Peer-based health interventions for people with serious mental illness: A systematic literature review

Health interventions delivered by peer specialists or co-facilitated by peer specialists and health professionals can help improve the physical health of people with serious mental illness (SMI). Yet, the quality of the studies examining these health interventions and their impact on health outcomes remains unclear. To address this gap, we conducted a systematic literature review of peer-based health interventions for people with SMI. We rated the methodological quality of studies, summarized intervention strategies and health outcomes, and evaluated the inclusion of racial and ethnic minorities in these studies. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to conduct our systematic literature review. Electronic bibliographic databases and manual searches were used to locate articles that were published in English in peer-reviewed journals between 1990 and 2015, described peer-based health interventions for people with SMI, and evaluated the impact of the interventions on physical health outcomes. Two independent reviewers used a standardized instrument to rate studies' methodological quality, abstracted study characteristics, and evaluated the effects of the interventions on different health outcomes. Eighteen articles were reviewed. Findings indicated that the strength of the evidence generated from these studies is limited due to several methodological limitations. Mixed and limited intervention effects were reported for most health outcomes. The most promising interventions were self-management and peer-navigator interventions. Efforts to strengthen the evidence of peer-based interventions require a research agenda that focuses on establishing the efficacy and effectiveness of these interventions across different populations and settings.     

Effects of music therapy with patients on a post-surgical oncology unit: A pilot study determining maintenance of immediate gains

Researchers have found that music therapy can be an effective psychosocial intervention for oncology patients. However, due to shortened inpatient hospital stays and the frequency of surgery for patients with cancer, there is a need to determine maintenance of single-session treatment gains with patients on a post-surgical oncology unit. The purpose of this pilot study was to evaluate maintenance of immediate music therapy treatment gains concerning relaxation, pain, anxiety, nausea, and perception of music therapy with patients on a surgical oncology unit. Participants were adult oncology inpatients (n = 27) and their caregivers (n = 4) receiving care on a surgical oncology unit. Participants completed five separate 10-point Likert-Type Scales at pretest, posttest, and 30–45-min follow-up. Participants received 20-min music therapy sessions consisting of patient-preferred live music. Analyses of variance (ANOVA) were computed on all patient data and indicated significant differences in relaxation, anxiety, and pain between pretest and posttest and pretest and follow-up measures. However, there were no significant differences from posttest to follow-up, indicating maintenance of treatment gains. Although generalizations are premature due to the lack of a comparison condition, it seems that beneficial effects of a single music therapy session for surgical oncology patients may be maintained in the short-term. Limitations, implications for clinical practice, and suggestions for future research are offered.     

Effects of music therapy on spirituality with patients on a medical oncology/hematology unit: A mixed-methods approach

Despite considerable interest in the potential relationship between oncology and spirituality, it remains unclear how the spiritual wellbeing of patients is best addressed in health care environments. The purpose of this study was to determine the effect of three music therapy doses on spirituality in patients on a medical oncology/hematology unit (N = 17). The researchers measured participants’ faith, peace, and meaning by using the FACIT-Sp. tool ( Brady, Peterman, Fitchett, Mo, & Cella, 1999) at pre- and posttest during a randomized controlled design. The researchers also incorporated interviews from patients concerning potential effects of music therapy and spirituality. Quantitative results indicated significant between-group differences in peace and faith subscales, with participants in the music therapy condition having higher posttest means than participants in the control condition. Qualitative data tended to support the importance of music therapy in meeting spiritual needs: Results of a thematic analysis indicated music therapy helped participants feel closer to God and elevated their moods. Consistent with the literature base, participants noted that that spiritual needs should indeed be addressed during a person's time at the hospital. Limitations of the study, areas for future investigation, and implications for clinical practice are provided.     

Methodological issues in childhood depression: a review of the literature

Sources and types of information used to assess depressed children are identified in a survey of the diagnostic criteria, assessment methods, and instruments reported in relevant studies in six core journals. Children's self-reports are the most frequently used source of data; the reliability of information provided by classmates is gradually gaining acceptance. The need for development of consistent criteria and sound instruments is highlighted.     

