Listening to music prior to bronchoscopy reduces anxiety - a randomised controlled trial

Elisabeth Jeppesen, Carsten M Pedersen, Klaus R Larsen, Emil S Walsted, Anne Rehl, Julie Ehrenreich, Sascha Schnoor, Vibeke Backer, Elisabeth Jeppesen, Carsten M Pedersen, Klaus R Larsen, Emil S Walsted, Anne Rehl, Julie Ehrenreich, Sascha Schnoor, Vibeke Backer

Abstract

Background: Listening to music as a means of relieving anxiety before and during endoscopy has been examined in several studies but results so far are contradictory and inconclusive. Aims: We aimed to determine whether listening to music could reduce anxiety prior to and during bronchoscopy, and whether it is influenced by the patient's preference in music. Methods: 300 patients undergoing bronchoscopy for suspected lung cancer were randomly assigned to: self-selected music, specially-designed music (MusiCureTM), or control (no sound). Spielberger's State-Trait Anxiety Inventory (STAI) was administered three times: at admission, after 20 min with or without music (preceding bronchoscopy), and shortly before discharge. The primary outcome was STAI state score after 20 min, with or without exposure to music prior to bronchoscopy. Results: On average, music reduced the STAI score by 2.5 points (95% CI, 1.1 to 4.0; p < 0.001) compared with the control group. This reduction was largest in the self-selected music group (3.4; 95% CI, 1.5 to 5.3; p < 0.001). In contrast, specially designed music did not significantly reduce STAI score (1.7; 95% CI, -0.3 to 3.6; p = 0.1). Conclusion: Listening to music reduces anxiety in patients undergoing bronchoscopy, provided that the music complies with the patient's preferences.

Keywords: Bronchoscopy; MusiCure; anxiety; lung cancer; music; self-selected music.

Figures

Figure 1.
Figure 1.
Flowchart of the trial (CONSORT flow diagram, www.consort-statement.org).
Figure 2.
Figure 2.
Timeline. BP = blood pressure; HR = heart rate; RR = respiratory rate; SaO2 = oxygen saturation; STAI = Spielberger’s state trait anxiety inventory; VAS = visual analogue scale.
Figure 3.
Figure 3.
Mean difference of STAI state score (Δ-STAI) from admission to 20 min with or without music prior to bronchoscopy. There was a significant effect of music on change of STAI score from admission to 20 min with or without music [F (2, 297) = 8.68, p < 0.001, ω = .05]. Tukey-adjusted post-hoc comparisons indicated that the change in STAI state score was significant with self-selected music (mean±SD) (−6.3 ± 6.2) compared with that for the control group (no sound) (−2,9 ± 5.1) (p < 0.001; d 0.6). MusiCure™ (−4.6 ± 5.9) did not significantly differ from no music (p = 0.1) nor from self-selected music (p = 0.09) in terms of change in STAI state score.
Figure 4.
Figure 4.
Patients overall perception of the sound prior to and during bronchoscopy. There was a highly significant difference between the music groups and the control group [H (2) = 33.81, p < 0.001]. When analysing the differences between the three treatments, the median VAS score of the control group (median (IQR); 4.5 mm (8.1)) compared with that for the group receiving MusiCure™ (8.3 mm (2.4); p < 0.001) and that of the group receiving self-selected music (8.1 mm (2.9); p < 0.001) was highly significant. No significant difference was found between MusiCure™ and self-selected music (p = 1.0).
Figure 5.
Figure 5.
STAI change from admission to after 20 min with or without music divided by how the patients appreciated the sound measured by VAS. There is only a significant difference in STAI change in the upper tertile of VAS measuring how patients appreciated the sound. (Kruskal–Wallis test is used because of the very different sizes of the groups).

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