Music Therapy: as Procedural Support under Peripheral Intravenous Access involving Young Children

Research output: Book/ReportPh.D. thesisResearch

Abstract

Background
Peripheral intravenous access (PIVA) is an umbrella term for all types of invasive procedures that require insertion of needles into a vein (e.g. intravenous catheters, blood drawing). PIVA constitutes the most frequently performed
medical procedure in the paediatric setting. In spite of administration of local anaesthesia, PIVA may cause pain in addition to elevated levels of anxiety and distress. Moreover, physical restraint during the procedure is often necessary, especially in young children. Consequently, as documented in the research literature, painful and distressing medical procedures may cause detrimental long-term effects. Three studies have examined the effect of music therapy procedural support (MTPS) under needle procedures. Consequently, this study aims at examining the effects of MTPS in an RCT. Moreover, the study addresses clinical aspects of the applied MT intervention and provides research-based clinical tools.

Methods
41 children (1 to 10 years) were enrolled and underwent a single PIVA procedure. The children were randomly assigned to either an MT or a comparable control group receiving PIVA. In addition, the music therapy (MT) group received individualised MTPS (i.e. music alternate engagement) before, during, and after PIVA. The intervention was performed by a trained music therapist and comprised preferred songs, improvised songs/music, and instrument playing. The study was carried out in accordance with the rules in force regarding research ethics and clinical MT practice.
The study examined the effect of MT in relation to 16 outcome measures comprising these outcome domains: Distress, Anxiety, Pain intensity, Overall satisfaction with PIVA, Compliance, Number of needle pricks, Duration
of the PIVA procedure, and Satisfaction with the applied MTPS intervention. In short, self-report, observational data, and count data were used.

Results
From an overall perspective, the results of the study were in favour of the MT group, except for parent-rated Child Pain, which was slightly higher in the MT group. In addition, similar mean scores were found in the two groups for
Parent Compliance. The results showed that a single MTPS session was highly significantly effective in reducing the Duration of the PIVA procedure (33%). The MT intervention was also significantly effective in reducing Child Anxiety. Trends towards significance were also found for child Anxiety, Pain, and Compliance. Results suggested that MTPS may be effective in reducing the Number of needle pricks. No significant result was found for Overall satisfaction with PIVA. Furthermore, the majority of the participants found the MT intervention beneficial. Finally, after removal of an outlier, the overall picture became more distinct and two additional significant results were found.

Conclusion
The study shows that a single MTPS session was statistically significantly effective in reducing the anxiety of the children and the Duration of the PIVA procedure. These findings combined with the overall picture of the results merit further research.
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Background
Peripheral intravenous access (PIVA) is an umbrella term for all types of invasive procedures that require insertion of needles into a vein (e.g. intravenous catheters, blood drawing). PIVA constitutes the most frequently performed
medical procedure in the paediatric setting. In spite of administration of local anaesthesia, PIVA may cause pain in addition to elevated levels of anxiety and distress. Moreover, physical restraint during the procedure is often necessary, especially in young children. Consequently, as documented in the research literature, painful and distressing medical procedures may cause detrimental long-term effects. Three studies have examined the effect of music therapy procedural support (MTPS) under needle procedures. Consequently, this study aims at examining the effects of MTPS in an RCT. Moreover, the study addresses clinical aspects of the applied MT intervention and provides research-based clinical tools.

Methods
41 children (1 to 10 years) were enrolled and underwent a single PIVA procedure. The children were randomly assigned to either an MT or a comparable control group receiving PIVA. In addition, the music therapy (MT) group received individualised MTPS (i.e. music alternate engagement) before, during, and after PIVA. The intervention was performed by a trained music therapist and comprised preferred songs, improvised songs/music, and instrument playing. The study was carried out in accordance with the rules in force regarding research ethics and clinical MT practice.
The study examined the effect of MT in relation to 16 outcome measures comprising these outcome domains: Distress, Anxiety, Pain intensity, Overall satisfaction with PIVA, Compliance, Number of needle pricks, Duration
of the PIVA procedure, and Satisfaction with the applied MTPS intervention. In short, self-report, observational data, and count data were used.

Results
From an overall perspective, the results of the study were in favour of the MT group, except for parent-rated Child Pain, which was slightly higher in the MT group. In addition, similar mean scores were found in the two groups for
Parent Compliance. The results showed that a single MTPS session was highly significantly effective in reducing the Duration of the PIVA procedure (33%). The MT intervention was also significantly effective in reducing Child Anxiety. Trends towards significance were also found for child Anxiety, Pain, and Compliance. Results suggested that MTPS may be effective in reducing the Number of needle pricks. No significant result was found for Overall satisfaction with PIVA. Furthermore, the majority of the participants found the MT intervention beneficial. Finally, after removal of an outlier, the overall picture became more distinct and two additional significant results were found.

Conclusion
The study shows that a single MTPS session was statistically significantly effective in reducing the anxiety of the children and the Duration of the PIVA procedure. These findings combined with the overall picture of the results merit further research.
Original languageEnglish
Number of pages240
Publication statusPublished - 2012
Publication categoryResearch

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