Women's issues and music therapists: A look forward

This study surveyed 1890 American and Canadian music therapists in order to examine present-day men and women music therapists’ experiences as they compare with each other and as they compare with their 1990 counterparts in terms of their situations, their practices, their approaches, and their personal, work, and family concerns (Curtis, 1990). Quantitative and qualitative analyses of the structured and open-ended survey items revealed commonalities and differences among the 682 respondents. In comparison to their 1990 counterparts, present-day women music therapists are significantly different: they are older, more educated, more often in academic settings, more satisfied with their career choice, and with many different concerns. Present-day men and women respondents’ experiences reflect more commonalities, differing only in that the men are older, more educated, more often in academic settings, and higher paid. The present-day women and men are similar to each other and differ significantly from their 1990 counterparts with 68%, 66%, and 91% respectively feeling that sex discrimination has a general impact. Similarly 31% of the present-day men and 25% of the women are familiar with feminist music therapy, as opposed to 16% in 1990. Present-day men and women music therapists share a passion for their work, with 98% and 95% respectively recommending music therapy careers, as opposed to 56% in 1990.     

Topics,methods and challenges in health promotion for people with intellectual disabilities: A structured review of literature

People with intellectual disabilities (ID) experience substantial health inequities compared, with the general population. Many secondary conditions and lifestyle related health problems could be, prevented with adequate health promotion. The aim of this structured review is to provide insight into, the main characteristics of published health promotion intervention studies for people with ID and, in, doing so, to identify best practice and knowledge gaps. Relevant studies were identified through a, structured literature search of multiple electronic databases (PubMed, CINHAS, Scopus, PsychINFO), the search strategy covered health promotion and intellectual disabilities for available papers, published between February 2002 and 2012. In total, 25 studies were included and analyzed. Overall, studies were diverse and explored a variety of health issues. Papers included a variety of participants (in relation to level of disability) and intervention approaches. With regard to quality, many studies, failed to report how they recruited their participants, and there were substantial challenges identified, by authors in relation to recruitment, implementation of interventions, and the selection of outcome, measures used as well as the usability of measures themselves. Our findings suggest that this field, experiences methodological weaknesses and inconsistencies that make it difficult to compare and, contrast results. Theoretically driven studies that take into account the views and expectations of, participants themselves are needed, as is research that investigates the reliability and validity of, outcome measures for the ID population. Collaboration with mainstream health promotion research is, critical.     

Music technology usage in music therapy: A survey of practice

The purpose of this study was to determine (a) how many music therapists use music technology in their clinical work, (b) trends regarding music technology usage related to gender, age, and/or geographical location, (c) how music therapists acquire knowledge and/or training in music technology, (d) barriers to using music technology in clinical work, (e) types of music technology music therapists currently use, and (f) why music therapists do or do not use music technology in their clinical practice. Participants (N = 600) completed a 27-question survey with a 95% completion rate. The return rates for participants by country were: (a) US 27%, (b) Australia 6%, (c) Canada 9%, and (d) UK 9%. Both quantitative and qualitative analyses of the data were conducted. A majority of the music therapists surveyed (71%, n = 443) reported using music technology in the clinical setting. Differences in technology usage were found according to age and gender of the participants. Most of the participants reported to be self-taught (61%, n = 464). Results of this study indicated that more training in music technology related to clinical practice is needed, with attention given to ways to make more technology accessible to a variety of learners.     

Body dissatisfaction and disordered eating in trans people: A systematic review of the literature

Abstract

Body dissatisfaction plays a prominent role in gender dysphoria. In some individuals body dissatisfaction appears to manifest disordered eating in order to suppress bodily features of natal gender and accentuate features of gender identity. To date, there has been no systematic review of the literature pertaining to body dissatisfaction and disordered eating in trans individuals. Such a review may highlight important implications for clinicians working with trans people. Therefore, the aim was to critically and systematically review the available literature examining body dissatisfaction or disordered eating in a trans population, and also the literature pertaining to how body dissatisfaction and disordered eating are related in trans people. This review found three studies that explored disordered eating in trans people, five studies that explored body image and disordered eating in trans people, and 18 studies that explored body image in trans people. The findings from this review suggest that body dissatisfaction is core to the distress trans people experience and that this dissatisfaction may also put some individuals at risk of developing disordered eating. Additionally, the findings appear to suggest that gender dysphoria treatment is successful at increasing body satisfaction and improving body image. The clinical implications are discussed.     

