Abstract
Objective:
To evaluate the effects of music therapy on perioperative anxiety, depression and postoperative satisfaction in elderly patients undergoing surgery for distal radius fractures.
Methods:
A retrospective cohort study of 186 patients (≥65 years) was conducted from January 2022 to December 2024. The participants were divided based on the treatment period: standard care (January 2022–June 2023, n = 92) or music therapy plus standard care (July 2023–December 2024, n = 94). Outcomes measured included anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]; anxiety levels (Visual Analog Scale for Anxiety [VAS-A]; sleep quality (Pittsburgh Sleep Quality Index [PSQ]; satisfaction; pain; length of hospital stay and functional recovery at preoperative, postoperative 24 hours, discharge and 2-week and 6-week follow-up timepoints.
Results:
The music-therapy group demonstrated progressive improvements across all timepoints. At 6 weeks, the music therapy group maintained superior outcomes compared with standard care: HADS-Anxiety (6.05 ± 1.98 vs. 7.34 ± 2.24, P < 0.001), HADS-Depression (5.86 ± 2.07 vs. 6.69 ± 2.53, P = 0.015), VAS-A (28.83 ± 12.94 vs. 33.47 ± 15.19 mm, P = 0.026) and Pittsburgh Sleep Quality Index (6.15 ± 1.94 vs. 7.33 ± 2.18, P < 0.001). Patient satisfaction scores were significantly higher (8.46 ± 0.94 vs. 7.93 ± 1.29, P < 0.001). Hospital stay was reduced (3.21 ± 0.89 vs. 4.12 ± 1.23 days, P < 0.001), opioid consumption decreased (23.59 ± 11.67 vs. 34.56 ± 13.89 oral morphine equivalents, P < 0.001) and functional recovery was superior (disability of the arm, shoulder and hand]: 28.01 ± 11.34 vs. 38.87 ± 13.78, P < 0.001).
Conclusion:
Music therapy considerably reduces anxiety and depression, enhances sleep quality and satisfaction and facilitates recovery of elderly patients undergoing distal radius fracture surgery.
Keywords: aged, anxiety, depression, music therapy, perioperative care, radius fracture
KEY MESSAGES
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(1)
Music therapy significantly reduced perioperative anxiety and depressive symptoms in elderly patients with distal radius fractures.
-
(2)
The treatment improved sleep quality and patient satisfaction while reducing postoperative pain and hospital length of stay.
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(3)
Music therapy enhanced functional recovery and the overall quality of life in elderly orthopaedic patients.
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(4)
This nonpharmacological treatment offers a safe and cost-effective approach to improving perioperative outcomes in geriatric surgery.
INTRODUCTION
Distal radius fractures represent the most common upper-extremity fracture in elderly patients, and they account for approximately 16% of all emergency department fracture presentations.[1,2] The incidence increases exponentially with age, particularly in women over 65 years, with an estimated annual incidence of 195–469 per 100,000 in this demographic.[3] These fractures, which represent a crucial marker of overall bone health and future fracture risk, often result from low-energy falls and show a strong association with osteoporosis.[4,5]
The perioperative experience of elderly patients undergoing distal radius fracture surgery is often complicated by heightened anxiety and depression. A total of 40–60% of elderly surgical patients experience clinically significant preoperative anxiety, with depression rates of 15–25%.[6,7] This psychological distress becomes pronounced due to fear of complications, concerns regarding functional recovery, social isolation and pre-existing comorbidities.[8] Depression considerably predicts poor outcomes, with affected patients demonstrating low functional scores, prolonged recovery times and less complete functional recovery. These psychological factors extend beyond wellbeing and affect physiological responses, pain perception and sleep quality.[9,10,11] Sleep disturbances commonly afflict elderly patients with distal radius fractures; a previous study showed that up to 75% experience significant sleep problems, which is correlated with increased pain, anxiety and functional limitations.[12] Traditional pharmacological approaches to managing perioperative anxiety in elderly patients are limited by potential adverse effects, drug interactions and concerns about cognitive impairment.[13]
Research on orthopaedic patients has shown that music therapy can effectively reduce perioperative anxiety, stabilise hemodynamic parameters and improve overall patient satisfaction. The neurobiological mechanisms underlying the therapeutic effects of music therapy involve multiple pathways. Music listening triggers the release of endogenous opioids, dopamine and serotonin while reducing cortisol levels and sympathetic nervous system activity.[14] Recent studies on elderly populations have demonstrated that music therapy can improve cognitive function, reduce depressive symptoms and enhance the quality of life in older adults. These effects are particularly relevant for elderly surgical patients who may experience delirium, cognitive decline and prolonged recovery. Previous research on elderly orthopaedic populations has shown promising but limited evidence for music therapy. Park et al.[15] conducted a systematic review and observed that moderate benefits in hip fracture patients, and studies on knee arthroplasty demonstrated reduced anxiety but inconsistent functional outcomes. However, no studies have specifically examined music therapy for elderly patients with distal radius fractures, who face unique challenges, including those concerning hand function and independence.
Despite growing evidence supporting music therapy in various clinical settings, limited research has specifically examined its effects on elderly patients undergoing orthopaedic surgery for distal radius fractures. This population presents unique challenges, including age-related physiological changes, multiple comorbidities, polypharmacy concerns and specific anxiety-provoking factors related to functional independence and quality of life. Outcomes following distal radius fracture surgery of elderly patients are influenced by factors beyond technical surgical considerations, including psychological state and patient expectations.
