Effects of Music Therapy and Deep Relaxation Techniques for Reducing Perioperative Anxiety in Patients Undergoing Spinal Surgeries: A Randomized Controlled Trial

ABSTRACT

Background:

This study aimed to evaluate the effectiveness of music therapy and deep relaxation technique (DRT) in reducing perioperative anxiety, a challenging occurrence that can negatively impact treatment results and patient distress, and mitigate the adverse effects of anxiety-reducing drugs.

Methodology:

The study involved 90 patients, including 28 using DRT, 31 using music therapy, and 31 without intervention. The Hamilton Anxiety Rating Scale was employed to measure perioperative anxiety levels. DRT, music therapy, and routine interventions were used.

Results:

The study found a significant difference in pretest and posttest perioperative anxiety scores between the DRT and music therapy groups. Notably, there was a significant difference between the music therapy and control groups and a highly significant difference between the control and DRT groups.

Conclusion:

The study found that both music therapy and DRT can effectively reduce perioperative anxiety in patients undergoing spinal surgeries.

INTRODUCTION

Anxiety, a subjective sensation triggered by the sympathetic, parasympathetic, and endocrine systems, is common in patients awaiting nonemergency surgery. Factors such as age, sex, scope of surgery, previous surgical experience, and individual vulnerability influence anxiety levels.[1]

Patients generally experience lower anxiety levels during general surgeries, such as orthopedic and ophthalmic procedures. However, they often experience increased anxiety during spinal surgery due to the perceived importance of the spinal cord. Research indicates that over 87% of neurosurgical patients report anticipating spinal surgeries, indicating a higher prevalence of preoperative anxiety compared to other surgical groups.[2]

Perioperative anxiety can lead to adverse outcomes such as cardiac events, readmissions, reduced quality of life, and an increased risk of mortality. It also contributes to postoperative pain, longer hospital stays, and decreased patient satisfaction.[3] Healthcare practitioners identify patients at risk of anxiety and depression by analyzing the underlying causes and variables to provide optimal care and effectively address postsurgery needs.[4]

During surgery, anesthesiologists should use nonpharmacological techniques to address anxiety, as pharmacological interventions can lead to dose-dependent depression of the central nervous system, as well as the cardiovascular and respiratory systems.[5]

Relaxation therapy and music have been proven to alleviate pain and reduce respiration rate, heart rate, and blood pressure by decreasing anxiety, muscle tension, as well as by distracting patients from the impending surgery.[6] This study aimed to explore the relationship between preoperative anxiety and negative outcomes following major general surgical procedures. It emphasizes the importance of prioritizing perioperative anxiety as a key component of patient care and suggests the exploration of nonpharmacologic coping strategies, such as music and deep relaxation techniques, for effective treatment.

METHODOLOGY

A randomized controlled trial was conducted at AIIMS, New Delhi, involving 105 patients who underwent spinal surgeries. A total of 90 participants were included in the study after meeting the inclusion and exclusion criteria.

The study included adults aged 18 and above who were undergoing elective spine surgery, such as cervical or lumbar disc surgery, and who had preoperative hospital stays. Exclusion criteria included emergency or fusion surgeries, children and adolescents, pregnant women, patients with psychiatric illness, nonparticipants, and those with hearing disabilities.

The study included demographic variables such as age, sex, education, occupation, family type, income, and history of previous surgery. The Hamilton Anxiety Rating Scale (HAM-A) was used to assess perioperative anxiety, with scores ranging from 14–17 to 25–30. The study was approved by the Institutional Human Ethics Committee, AIIMS, New Delhi (Ref No: IEC-371/0706.2019 RP-56/2019 Dated: 31-08-2019). All patients were informed about the study, provided consent, and recruitment and data collection commenced following protocol approval.

The study collected patient demographics and anxiety levels using a personal information form and the HAM-A scale. Patients were randomized into three groups: deep relaxation technique, music therapy, and conventional therapy or routine care. Data and HAM-A scale were provided to patients after obtaining informed consent. Post-tests were conducted during the first preoperative period after recovery.

The study utilized deep relaxation techniques (DRT) and music therapy to help patients relax. DRT was performed using an audio tape prepared by yoga practitioner Mr. Hansaram, while music therapy was conducted using headphones, allowing patients to select their preferred songs. Both techniques were administered one hour before meals. The study utilized descriptive and inferential statistics to analyze the data, which was systematically arranged and tabulated according to the study’s objectives.

RESULTS

This study collected data from 90 patients aged 18–30, the majority of whom were males and had an education level up to primary school. Most participants were married and unemployed. A total of 32.2% had a history of previous surgery, while 67.77% had never undergone any surgery. Additionally, 88.8% of participants reported a prior health history.