Cost-effectiveness of clinical interventions for delirium: A systematic literature review of economic evaluations

Objective

Little is known about the economic value of clinical interventions for delirium. This review aims to synthesise and appraise available economic evidence, including resource use, costs, and cost-effectiveness of interventions for reducing, preventing, and treating delirium.

Methods

Systematic review of published and grey literature on full and partial economic evaluations. Study quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).

Results

Fourteen economic evaluations (43% full, 57% partial) across nine multicomponent and nonpharmacological intervention types met inclusion criteria. The intervention costs ranged between US$386 and $553 per person in inpatient settings. Multicomponent delirium prevention intervention and the Hospital Elder Life Program (HELP) reported statistically significant cost savings or cost offsets somewhere else in the health system. Cost savings related to inpatient, outpatient, and out-of-pocket costs ranged between $194 and $6022 per person. The average CHEERS score was 74% (±SD 10%).

Conclusion

Evidence on a joint distribution of costs and outcomes of delirium interventions was limited, varied and of generally low quality. Directed expansion of health economics towards the evaluation of delirium care is necessary to ensure effective implementation that meets patients' needs and is cost-effective in achieving similar or better outcomes for the same or lower cost.     

Effects of cognitive-behavioral music therapy on fatigue in patients in a blood and marrow transplantation unit: A mixed-method pilot study

Cancer-related fatigue (CRF) is an under-treated condition frequently experienced by cancer patients, which can negatively affect wellbeing during and after hospitalization. The purpose of this mixed-method pilot study was to determine if and how cognitive-behavioral music therapy (CBMT) might reduce fatigue in hospitalized patients in an adult blood and marrow transplant (BMT) unit. The researchers measured the effects of CBMT on five aspects of participant fatigue using a convergent parallel mixed-method design. The participants (N = 11) were randomly assigned to experimental or wait-list control conditions and completed the Multidimensional Fatigue Inventory (Smets, Garssen, Bonke, & De Haes, 1995) at pre- and posttest. The experimental participants completed a semi-structured interview prior to hospital discharge. The quantitative results indicated no significant between-group differences regarding fatigue. However, the experimental participants tended to have decreases in the mean fatigue scores from pre- to posttest, whereas the control participants had increases in the mean fatigue scores from pre- to posttest. The qualitative data tended to support the quantitative data and indicated that CBMT: (a) cognitively influenced fatigue by increasing motivation and self-efficacy, (b) affectively influenced fatigue by promoting relaxation and restful states, and (c) represented a meaningful, unique, and holistic service for hospitalized BMT patients. CBMT may be an effective intervention regarding various aspects of fatigue in hospitalized BMT patients. Because of the small sample size, the results should be interpreted with caution. The limitations of the study, implications for clinical practice, and suggestions for future research are provided.     

Nuanced effects of music interventions on rehabilitation outcomes after stroke: a systematic review

Background: Music is affordable and easily integrated in rehabilitation exercises, and has demonstrated different effects on the brain. We hypothesized that music interventions could improve rehabilitation outcomes after stroke.

Objective: the aim of our review is to determine the effectiveness of different types of music interventions according to the rehabilitation objectives after stroke.

Method: A systematic review of randomized controlled trials, clinical controlled trials and cross-over design performed on PubMed and PEDro in May 2018. All of these studies focus on acute, sub-acute or chronic stroke rehabilitation with music or rhythmic auditory stimulation intervention in adults during clinical outcomes. Two independent reviewers extracted the data and assessed the risk of bias before bringing it together.

Results: Twenty-seven studies were included and analyzed. Our review found positive effects on physical status (upper-limb activity; gait parameters, balance), on cognition (neglect, attention, communication) and mood. The analysis of the quality of the evidence showed that a majority of the studies had a high risk of bias.

Conclusion: Focusing on high to moderate level evidence, our review highlighted that rhythmic auditory stimulation has a positive effect on gait and balance; that receptive music therapy improves mood as well as some cognitive functions; that there is not enough evidence to determine the effectiveness of active music therapy and melodic intonation therapy. High-quality trials with large samples would be necessary to further assess and/or recommend these interventions.     

