Effects of Vibroacoustic Music on Symptom Reduction in
Hospitalized Patients

by Tim Hulley, M.A., C.M.P.

Visual Analog Pre-Post Percentage Difference

September 1997

ProgramEvaluation Vibroacoustic Network Respondents:

"Our program evaluation at the Clinical Center of the National Institutes of Health has given us enough data to suggest a series of research protocols that we (four of us who use the acoustic recliners daily with our wide variety of patients) will be laying out in the next few months.  So far, with N=190, we have seen statistically significant and clinically significant results in both tension-anxiety reduction as well as symptom reduction.  We have revised our simple patient reported session evaluation form as attached.  The data has been broken down into diagnostic groups (all chronic disease processes: cancer, AIDS, heart and lung, blood, and psychiatric disorders are the main groups), with no noticeable drop off in reported effectiveness by group.  The results are not publishable since we did not do a randomized clinical trial, only simple program evaluation project.  But we are VERY encouraged by the data."

November, 1997

Effects of Vibroacoustic Music on Symptom Reduction in Hospitalized Patients Brief description:

Patients experiencing a variant of symptoms were offered vibroacoustic music.   Patient report of both state of relaxation and symptom intensity were collected before and after the 40 minute session.  This program evaluation has provided information with which to develop a research plan.

Abstract

The need for hospitalized patients to experience the relaxation response as an antidote to the stress of treatment and adjustment to the possibility of chronic or life threatening conditions is clear.  The systematic application of music to promote positive changes in behavior has been used successfully in a variety of hospital settings.  The effectiveness of music interventions has been measured physiologically and behaviorally.

In order to provide patients with assistance in achieving a relaxation response, recreation therapists at a major research hospital created several relaxation opportunities for patients and their family members.   Among them are a weekly class, "The Art of Relaxation."  This class is both didactic and experiential.  Held in a patient lounge, it can accommodate up to nine individuals.  The content includes a short introduction, an explanation of four components of relaxation (from Benson), and examples of short form relaxation techniques (i.e. eye roll-sigh).  This is followed by a 15-20 minute experiential session using one of the following techniques:  progressive relaxation, guided imagery, rhythmic breathing, body scan, or autogenic training.The recreation therapists also created a relaxation room with four Somatrons, a commercially available vibroacoustic recliner.  The Somatrons deliver ear level stereo auditory and tactile vibrations that allow the body to feel the music that is normally only heard.  Patients can access an initial session in the relaxation room using Therasound music titled "Balance" designed or its anxiolytic properties.

Subsequent uses of the relaxation room have used either "Balance" or music from "The Musical Body" (Therasound).  In all cases, this is a therapist guided session with about 10 minutes of debriefing after the music.This presentation of the program evaluation data from the use of the vibroacoustic recliners with anxiolytic music gathered from 268 adult patients with varying diagnoses over the last 17 months.  The measures were patient self-report instruments completed immediately pre and post to assess symptom intensity and relaxation.  Symptoms, up to three, were identified by the patients.  Symptom intensity was measured on a visual analogue scale.  Relaxation was measured seven item Self-Report Rating Scale for Tension and Relaxation (Poppen, 1988, p.126).The results follow.  The most frequently identified symptoms were tension-anxiety (73), pain (67), fatigue (62), nausea (27), headache (23), and depression (15) which comprised 92% of the first symptoms mentioned.  (Note: patients could state up to three symptoms and rate each,  But this report analyzed only the first mentioned symptom.)  Each of these symptoms showed reduction in intensity based on pre-post mean scores.  Cumulatively, the pre rating mean was 67.20 (of 100) and the post rating mean was 31.55, a 53% reduction of symptoms.  The most frequently self-reported symptoms that were reduced included tension-anxiety (p <.001), pain (p <.0001), fatigue (p <.0001), nausea (p <.0005), headache (p <.0001), and depressed mood (p<.0004).  The intensity of symptoms was reduced from pre to post by following percentages:  tension-anxiety, 54.65%; pain, 58.31%; fatigue, 46.63%; nausea, 56.44%; headache, 51.64%; and depressed mood, 46.63%.

To measure the state of relaxation, the seven point Self-Report Rating Scale for Tension and Relaxation was used.  With an N=272, the pre rating was 5.12(5 is "Feeling Some Tension in Some Parts of My Body") while the post rating was 2.77 (3 is "Feeling More Relaxed Than Usual"), a statistically significant difference (p<.0001).  Although this scale is nominal, tests of fit allow for estimation of effective improvement of 33.4% in state of relaxation.

Clinical impressions of the group of five recreation therapists were commensurate with the statistical significance levels indicated.   Most patients were buoyed by having a perceived effect on their symptom burden.   We used this positive outcome to point out that patients could clearly benefit by regular practice of an effective relaxation technique.  They were given additional training in the "Art of Relaxation" class, through individual instruction, or by readings.

This program evaluation data was not a research study.  It did not use random assignment, control group, or a comparison group.   Nonetheless, it did generate enough data to suggest the worthiness of writing a research plan for several sequential research protocols.  Our group of recreation therapists have decided to continue focus on symptom reduction.  We will measure the duration of the symptom intensity reduction beyond the vibroacoustic session.   Furthermore, we will be comparing subsequent sessions to see whether the treatment effect is as robust with additional treatment.  We have done preliminary analyses by diagnosis and see a different set of symptoms per diagnosis so we will continue to collect data based on diagnosis.  We are considering what could constitute an adequate control group (e.g., no treatment, music with no tactile input, different kinds of music, music of choice vs. prescribed music).  How does vibroacoustic music compare with the other relaxation techniques, such as progressive relaxation, autogenic training, mindfulness meditation, and guided imagery?  In addition, what should be the research participant inclusion criteria?  Should there be a minimum baseline of perceived tension-relaxation or symptom intensity? And finally, which study should come first and what is a proper sequencing so that a cluster of studies could be done in such a way as to build a body of knowledge around vibroacoustic music as a developing technology?

"The recliners referred to in this study are four Somatron Professional Power Models.  NIH also has Somatron mats in daily use."

Byron Eakin, Somatron Corporation