The research pipeline

I, as well as several current and former members of our editorial team, have conducted our fair share of systematic reviews to summarize the available evidence on music therapy with specific populations. Evidence summarized in these systematic reviews is typically derived from randomized controlled trials (RCTs) (and sometimes controlled clinical trials). Systematic reviews play an important role in the development of clinical care guidelines and the identification of research gaps and recommendations. As RCTs feed into these systematic reviews, they are vital for the uptake of music therapy in healthcare systems across the globe. Before research teams are ready to design, implement and receive funding for large-scale RCTs, a significant amount of preparatory work is needed as is outlined in the guidelines for the development and testing of complex interventions by the Medical Research Council (MRC) in the UK:

Developing, piloting, evaluating, reporting and implementing a complex intervention can be a lengthy process. All of the stages are important, and too strong a focus on the main evaluation, to the neglect of adequate development and piloting work, or proper consideration of the practical issues of implementation, will result in weaker interventions, that are harder to evaluate, less likely to be implemented and less likely to be worth implementing. (Craig et al., 2021, p. 4)

The National Center for Complementary and Integrative Health (NCCIH) in the United States also emphasizes the importance of a phased approach to testing and the identification or development of a theory that explicates the hypothesized process of change (i.e. underlying mechanisms NCCIH, n.d.). Similar to the MRC, NCCIH developed a research framework for the development and testing of mind and body interventions that includes necessary testing phases: (a) studies to demonstrate a clinically meaningful signal, (b) intervention development, refinement and standardization, (c) feasibility and pilot testing, (d) efficacy testing using RCTs, (e) effectiveness and comparative effectiveness research, and (f) dissemination and implementation studies.

This issue contains several studies that exemplify the necessary early steps in the intervention research pipeline. Gaden, Ghetti, Kvestad, and Gold (p. 107) present the theoretical framework and intervention protocol of a resource-oriented music therapy approach for premature infants and their caregivers. Besides detailing the intervention protocol that was tested in an earlier feasibility study, they present the hypothesized mechanisms of change. Identification of underlying mechanisms is essential in intervention development and the selection of outcomes to be measured in the clinical trial. This protocol is now used in a large multi-national RCT, the LongSTEP trial. Fuller, Kaplun, and Short (p. 153) conducted an exploratory study to examine the role of visual schedules in a group music therapy program with families with complex needs. This initial study resulted in a preliminary theoretical model and recommendation for subsequent research. Aalbers, Vink, de Witte, Pattiselanno, Spreen, and van Hooren (p. 133) report on a feasibility study of the use of emotion-regulating improvisational music therapy with young adult students with depressive symptoms. The feasibility data led to important insights for further optimization of the intervention protocol and training of music therapists. Intervention refinement and optimization of training manuals and procedures are important steps to improve treatment fidelity in subsequent larger clinical trials.

This issue also contains a theoretical article by Frank and Gilboa (p. 176) about different aspects of dialogue in music therapy, namely ontological, ethical and pragmatic. The theoretical framework they present goes beyond dialogue in music improvisation which has been the topic of many publications in the music therapy literature (e.g. Garred, 2006; Hadar & Amir, 2021; Stensæth, 2017). Instead, the framework is intended for conceptualization and analysis of clinical encounters in music therapy as a phenomenon broader than music improvisation or verbal dialogue alone. A clinical case vignette is included to demonstrate these three dialogic dimensions. Finally, Jennifer Fiore contributed a review of the book Music Therapy in Children and Young People’s Palliative Care, edited by Anna Ludwig (p. 194).

Before letting you delve into this issue, I wanted to let you know that Grace Thompson has agreed to join me as co-Editor-in-Chief starting as I plan to step down as Editor-in-Chief in the near future. Grace has been Associate Editor since 2019 and has done a tremendous job in this role. To ensure a smooth transition, we decided to first serve side-by-side as co-Editors-in-Chief. I am thrilled that Grace accepted our invitation for this new role. I also wanted to let you know that Claire Ghetti will be stepping down as Associate Editor after serving this journal for 6+ years. Claire’s contributions to this journal have been tremendous. In her many years of service, she guided a large number of manuscripts towards publication using critical reflection, clear guidance and decision-making, encouragement, and exceptional commitment to mentoring of authors. Her critical perspective also played an important role in the growth of this journal. On behalf of the editorial team, we thank you for your service, Claire. We will truly miss you!