Quality of life in obstructive sleep apnea: a systematic review of the literature

Objective: To review the literature on obstructive sleep apnea (OSA) and health-related quality of life (HRQOL).Background: OSA affects nearly one in four men and one in ten women aged 30–60 years in the United States. Health consequences of OSA can include neuropsychiatric and cardiovascular sequela that disrupt professional, family, and social life and negatively impact HRQOL.Methods: We conducted a comprehensive review of the literature on HRQOL and OSA, with special attention paid to instruments developed specifically for OSA.Results: Generic instruments used to study HRQOL and OSA include: Medical Outcomes Study Short Form-36, Nottingham Health Profile, Sickness Impact Profile, Functional Limitations Profile, EuroQol, and Munich Life Quality Dimension List. Specific instruments include: Calgary Sleep Apnea Quality of Life Instrument, Functional Outcomes of Sleep Questionnaire, OSA Patient Oriented Severity Index, the OSA-18, and Cohen's pediatric OSA surgery quality of life questionnaire.Conclusions: OSA patients have impaired HRQOL when compared with healthy age- and gender-matched controls. Treatment with continuous positive airway pressure appears to improve HRQOL. Other treatment modalities have not been rigorously studied. In addition, more data are needed from preference-based measures that allow conversion to utility scores, which can be used to calculate quality-adjusted life years and cost-effectiveness ratios.     

Music in the treatment of neurological language and speech disorders: A systematic review

Background: Acquired brain injury resulting from a stroke can result in impairments in, among other things, communication. Music therapy has been used in rehabilitation to stimulate brain functions involved in speech. The use of elements of music is well known and more often used in the treatment of aphasia and apraxia of speech.

Aims: The aim of the study is to synthesise studies on the effect of music parameters in the treatment of neurological language and speech disorders. In addition, possible mechanisms that explain recovery are investigated.

Methods & Procedures: Search terms were formulated based on the research question. A systematic search in databases was performed using these search terms. Then inclusion criteria were formulated and articles meeting the criteria were reviewed on patient characteristics, interventions, and methodological quality.

Outcomes & Results: A total of 1250 articles have been selected from the databases, of which 15 were included in this study. The Melodic Intonation Therapy was the most studied programme. Melody and rhythm were the music interventions that have been applied the most. Measurable recovery has been reported in all those reviewed studies using music in the treatment of neurological language and speech disorders. In three studies research was also conducted into the mechanisms of explanation of the measured recovery. However, the methodological quality of the investigated studies was rated as “low”, using the ASHA level of evidence indicators for judging research.

Conclusions: Although treatment outcomes were reported as positive in all of the 15 reviewed studies, caution should be used relative to conclusions about the effectiveness of treatments that incorporate components of music with neurologically impaired individuals. Methodological quality was rated as low and interpretations of mechanisms of recovery were contradictory. Suggestions for standardising and improving methodological quality drawn from the analysis are presented.     

Understanding music as a temporal-aesthetic way of being: Implications for a general theory of music therapy

Music therapy is generally considered a discipline that utilizes music for promoting health, in which music is understood as a phenomenon inextricably tied to the medium of sound. Yet, alternatively, music therapy may also be considered a discipline that promotes human health both as and through music, in which music is understood as a temporal-aesthetic way of being transcending the concrete medium of sound, that manifests across all of the domains targeted in clinical music therapy goals. This explorative perspective potentially resolves certain critical dichotomies and dilemmas with which the music therapy field has had to contend, while meaningfully distinguishing music therapy's indigenous expertise and unique value from those of related health disciplines. Moreover, it carries implications for the formulation of a general theory of music therapy, applicable across a plurality of specific music therapy models, methods, and practices. Likewise, it carries implications for general theories of other expressive arts therapies, based upon understanding their respective modalities as particular ways of being, transcending concrete media.     

Carer-led health interventions to monitor,promote and improve the health of adults with intellectual disabilities in the community: A systematic review

Using carers to help assess, monitor, or promote health in people with intellectual disabilities (ID) may be one way of improving health outcomes in a population that experiences significant health inequalities. This paper provides a review of carer-led health interventions in various populations and healthcare settings, in order to investigate potential roles for carers in ID health care. We used rapid review methodology, using the Scopus database, citation tracking and input from ID healthcare professionals to identify relevant research. 24 studies were included in the final review. For people with ID, the only existing interventions found were carer-completed health diaries which, while being well received, failed to improve health outcomes. Studies in non-ID populations show that carers can successfully deliver screening procedures, health promotion interventions and interventions to improve coping skills, pain management and cognitive functioning. While such examples provide a useful starting point for the development of future carer-led health interventions for people with ID, the paucity of research in this area means that the most appropriate means of engaging carers in a way that will reliably impact on health outcomes in this population remains, as yet, unknown.     

