Alternative Therapies In Health And Medicine

efore and after surgery. 4,5 During recovery after surgery, patients
may feel helpless and be concerned about loss of control, physical
discomfort, and doubts about their progress. 2,6 In addition, unfamiliar
environments and sounds can create physiologic complications
and delay recovery. 7,8
Along with having anxiety, patients experience pain after cardiac
surgery. This type of postoperative pain has no functional value
beyond signaling the presence of tissue damage from surgery, and it
may actually have harmful psychologic and physiologic consequences.
As the stress response increases, wound healing may be
impaired. 8,9 Pain also interferes with the patient’s sleep and appetite
and can create anxiety, compounding complications with other components
of the cardiovascular system and gastrointestinal tract,
thereby prolonging recovery. 10,11
The Agency for Healthcare Research and Quality recommendations
for pain management include the use of cognitivebehavioral
interventions such as relaxation, music, distraction,
and imagery. 12 These interventions have been shown to reduce
the amount of pain medication used and to improve the management
of pain and anxiety. 13,14
Music is well known as a positive integrative therapy with
its therapeutic qualities of enhancing well-being, reducing anxiety
and stress, and distracting people from unpleasant painful
stimuli. 13,15-19 Ambient Therapy (Ambience Medical, Omaha,
Nebraska) uses specifically designed music that combines natural
sounds recorded in a 200 x 200–foot time-delay algorithm
with musical parts created to enhance emotions. These specifically
recorded sounds of nature are thought to minimize the
patient’s perception of spikes or startle sounds in his or her environment.
This effect is hypothesized to provide patients with a
new perceptual reality so that the hospital environment is soothing
and comforting, helping the patient counteract feelings of
pain and anxiety. 20 Evidence shows that a convergence occurs
between sensory input (such as ambient music) and neural output
(through the central nervous system) that regulates pain and
stress responses. 21
The purpose of this study was to test the effects of structured
music with nature sounds on the level of pain and anxiety in cardiac
surgical patients.
Methods
Research Design
A stratified randomized experimental design was used to assign
patients to standard postoperative care in combination with ambient
music sessions (the music group) or to standard postoperative
care in combination with matched quiet resting sessions (the control
group) (Figure 1). This protocol was reviewed and approved by the
Mayo Clinic Institutional Review Board.
Research Setting
The participants were cardiac surgical patients at Saint Marys
Hospital in Rochester, Minnesota. Data were collected while the
patients were in the cardiovascular surgical intensive care and progressive
care units of the hospital.
Enrollment
Allocation
Completion
Analysis
349 Patients assessed for eligibility
173 Randomized
87 Allocated to
standard care and
quiet resting sessions
51 Completed
the sessions
51 Included
in analysis
176 Excluded
55 Did not meet inclusion criteria
89 Refused to participate
32 Excluded for other reasons
86 Allocated to
standard care and
ambient music sessions
49 Completed
the sessions
49 Included
in analysis
FIGURE 1 Patient Flowchart. In this randomized controlled trial, cardiac
surgical patients were randomly assigned to receive standard postoperative
care with sessions of either quiet rest or ambient music.
Inclusion Criteria
Participants were cardiac surgical patients, aged 18 years or
older, who had undergone first-time CABG surgery or cardiac valve
surgery (or both) and had consented to participate in the study.
Exclusion Criteria
Patients were excluded from the study if they were non–English
speaking, if they were intubated on postoperative day 2, or if they
had a diagnosis of chronic pain, a chronic psychiatric disorder, or a
hearing impairment that would interfere with hearing the music.
Randomization
At the start of postoperative day 2, patient pain levels were
assessed on a scale from 0 (no pain) to 10 (the most intense pain),
and stratification for randomization was based on a pain level of 4 or
less (the institutional pain level goal) or greater than 4. The randomization
was blocked to ensure balanced allocation throughout the
course of the study. There were 25 randomized blocks of 4 patients
and 25 randomized blocks of 2 patients. Each set of 50 blocks was
changed into a random order as well. To account for potentially nonrandom
dropouts, the randomization scheme was determined in
advance for 150 patients per stratum, and enrollment was continued
until at least 100 patients in total had completed day 4 of the study.
The use of cards in sealed envelopes prevented the study coordinator
Nature Sounds and Music After Cardiac Surgery
ALTERNATIVE THERAPIES, jul/aug 2011, VOL. 17, NO. 4 17