Comparing Mirror and Music for Dialysis Needle Pain (MIRROR-MUSIC)

January 6, 2026 updated by: Izmir Kavram, Izmir Kavram Vocational School

Mirror Therapy Versus Music Therapy for Pain During Arteriovenous Fistula Cannulation in Hemodialysis Patients: A Randomized Controlled Trial

Inserting needles into the vascular access (fistula) is a major source of pain and anxiety for many hemodialysis patients. This study compared two simple, non-drug techniques to reduce this pain: listening to music and looking into a mirror during the needle insertion.

A total of 75 adult patients receiving regular hemodialysis at Izmir Özel Can Dialysis Center were randomly divided into three groups: a music group, a mirror group, and a control group. Patients in the music group listened to calming, instrumental Turkish classical music (makam) via headphones during cannulation. Patients in the mirror group looked at the reflection of their healthy arm in a mirror. The control group received standard care without these interventions.

Pain intensity was measured immediately after needle insertion using a 10-cm Visual Analogue Scale (VAS), where 0 means "no pain" and 10 means "the worst imaginable pain." Pain scores were compared between the groups to determine which method was more effective.

The results of this study may provide nurses and patients with easy-to-use, evidence-based options to make hemodialysis needle procedures less painful and stressful.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Study Design: This was a prospective, three-arm, parallel-group, randomized controlled trial with a 1:1:1 allocation ratio.

Setting and Sample: The study was conducted at the Hemodialysis Unit of Izmir Özel Can Dialysis Center between December 1 and 30, 2025. The study population consisted of 150 patients. The sample size was calculated using G*Power 3.1.9.2 software. With a significance level (alpha) of 0.05, a power (1-beta) of 80%, and an effect size of 5%, a sample of 25 patients per group (total n=75) was determined to be sufficient for a three-group comparison.

Inclusion Criteria:

Age between 18 and 85 years.

Receiving hemodialysis treatment three times per week.

Literate (able to read and write).

No hearing impairment.

Native Turkish speaker.

On hemodialysis for at least 6 months.

Baseline pain score >3 on the Visual Analogue Scale (VAS).

Willing to listen to music.

Exclusion Criteria:

Presence of a psychological disorder.

Communication problems.

Diagnosis of cancer.

Unwillingness to participate in the study.

Randomization: Eligible patients were randomly assigned to one of three groups: the Music Intervention Group, the Mirror Intervention Group, or the Control Group.

Interventions:

Music Intervention Group: During the arteriovenous fistula (AVF) cannulation procedure, patients listened to pre-selected instrumental Turkish classical music (makam), specifically Nihavend and Muhayyerkürdi maqams, via an MP3 player and headphones. The volume was adjusted to a comfortable level.

Mirror Intervention Group: During cannulation, a standard mirror (40 cm in diameter) was positioned on a table stand. It was adjusted so that patients could see the reflection of their healthy (non-cannulated) arm. The distance between the fingertips of the reflected hand and the mirror surface was approximately 30 cm. Patients were instructed to focus only on the image of their healthy hand in the mirror. The cannulation was performed in two phases: immediately after looking at the healthy hand image (incongruent phase) and after 10 minutes of adaptation to the mirror image (adaptation phase).

Control Group: Patients received standard cannulation care without any additional intervention.

Data Collection Tools:

Patient Information Form: Collected socio-demographic characteristics, dialysis duration, and details about pain (location, intensity, type, timing, cause, and coping methods).

Visual Analogue Scale (VAS): A 10-cm horizontal line used to measure pain intensity, where the left end (0 cm) represents "no pain" and the right end (10 cm) represents "the worst pain imaginable." Patients marked their current pain level on the line, and the distance from the left end was measured in centimeters to obtain a numerical score (0-10).

Procedure: After providing informed consent, all participants completed baseline assessments (Patient Information Form, VAS). The interventions were applied during subsequent cannulation sessions as described. Procedural pain was assessed using the VAS immediately after cannulation.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
75

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
    • İzmir
      • Konak, İzmir, Turkey (Türkiye)
        • Izmir Kavram Vocational School

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Being 18-85 years of age or older

    • Receiving HD treatment 3 days a week
    • Being able to read and write
    • Having no hearing impairment
    • Having Turkish as their native language
    • Having received HD treatment for at least 6 months
    • Having a VAS pain score >3
    • Agreeing to listen to music

Exclusion Criteria:

  • Having a psychological disorder

    • Having communication problems
    • Having cancer
    • Not wanting to participate in the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Mirror group
During arteriovenous fistula cannulation, patients viewed the reflection of their healthy arm in a 40-cm mirror placed approximately 30 cm away. They focused on this image for 10 minutes before cannulation (adaptation phase), and the procedure was performed while they continued to look at the mirror. The visual illusion aimed to modulate pain perception.
Device: Mirror Therapy (Visual Illusion Therapy)
A non-pharmacological, behavioral intervention. A standard mirror (40 cm diameter) is positioned to allow the patient to view the reflection of their non-cannulated, healthy arm during arteriovenous fistula cannulation. The patient focuses on this visual illusion for an adaptation period (10 minutes) before the needle insertion. The intervention is based on the principles of graded motor imagery and aims to reduce procedural pain by modulating cortical representation and attention.
Experimental: Music group
During arteriovenous fistula cannulation, patients listened to pre-selected, calming instrumental Turkish classical music (Nihavend and Muhayyerkürdi maqams) via headphones and an MP3 player at a comfortable volume. The music started before cannulation and continued throughout the procedure.
Other: Music Therapy
A non-pharmacological, complementary therapy. Patients listen to pre-recorded, instrumental Turkish classical music (specifically Nihavend and Muhayyerkürdi maqams) via headphones during the cannulation procedure. The music is selected for its calming properties and starts before needle insertion. The intervention aims to reduce pain and anxiety through auditory distraction, emotional modulation, and relaxation.
No Intervention: Control group
Patients received routine, standard cannulation care as per the hemodialysis unit protocol, without any additional non-pharmacological intervention such as mirror or music therapy.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Procedural pain intensity during arteriovenous fistula cannulation
Time Frame: Procedure (during cannulation)
Pain intensity experienced by the patient immediately following the needle insertion for hemodialysis. This primary outcome is measured during the second and third hemodialysis sessions following randomization (the first session post-randomization served as a runin with no intervention). Pain is measured using a 10-cm Visual Analogue Scale (VAS). Scores range from 0 to 10, where 0 cm represents 'no pain' and 10 cm represents 'the worst pain imaginable,' and higher scores indicate worse pain (greater pain intensity). The patient marks their pain level on the line, and the score is recorded in centimeters.
Procedure (during cannulation)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Izmir Kavram Vocational School

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Izmir Bakircay University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
December 1, 2025

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 1, 2025

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 6, 2025

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
December 15, 2025

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
December 27, 2025

First Posted (Estimated)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
January 6, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
January 8, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
January 6, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 22.10.2025/2544

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The datasets generated during this study are not publicly available due to the small sample size and the potential risk of compromising individual privacy, even after de-identification. However, anonymized data may be made available from the corresponding author upon reasonable request and with permission from the institutional ethics committee.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Cookie Settings

We use cookies to ensure that we give you the best experience on our website. For more details carefully read our Privacy and Cookies Policy. ...>>>You can change your preferences or withdraw your consent at any time by deleting the cookies from your website or computer as described in the policy. Please accept it and choose your preferences by ticking the corresponding boxes in the "Manage Settings" section below. Please carefully read our Terms of Service before you proceed with using any part of this website.
«Manage Settings