Music Therapy Postoperatively for Pain Control

This paper focuses on the intervention- music therapy to control pain in the postoperative period. Pain is an unavoidable factor following a surgery. Using pharmacological intervention to treat post-operative pain arises several adverse effects like adverse drug reactions and the other physiological side effects. The paper validates the effectiveness of the pain therapy by developing a clinical question, PICO and all the steps in an EBP practice.

Running head: EVIDENCE BASED PRACTICE
EVIDENCE BASED PRACTICE
Name of the University
Author Note

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EVIDENCE BASED PRACTICE
Music Therapy Postoperatively for Pain Control
Introduction
The growing needs of the health care consumers and the complexity of the health care
issue are prompting the nurses to push their limits beyond their conventional nursing practice.
Nowadays, the nurses have to work in frontline with the doctors and multidisciplinary teams,
handling critical cases (Straus et al., 2013). This calls for more research. Remaining updated
to the recent works enhances the clinical reasoning and the critical thinking among the nurses
providing the nurses with the opportunities to provide an individualized care.
This paper focuses on the intervention- music therapy to control pain in the post-
operative period. Pain is an unavoidable factor following a surgery. Using pharmacological
intervention to treat post-operative pain arises several adverse effects like adverse drug
reactions and the other physiological side effects. Studies have shown that listening to music
can decrease pain and anxiety in the postoperative period. Hence, this paper would validate
the effectiveness of the pain therapy by developing a clinical question, PICO and all the steps
in an EBP practice.
EBP process
Clinical question:
Does music therapy helps in alleviating pain in elderly patient, in the post-operative period in
comparison to other pharmacological interventions?

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EVIDENCE BASED PRACTICE
A clinical question should be directly relevant to the patient and the challenge at hand.
The clinical question should be phrased in a way facilitating the search for the answer. The
framework helps in organizing and focusing on the foreground question in to a query that is
searchable. While developing a PICO, it is necessary to assess what type of question are we
asking (diagnosis, therapy, prognosis, prevention or etiology) (Riva et al., 2017).
After the formation of the PICO question, the next step involves searching of the
evidence-based research articles. The evidence-based hierarchy allows to adopt a top down
approach to locate the best evidence, when the initial literary search is being conducted. The
study types in the EBP hierarchy is based on the strength and the precision of the research
methods (Clarke et al., 2013). Different types of the hierarchies exists for different types of
clinical questions. The topmost level of the EBP hierarchy consists of systematic reviews
and the meta-analysis followed by critically appraised topics (level 2), followed by the
critically appraised individual articles (level 3). Randomized control trials being at the level
4, followed by cohort studies at level 5, case-controlled studies at level 6 and ideas, editorials,
opinions and anecdotal records at the base of the pyramid (Clarke et al., 2013).
PICO table
P(Population) Geriatric patient who had undergone a surgery
I(Intervention) Music therapy
C(Comparison
)
Elderly patients receiving pharmacological intervention.
O (Outcome) Reduction of pain

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Acquire the evidence based research
A search strategy can be defined as an organized structure of the key terms used for
searching an electronic database. A proper search strategy should combine the key concepts
of the clinical question for retrieving the accurate results. The search strategy should account
for all the possible search terms, phrases and the keywords, the truncated and the wildcard
variations of the search terms and the subject headings (Aromataris & Riitano, 2014).
In order to search the relevant papers electronic search engines like Google scholar
and databases like CINAHL and PubMed are used.
According to Aromataris & Riitano, (2014), it is necessary to conduct a proper search
of the already available reviews being published online. Initially a Google search is being
conducted to have an insight about the number of research papers obtained online. After
doing an adjustment of the publication year, the result of search was decreased. Boolean
operators were used for associating the words from the search and for narrowing down or
broadening the results. Recent full text systematic reviews were selected for the appraisal.

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Search strategy
(Created by the Author)
Inclusion and the exclusion criteria
It is the inclusion and the exclusion criteria that helps the literary search to have clear
focus and excess time is not wasted to search for the irrelevant papers. A proper exclusion
and the inclusion criteria helps to restrict the bibliographic resources.
Initial Inclusion and Exclusion Criteria
Inclusion Exclusion
Systematic reviews or Meta analyses,
randomised control trials
Opinion, editorials.
Language: English -
Year of publication: 2012 to 2019 Older than 2012
Peer reviewed journal article -
The inclusion and the exclusion criteria generally generates a good amount of materials.
1
Pain
OR
Anxiety
OR
Depression
2
Geriatric
patients
OR
elderly
patients
AND
Older
adults
3
Music
therapy
OR
Music
medicine
AND
Music
protocol

