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

Figures & data

Figure 1. Flowchart of the trial (CONSORT flow diagram, www.consort-statement.org).

Table 1. Baseline characteristics.

	All (n = 300)	Controls (n = 100)	MusiCure (n = 100)	Self-selected (n = 100)	p
Female/male	154/146	48/52	51/49	55/45	0.6
Age in years	61 (12)	61 (14)	61(12)	61 (12)	0.9
Height in cm	172.4 (9.7)	172.7 (9.1)	171.6 (9.7)	172.9 (10.2)	0.6
Weight in kg	76.9 (17.9)	76.3 (17.8)	76.0 (16.4)	78.5 (19.4)	0.6
BMI	25.8 (5.1)	25.5 (5.2)	25.8 (5.1)	26.1 (5.0)	0.7
FEV1 percent of predicted	79.2 (21.7)	81.4 (20.1)	79.9 (20.4)	76.2 (24.3)	0.2
FEV1/FVC ratio	71.1 (11.9)	72.3 (11.7)	71.2 (10.6)	69.9 (13.2)	0.4
Systolic blood pressure	140 (19)	137 (18)	141 (19)	143 (19)	0.07
Diastolic blood pressure	85 (12)	83 (13)	86 (12)	86 (12)	0.2
Mean arterial pressure	104 (13)	101 (13)	105 (13)	105 (13)	0.09
Heart rate	78 (14)	77 (14)	79 (15)	80 (15)	0.3
Plasma cortisol (nmol/L)	364 (139)	386 (149)	344 (128)	361 (136)	0.1
Baseline anxiety
-State	41.5 (12.6)	40.0 (11.5)	41.4 (14.0)	43.0 (11.9)	0.2
-Trait	33.6 (10.0)	34.3 (10.8)	32.8 (9.8)	33.6 (9.4)	0.6

Data are expressed as mean (standard deviation, SD).

Table 2. Track list for the categories in the group of self-selected music.

EASY LISTENING: 1. More, by Alex Alstone, Boston Pops Orch. Dir. Arthur Fiedler 2. Some Enchanted Evening, by Rogers & Hammerstein, The Mantovani Orch. 3. Moon River, by Henry Mancini, James Last Orch. 4. El Condor Pasa, trad. performed by Georges Zamfir 5. Love Story, by Francis Lai, played by Richard Clydermann 6. Lounge jazz, Cafe Music BGM Channel, Free library music 7. The Dream of Olwen, by Charles Williams, Russ Conway Orch. 8. La Vie En Rose, by Édith Piaf, played by 101 Strings Orch. Total: 24:44

EVERGREENS: 1. A Nightingale Sang at Berkeley Square, lyrics by Eric Maschwitz and music by Manning Sherwin, performed by Nat King Cole 2. Moonlight Serenade, by Glenn Miller, played by the Glenn Miller Big Band 3. Raindrops Keep Falling on My Head, by Hal David and Burt Bacharach, performed by B. J. Thomas 4. As Time Goes By, by Herman Hupfeld, piano solo performed by Shirin 5. Singin’ in The Rain, by Lennie Hayton, instrumental version by Arthur Freed 6. Summertime, by George Gershwin, instrumental version performed by 101 Strings Orch. 7. Greensleeves, trad, performed by London Festival Orch. 8. Gone With The Wind (Tara’s Theme), by Max Steiner, performed by The Royal Philharmonic Orch. 9. Limelight, by Charles Chaplin, André Rieu, violin Total: 26:24

JAZZ: 1. Softly, as in a Morning Sunrise, by Sigmund Romberg and Oscar Hammerstein II, performed by Modern Jazz Quartet 2.Take Five, by Paul Desmond, performed by The Dave Brubeck Quartet 3. Georgia On My Mind, by Hoagy Carmichael and Stuart Gorrell, performed by Oscar Peterson trio 4. ‘Blue in Green’ from the album ‘Kind Of Blue’, Miles Davis Group 5. Solitude, Ben Webster – From the album ‘Big Ben Time’ recorded by the Ben Webster Quartet Total: 24:11

CLASSICAL: 1. J.S. Bach: Air – Suite No. 3 in D major, BWV 1068, Performed by The Berlin Philharmonic Orchestra, Conducted by Sir Simon Rattle 2. W.A. Mozart: Klarinetkoncert 2. sats. David Shifrin: Clarinet, Mozart Festival Orchestra Conducted by Gerard Schwarz 3. F. Chopin: Nocturne op. 9 no. 2 Eb dur, Valentina Lisitsa piano 4. A. Vivaldi: 4 Seasons, Winter, Largo, Performed by the Stuttgart Chamber Orchestra conducted by Martin Sieghart, solo violin: Rainer Kussmaul 5. J.S. Bach: Prelude C major BWV 846, from the Well Tempered Clavier Book One, Robert Hill, harpsichord 6. J. Massenet: Meditation from ‘Thais’, Joshua Bell, violin; Royal Philharmonic Orchestra; Andrew Litton, conductor Total: 26:25

POP/ROCK: 1. ABBA: I Have A Dream, by Benny Andersson and Bjorn Ulvaeus, from the 1979 album, Voulez-Vous 2. Bruce Springsteen: The River, by Bruce Springsteen, from the album ‘The River’ 1980 3. Elvis: All Shook Up, by Otis Blackwell, performed by Elvis Presley1957 4. David Bowie: Life On Mars, by David Bowie, from the album ‘Hunky Dory’ 1971 5. Prince: Diamonds and Pearls, by Prince, from the album ‘Diamonds and Pearls’ 1991 6. Michael Jackson: You Are Not Alone, by R. Kelly and Michael Jackson, from the album HIStory 1995 Total: 25:29

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.

Table 3. Comparison of STAI scores.

	On admission				After 20 min with intervention				On discharge
	Control	MusiCure	Self- selected	p	Control	MusiCure	Self- selected	p	Control	MusiCure	Self- selected	p
STAI	40.1	41.9	42.9	0.3	36.3	36.7	36.7	1.0	31.9	32.4	32.2	1.0
State	(11.7)	(14.1)	(11.9)		(11.3)	(13.0)	(11.7)		(10.3)	(10.4)	(9.0)
PP	N = 95	N = 91	N = 99		N = 91	N = 86	N = 95		N = 80	N = 87	N = 93
STAI	40.0	41.4	43.0	0.2	37.1	36.9	36.8	1.0	32.8	32.8	33.1	1.0
state	(11.5)	(14.0)	(11.9)		(12.4)	(13.0)	(11.6)		(10.6)	(10.9)	(9.5)
ITT	N = 99	N = 100	N = 100		N = 99	N = 100	N = 100		N = 99	N = 100	N = 100
STAI	34.1	33.3	33.4	0.9	–	–	–	–	34.9	33.1	32.6	0.3
Trait	(11.0)	(9.9)	(9.5)						(11.1)	(10.6)	(9.3)
PP	N = 91	N = 92	N = 97						N = 86	N = 83	N = 88
STAI	34.3	32.8	33.6	0.6	–	–	–	–	34.6	32.9	33.3	0.5
Trait	(10.8)	(9.8)	(9.4)						(11.1)	(10.0)	(9.4)
ITT	N = 96	N = 99	N = 100						N = 96	N = 99	N = 100

Data are expressed as mean (standard deviation, SD).

PP, per-protocol analysis.

ITT, intention-to-treat analysis with the principle last-observation-carried-forward.

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. 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. 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).