Figure 1 indicates that in the pre-test DRT group, 82.1% of participants experienced severe anxiety. In the music therapy group, 80.7% had severe anxiety, 16.1% had moderate anxiety, and 3.2% had mild anxiety. In the control group, 83.9% of participants had severe anxiety, 9.7% had moderate anxiety, and 6.4% had mild anxiety.

Figure 1.

Frequency and percentage distribution of patients undergoing spinal surgeries according to pretest and posttest perioperative level of anxiety

Table 1 shows significant differences in pre- and post-operative anxiety levels between the two groups: the DRT group (mean score of 32.82) and music therapy group (mean score of 32.19). The DRT group had a significantly higher pre-test anxiety score (P < 0.05), as did the music therapy group (P < 0.05). Both groups showed significant differences in anxiety levels.

Table 1.

Comparison of pretest and posttest mean scores of perioperative anxiety within the groups to identify the effectiveness of DRT and music therapy for a sample size of n=90

Group	n	Pretest		Posttest		Mean difference	Paired t- test
		Mean	SD	Mean	SD
DRT Group	28	32.82	10.51	05.39	0.71	27.43	t=13.708 df=27 P=0.000*
Music Therapy Group	31	32.19	10.38	06.93	0.6	25.33	t=14.854 df=30 P=0.000*
Control Group	31	28.97	10.99	30.10	1.6	01.13	t=01.413 df=30 P=0.168

Table 2 demonstrates that both DRT and music therapy significantly reduced perioperative anxiety in patients undergoing spinal surgeries. The DRT group had a mean difference of 3.85 and 24.70 compared to the control group, while the music therapy group showed a mean difference of 3.23 and 23.16.

Table 2.

Comparison of overall mean differences in pretest and posttest levels of perioperative anxiety scores between intervention groups of patients undergoing spinal surgeries for a sample size of n=90

Study Group		Pretest perioperative anxiety score			Posttest perioperative anxiety score
		Mean Difference	Std. Error	P	Mean Difference	Std. Error	P
DRT	Music	0.63	2.773	1.000	01.54	1.623	1.000
Music	Control	3.23	2.702	0.707	23.16	1.582	0.000*
Control	DRT	3.85	2.773	0.505	24.70	1.610	0.000*

*Mean difference is significant at the 0.05 level

Table 3 shows significant associations between perioperative anxiety in the DRT and music therapy groups and demographic variables such as sex, family type, marital status, previous health history, and previous hospital stays.

Table 3.

Association between posttest perioperaive anxiety level scores and selected demographic variables in the intervention group

Variable	Variable characteristics	DRT Group (n=28)				Music Group (n=31)
		Mean	SD	Df	χ 2	Mean	SD	Df	χ 2
Age in years	18–30	2.39	1.22	4	χ2=5.929 P=0.039	2.48	1.50	5	χ2=14.484 P=0.002*
	31–40
	41–50
	51–60
	61–70
	Above 70
Sex	Male	1.21	0.41	1	χ2=9.143 P=0.003*	1.45	0.50	1	χ2=0.290 P=0.247
	Female
Occupation	House wife	3.50	1.26	4	χ2=5.571	3.68	1.40	4	χ2=17.871 P=0.000**
	Daily wager				P=0.012
	Monthly salary
	Business
	Unemployed
Type of the family	Nuclear	1.75	0.44	1	χ2=7.000 P=0.009 *	1.84	0.37	1	χ2=14.226 P=0.000*
	Joint
Marital status	Married	1.25	0.44	1	χ2=7.000 P=0.009 *	1.06	0.44	1	χ2=7.258 P=0.007*
	Unmarried
Monthly family income	Nil								χ2=19.484 P=0.000*
	Less than 10000	1.86	0.65	5	χ2=8.000 P=0.004	2.00	1.23	4
	10001–20000
	20001–30000
	30001–40000
	Above 50000

*Significant at P<0.05 level

DISCUSSION

The study examined the impact of music therapy and DRT on reducing perioperative anxiety in patients who had undergone spine surgeries. The results showed that patients with complications were four times more likely to experience preoperative anxiety, highlighting the need for effective prevention and treatment methods.[7]

Toussaint et al.[8] (2021) found that progressive muscular relaxation, deep breathing, and guided imagery significantly increased relaxation levels in participants compared to a control group.

Further evidence was provided by Kee Kwong KC, Kang CX, and Kaliperumal (2022), who conducted a quantitative analysis of five research studies. Their analysis revealed a significant reduction in anxiety levels among individuals undergoing neurosurgery.[9]

CONCLUSION

The study found that music therapy and DRT effectively reduce anxiety in patients undergoing spinal procedures. These interventions are recommended due to their ease of application, safety, and cost-effectiveness, making them valuable options for potentially improving patient outcomes.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.