implemented in the treatment protocol and sustainable in economic and training terms, through programming with a qualified music expert. Personality variables, cognitive-affective components  and the patient’s clinical condition, especially respiratory system efficiency and symptom burden, show a close correlation with music preferences , stated even before COVID-19 disease. Therefore, the importance of exploring the in-patients’ preferences, usages, and feelings for COVID-19 before initiating a music-based intervention is crucial. This knowledge, would allow health and music professionals to personalize the intervention and to explore important correlations between habitual music preferences and attitudes than those experienced by the patient as result of proposed music listening. Studies uniquely states methodological weaknesses in music-based interventions [8,11]. There is a lack of scientific rigor in music selection, involvement of music experts, and objective reporting and description of the music pieces used . Music, also, was rarely selected to achieve specific effects according to reference frameworks [8,11]. Patients often selected pieces without a scientific rationale, resulting a little directional effect. The opportunity to identify music mechanisms for action would allow researchers to advance beyond basic questions about efficacy and begin to answer questions about how, why, and for whom an intervention works .
The implementation of CFIR would also provide a new methodological approach in clinical practice, promoting a personalised music-based intervention, according to the needs of the institutional settings and the patient’s preferences. Music promotes early weaning to invasive mechanical ventilation , social interaction , quality of life and sleep [14,15], mood and well-being in healing environment ; reducing procedural stress and the need for anxiolytic and sedative drugs [17,18]. Significant psycho-physical benefits, in condition of clinical stability or instability, represent important outcomes in COVID-19 hospitalization. Relaxation, distraction, entertainment and emotional support of listening to music, according to the patient’s preferences through the CFIR framework, can also contribute, with scientific rationale, to cope loneliness, isolation, fear and psychopathological states resulting from COVID-19 disease.
Conflict of interest
The Author declare that there is no conflict of interest.
The author states that he has not obtained any funding or financial sponsors.
1. Hen X, Li H, Zheng X, Huang J. Effects of music therapy on COVID-19 patients’ anxiety, depression, and life quality: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021 ;100(26):e26419.
2. Bradt J, Dileo C, Myers-Coffman K, Biondo J. Music interventions for improving psychological and physical outcomes in people with cancer. Cochrane Database Syst Rev. 2021;10(10):CD006911.
3. Kakar E, Billar RJ, van Rosmalen J, Klimek M, Takkenberg JJM, Jeekel J. Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis. Open Heart. 2021;8(1):e001474.
4. Rico L., Caballero F., Martìn M., Cabello M., Ayuso-Mateos, Miret M. Association of loneliness with all-cause Mortality. A meta-analysis. PLoS One. 2018; 13(1):e0190033.
5. Cabedo-Mas A, Arriaga-Sanz C, Moliner-Miravet L. Uses and Perceptions of Music in Times of COVID-19: A Spanish Population Survey. Front Psychol. 2021; 11:606180.
6. Chen X, Li H, Zheng X, Huang J. Effects of music therapy on COVID-19 patients’ anxiety, depression, and life quality: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021 Jul 2;100(26):e26419.
7. Liwka A, Pilinski R, Przybyszowski M, Pieniazek M, Marciniak K, Wloch T, et al. The influence of asthma severity on patients’ music preferences: Hints for music therapists. Complement Ther Clin Pract. 2018; 33:177-183.
8. Williams C, Hine T. An investigation into the use of recorded music as a surgical intervention: A systematic, critical review of methodologies used in recent adult controlled trials. Complement Ther Med. 2018; 37:110-126.
9. Carter JE, Pyati S, Kanach FA, Maxwell AMW, Belden CM, Shea CM, et al. Implementation of Perioperative Music Using the Consolidated Framework for Implementation Research. Anesth Analg. 2018; 127(3):623-631.
10. Greenberg DM, Baron-Cohen S, Stillwell DJ, Kosinski M, Rentfrow PJ. Musical Preferences are Linked to Cognitive Styles. PLoS One. 2015; 10(7):e0131151.
11. Robb SL, Hanson-Abromeit D, May L, Hernandez-Ruiz E, Allison M, Beloat A, et al. Reporting quality of music intervention research in healthcare: A systematic review. Complement Ther Med. 2018; 38:24-41.
12. Bradt J, Dileo C. Music interventions for mechanically ventilated patients. Cochrane Database Syst Rev. 2014;2014(12):CD006902.
13. Boster JB, Spitzley AM, Castle TW, Jewell AR, Corso CL, McCarthy JW. Music Improves Social and Participation Outcomes for Individuals With Communication Disorders: A Systematic Review. J Music Ther. 2021 Mar 16;58(1):12-42.
14. Bradt J, Dileo C, Myers-Coffman K, Biondo J. Music interventions for improving psychological and physical outcomes in people with cancer. Cochrane Database Syst Rev. 2021 Oct 12;10(10):CD006911.
15. Kakar E, Venema E, Jeekel J, Klimek M, van der Jagt M. Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis. BMJ Open. 2021 May 10;11(5):e042510.
16. McCaffrey R. Music listening: its effects in creating a healing environment. J Psychosoc Nurs Ment Health Serv. 2008 Oct;46(10):39-44.
17. Walter S, Gruss S, Neidlinger J, Stross I, Hann A, Wagner M, et al. Evaluation of an Objective Measurement Tool for Stress Level Reduction by Individually Chosen Music During Colonoscopy-Results From the Study “ColoRelaxTone”. Front Med (Lausanne). 2020 Sep 15;7:525.
18. Fu VX, Oomens P, Klimek M, Verhofstad MHJ, Jeekel J. The Effect of Perioperative Music on Medication Requirement and Hospital Length of Stay: A Meta-analysis. Ann Surg. 2020 Dec;272(6):961-972.