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Critical appraisal
Finally, the critical appraisal is one of the crucial step in the evidence-based practice.
A good critical appraisal assists in identifying the methodological flaws in the research and
provide the consumers of the research with the opportunity for making informed decisions
about the quality of the research (LoBiondo-Wood & Haber, 2017). Critical appraisal can be
defined as a systematic process that ivolves analysis of the research methods, validity and the
usefulness of the research. There are several critical appraisal tools like the CASP (Critical
Appraisal Skills Programme) and CEBM (Centre for Evidence-Based Medicine) for
appraising the articles critically.
The concerned articles and the biases are measured on the basis of some self-asked
questions- as why the study was done, the type of study, the study characteristics, whether the
PICO format is relevant and would help us to answer the question, or if any measures has
been taken for addressing the bias. A critical appraisal tool also validates whether the results
are valid or the outcome measures are relevant with a succinct conclusion.
In this paper, a CRAAP tool has been used for checking the reliability and the validity
of the research papers. Four papers have been chosen to validate the clinical question. The
paper by Vaajoki, Peitila, Kankkunen, and Vehvilainen-Julkunen (2011), has discussed about a
prospective clinical trial consisting of One hundred and sixty-eight men and women for evaluating
as of listening to music after the abdominal surgery would help to decrease post-operative pain. The
study demonstrated that the music group experienced less pain in the post-period. The validity of the
study can be proven with the fact that the results of the study has been tallied with some previous
papers of different authors (Noble & Smith, 2015). The statistical analysis was conducted by using
the ANOVA for the analysis of the pain intensity and the pain distress over time. Mann-Whitney U-

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EVIDENCE BASED PRACTICE
test was performed for assessing the independent groups. Thus, the results can be termed to be valid,
as statistically significant results have been obtained.
A quasi-experimental study was conducted by Lin, Lin, Huang, Hsu, and Lin (2011), for
determining if music therapy had any effect on anxiety, postoperative pain and physiological
wellbeing of the patient. Sixty patients were being recruited for the study and group under the study
listened to music in the evening before the surgery to the second day after the surgery and the control
group did not listen to any music. VAS scale was used for measuring the level of anxiety in the
patient. However, it has to be mentioned that the study lacked follow up and do not involves
substantial evidence for the long-term effects of the therapy. The study cannot be validated due to
some methodological constraints. Again, the participants listened to music at any time they wanted
and thus there was a wide variation in the music session among the participants. Again, the study
sample cannot the applicable to the generalized population.
Another study conducted by Jose, Verma, and Arora (2012) had determined the pain
perception in the patients with cardiothoracic surgery. Sixty-four subjects were included in the study.
The trustworthiness of the study is questionable as opinions are entirely based on the self-reported
data and might cause response bias thus reducing the trustworthiness of the study. The strength of the
study is that statistically significant results are detected.
A stratified randomized controlled trial was conducted by, Cutshall et al, (2011), the
weightage of this paper can be ensured the fact that randomization has was blocked for ensuring a
balanced allocation throughout the course of the study. Randomization is possibly done for the
elimination of the response biases. A control group had also been included who were asked to rest.
The purpose of the control group is to determine the effect of a particular intervention by the
elimination of any placebo effect. One of the strength of the study is that the study contained effective
justification about the low sample size. The validity and the rigor of the study was not analyzed in this
paper.

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Apply
Only few literatures could be found that validated the effect of music therapy in pain
reduction in the post-operative period. In most of the papers discussed, the generalizability of
these papers can be restricted because of the nature of the study sample used. The
effectiveness of the therapy depends upon the intensity of the pain and the type of surgery
that the patient had undergone (DiCenso, Guyatt & Ciliska, 2014).
One of the implication of this study is that the intervention is cost effective and is
generally not associated with any side effects (Jose, Verma & Arora, 2012). Currently music
therapy are being successfully applied in the palliative care patients as a low cost approach.
The training materials for the intervention is cheap and available and hence can be easily
used.
Audit
Regular audit is required for checking the effectiveness of the interventions. Audits
can be done by seeking feedback from the patient and the patient’s families (DiCenso, Guyatt
& Ciliska, 2014). Again, a self-evaluation checklist can be used for evaluating the outcomes
of EBP. Some of the self-evaluation questions includes-
- Am I asking a well-formulated question?
- Am I becoming efficient in collecting the best evidence?
- Am I introducing critical appraisal to my practice?
- Am I creating the evidence summaries effectively?

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