Indigenous music therapy theory building through grounded theory research: The developing indigenous theory framework

There are diverse understandings within music therapy about what constitutes theory. Also, there is debate about whether research methodology, developed outside of the field of music therapy, is able to support the development of music therapy theory that is indigenous to the profession. In this paper, a framework, called the developing indigenous theory (DIT) framework, which allows for the development of indigenous theory through the use of grounded theory research methodology, is presented. A new definition of indigenous music therapy theory is provided. Here, indigenous music therapy theory refers to knowledge emergent from music therapy relationships which are able to be plausibly generalised across settings and time, allowing for the development of theory that is idiosyncratic to the field of music therapy. The difference between “precursors to theory” and actual “theory” are examined, and the outcomes of numerous studies are considered through the use of the framework. The distinction between complete and modified grounded theory studies is discussed. It is suggested that the DIT framework may hold relevance for the development of theory in other human relationship-based arts therapies.     

Arts-based research practices in music therapy research: Existing and potential developments

Poetry, drama, music, dance, and visual art are increasingly used in healthcare research to learn about the experiences of healthcare workers and recipients, to gain access to marginalized voices, and to communicate research findings to a wide range of people. Despite this emerging inclination towards the recognition of the value of the arts for healthcare research, creative arts processes have had limited use in music therapy research to date. In this article, we reflect on the small body of existing music therapy literature about arts-based research and explore possible reasons for the current neglect of these methods. We provide examples from Alison's doctoral research that demonstrate the value of using arts-based research for developing a deeper understanding of the profession of music therapy. Our reflection on the current literature leads us to propose further uses for arts-based research practices, for developing rich and evocative findings, accessing the voices of people who receive music therapy services, and communicating music therapy research findings to a broader audience eager for this information.     

Distance-delivered interventions for PTSD: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated the efficacy of distance-delivered, guided approaches to treatment (e.g., delivered via telephone, Internet, mail, videoconferencing) for clinical and subclinical posttraumatic stress disorder (PTSD). A comprehensive search yielded 19 randomized controlled trials (1491 participants) to be included. Meta-analyses revealed that distance-delivered interventions led to significant within-group improvements in PTSD symptoms at post-treatment (g = 0.81, 95% CI 0.65 to 0.97) and 3–6 month follow-up (g = 0.78, 95% CI 0.59 to 0.97). Within-group depression and quality of life outcomes showed similar results, with medium post-treatment and follow-up effects. Compared to a waiting list, distance delivery (specifically, Internet treatments) led to superior PTSD outcomes (g = 0.68, 95% CI 0.51 to 0.86). Compared to face-to-face interventions, distance delivery (specifically, videoconferencing treatments) did not result in significantly different PTSD outcomes at post-treatment (g = −0.05, 95% CI −0.31 to 0.20) but led to inferior outcomes at 3–6 month follow-up (g = −0.25, 95% CI −0.44 to −0.07). Distance delivery of PTSD treatment is promising, but research is needed to determine its optimal use.     

Positive psychological interventions for neurological disorders: A systematic review

Objectives: Psychological well-being in people with neurological diseases can be compromised due to brain damage or psychological reactions towards chronic disabilities. This systematic review evaluated the efficacy of positive psychological intervention (PPI) in neurological populations. Methods: Previous studies relevant to this topic were identified by searches in PUBMED, EMBASE, MEDLINE, and PSYCINFO databases from Jan 1980 to August 2017. Results: Of 1361 articles identified, 31 studies were included. Nineteen studies were randomized controlled trials. Sixteen studies had sample sizes of less than 30. Twelve studies were rated as high quality using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools. Six therapies were found: mindfulness-based approaches, positive savoring, life summary, expressive-based, hope-based interventions, and character strengths. These interventions were shown to improve quality of life, reduce symptomatic distress, and depressive symptoms. Conclusion: PPIs promote well-being among patients with neurological deficits. For PPIs to be considered as an evidence-based practice, more trials with adequate statistical power are required.