Music therapy effect Health Related Quality of Life in children - - PowerPoint PPT Presentation

Music therapy effect Health Related Quality of Life in children undergoing HSCT; a randomized clinical study

Lena Uggla, Music therapist, PhD student, Karolinska Institutet, Stockholm, Sweden BMT Tandem Meetings Feb 22, 2018, Salt Lake City, Utah

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Can music therapy improve quality of life and support the somatic recovery after hematopoietic stem cell transplantation in children and adolescents?

The aim of the study

Examine whether music therapy can help psychological and somatic rehabilitation for the child after allogeneic hematopoietic stem cell transplant (HSCT).

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Allogeneic HSCT

Hematopoietic Stem Cell Transplantation

• The children are isolated 4-6 weeks
• The treatment is very intense

for approximately 6 months.

• The treatments affect the patient's family

and their relationships.

The Health Related Quality of Life for the children and the parents

• Health Related Quality of Life (HRQoL) after HSCT

 1-3 years to return to the same as pre HSCT.  Lowest levels at 1 and 3 months post HSCT.

• Post Traumatic Stress Disorder (PTSD)

 The effects of trauma more crucial in younger age.  Children going through HSCT show PTSD symptoms

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Increased heart rate and stress

• In general:

Elevating heart rate and stress is documented.

• Heart rate is a vital indication of anxiety and arousal,

predict posttraumatic stress or PTSD.

• Children, admitted to a hospital, due to e.g. an accident, and

diagnosed with elevated heart rate, increased risk of developing PTSD 6 months later.

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Music interventions

• Music medicine

 Pre-recorded music  Carried out by other healthcare professionals

• Music therapy

 Performed by a music therapist

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Music therapy

• To help the patient through difficult experiences.
• A way to communicate and express yourself with a music

therapist.

• Receptive / Expressive
• Individual / in group
• No prior knowledge
• A safe therapeutic alliance with

the child.

• The child's initiative, will and wishes.

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Study 1 & 2 Study 3 Study 4

• Two-armed controlled randomized study (RCT).
• Children and adolescent 2 months -17 years
• 38 children

 Group A, music therapy twice a week  Group B, control group, received music therapy after discharge

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Research design, study 1 and 2

Group A RN RN RN RN Admission _____________ Discharged from clinic 6 months RN week 1 RN 2 3 4 Group B = Questionnaires etc RN = Research Nurse = music therapy session

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Physiological results N= 24

Morning and evening, twice a week both group A and B, 4-8 hours after group A music therapy intervention

• Blood pressure
• Saturation
• Heart rate

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Physiological results N= 24

Morning and evening, twice a week both group A and B, 4-8 hours after group A music therapy intervention

• Blood pressure – no effect
• Saturation – a trend
• Heart rate – significant difference p=0.001

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HRQoL questionnaires

• PedsQL 4.0 Generic scale
• PedsQL 3.0 Cancer module

At admission and discharged Both group A and group B

• 2-4 years of age, parent proxy report
• 5-18 years of age, both children and parent proxy report

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PedsQL 4.0 in total

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Four domains: The mean of the music therapy group (A) increase in 2 from 4 domains. The mean of the control group (B) decrease in all 4 domains.

• Physical

p=0.0079

• Emotional
• Social
• School/Cognitive

p=0.3

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PedsQL 4.0 at discharged

Four domains: The mean of the music therapy group (A) increase in 2 from 4 domains. The mean of the control group (B) decrease in all 4 domains.

• Physical

AB p=0.0079

• Emotional

AB

• Social

AB

• School

AB p=0.3

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PedsQL 4.0 at discharged

PedsQL 3.0 Cancer module at discharged

8 items, the mean of the music therapy group (A) increase in 4 from 8, the mean of the control group (B) decreased in all items.

• Pain and hurt
• Nausea
• Procedural anxiety
• Treatment anxiety

p=0.017

• Worry

p=0.041

• Cognitive problems

p=0,24

• Perceived physical appearance
• Communication

p=0.2

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PedsQL 3.0 Cancer module at discharged

8 items, the mean of the music therapy group (A) increase in 4 from 8, the mean of the control group (B) decreased in all items.

• Pain and hurt

A, B 

• Nausea

A, B 

• Procedural anxiety

A, B 

• Treatment anxiety

A B p=0.017

• Worry

A B p=0.041

• Cognitive problems

A B p=0,24

• Perceived physical appearance

A, B

• Communication

A B p=0.2

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Four domains: The mean of the music therapy group (A) increase in 2 from 4 domains. The mean of the control group (B) decrease in all 4 domains. Children: Parents:

• Physical

AB p=0.0079 AB

• Emotional

AB AB p=0.06

• Social

AB AB

• School

AB p=0.3 AB p=0.07

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PedsQL 4.0 at discharged

PedsQL 3.0 Cancer module at discharged

8 items, the mean of the music therapy group (A) increase in 4 from 8, the mean of the control group (B) decreased in all items. Children: Parents:

• Pain and hurt

A, B  AB

• Nausea

A, B  AB

• Procedural anxiety

A, B  AB

• Treatment anxiety

A B p=0.017 AB

• Worry

A B p=0.041 AB

• Cognitive problems

A B p=0,24 AB

• Perceived physical appearance

A, B A, B p=0.045

• Communication

A B p=0.2 AB

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Conclusion

• Children and parents assess the HRQoL of the child differently.
• Music therapy reduced the heart rate for children undergoing

HSCT for at least four to eight hours, indicating reduced stress levels and potentially reducing the risk of developing PTSD.

• The combination of lower heart rate after intervention and higher

HRQoL at discharged may indicate that music therapy should be a complementary treatment and support for the child during HSCT. The creative and relational process in music therapy is important, giving the child a greater sense of control and enables emotional self-regulation.

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In collabortaion/Acknowledgements

Britt Gustafsson, Senior consultant in pediatric hematology, professor, Björn Wrangsjö, Psychiatrist in pediatrics, associate professor, psychoanalyst, GIM-therapist. Britt-Marie Svahn, PhD, RN Olle Ringdén, professor, senior consultant, Karolinska Institutet Charlotta Hausmann, research nurse, CAST, Karolinska University Hospital Eva Martell, research nurse, CAST, Karolinska University Hospital Lars Ole Bonde, professor, music therapist, Aalborg University, Denmark.

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The Swedish Childhood Cancer Foundation Ekhaga Foundation Swedish Research Council

Thank you very much for your attention!