While existing literature demonstrates the efficacy of non-pharmacological interventions in reducing perioperative morbidity, limited research has systematically examined structured music therapy’s multidimensional therapeutic potential in elderly patients with distal radius fractures. This study aims to evaluate the comprehensive effects of structured music therapy on psychological well-being, pain management and functional recovery trajectories in elderly patients (≥65 years) undergoing surgical treatment for distal radius fractures. By employing validated psychometric instruments across multiple assessment domains, we seek to establish evidence-based foundations for integrating music therapy into standard perioperative care protocols, thereby contributing to the evolving paradigm of holistic, patient-centred orthopaedic care.
MATERIALS AND METHODS
Study Design
This retrospective cohort research was conducted at our level I trauma centre between January 2022 and December 2024. A total of 248 elderly patients (≥65 years) with distal radius fractures were initially assessed for eligibility. Among these patients, 31 were excluded due to multiple trauma, 18 due to cognitive impairment prevented valid questionnaire completion, 9 due to severe hearing impairment and 4 due to incomplete follow-up data. Ultimately, 186 patients were enrolled in the final analysis [Figure 1]. The participants were divided into two groups based on the perioperative therapy received: those who received standard perioperative care were classified into the standard care group (n = 92), and those who received music therapy in addition to standard care were allotted to the music-therapy group (n = 94). Group allocation was based on the availability of music therapy services during various periods at our institution. Patients treated between January 2022 and June 2023 received standard care, and those treated between July 2023 and December 2024 had access to music therapy services as a part of enhanced perioperative care protocols. Two independent researchers reviewed electronic health records and follow-up questionnaires to ensure data consistency and resolved discrepancies through discussion. The study protocol received approval from the Institutional Review Board of the Sichuan Province Orthopedic Hospital (KY2025-048-01), and written informed consent was obtained from all participants. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki.[16]
Figure 1.
Research subject flowchart.
Inclusion and Exclusion Criteria
Inclusion criteria: (1) Patients aged ≥65 years with acute unilateral distal radius fractures requiring surgical treatment; (2) availability of complete perioperative medical records, including caring logs and standardised psychological assessments at baseline and follow-ups; (3) cognitive capacity to provide informed consent and complete questionnaires [Mini-Mental State Examination (MMSE) score ≥24]; (4) adequate hearing ability to perceive music therapy; (5) expected survival ≥6 months based on clinical assessment.
Exclusion criteria: (1) Multiple trauma or bilateral upper-extremity injuries; (2) pre-existing diagnosed psychiatric disorders requiring active pharmacological treatment; (3) severe cognitive impairment or dementia (MMSE <24); (4) severe hearing impairment preventing music appreciation; (5) concurrent participation in other psychological nursing during the study period; (6) incomplete postoperative follow-up data; (7) pathological fractures or malignancy-related fractures; (8) previous history of wrist surgery on the affected side.
Therapy Protocols
Standard Care Group
The standard care group received conventional perioperative care following established institutional protocols. Preoperatively, the patients underwent routine anaesthetic consultation, surgical planning and standard preoperative education, including procedural explanation and postoperative expectations. Intraoperative care included standardised anaesthetic protocols with either regional (brachial plexus block) or general anaesthesia based on patient factors and surgeon preference. Postoperative pain management followed a multimodal approach incorporating regional anaesthetic techniques; oral analgesics (acetaminophen, nonsteroidal anti-inflammatory drugs when appropriate) and opioids for breakthrough pain. All patients were given access to occupational therapy consultation with standardised home exercise programs and follow-up protocols. Environmental noise control was maintained at ambient levels below 55 dB in patient care areas, with no structured auditory caring provided.
Music Therapy Group
The music-therapy group received structured music therapy caring in addition to all components of standard care. A certified music therapist (MT-BC) designed the therapy protocol in accordance with established clinical guidelines for perioperative music therapy. The music library comprised 48 instrumental tracks (mean duration 4.8 ± 1.3 minutes) selected for their calming properties, including classical compositions (Bach, Debussy, and Mozart); contemporary instrumental pieces and culturally appropriate traditional melodies. Tracks were curated to maintain 60–80 beats per min, consistent with relaxation-inducing tempos.[17,18]
Preoperative Phase: Music therapy sessions began 24 hours prior to surgery. Patients received individualised 30-minute sessions twice daily (morning: 09:00–09:30, evening: 19:00–19:30) in private rooms using high-quality noise-cancelling headphones (Sony WH-1000XM4) calibrated to 45–50 dB. Each session initiated with 5 minutes of guided breathing exercises conducted by a music therapist, followed by patient-selected music from the curated library. Therapists documented patient preferences and emotional responses using standardised assessment forms.
Intraoperative Phase
With the surgeon’s consent, selected patients in the music-therapy group received intraoperative music through specialised headphones during regional anaesthesia procedures. Music selection focused on previously identified patient preferences, with the volume maintained at safe levels (40–45 dB) to ensure surgical communication was not compromised.
Postoperative Phase
Music therapy was continued in the post-anaesthesia care unit and surgical ward. The patients attended sessions twice daily for the duration of their hospitalisation, with additional sessions available upon their request. Therapists modified the music selection based on patient feedback and recovery status. Prior to discharge, patients received portable audio devices (iPod Touch, 32GB) preloaded with personalised music selections and written instructions for continued home use.
Follow-up Protocol
Post-discharge music-therapy support included weekly 20-minute telephone sessions with the music therapist for the first month, followed by biweekly sessions for 6 weeks. Patients kept daily music listening logs documenting session duration, timing and subjective experience ratings. Compliance was assessed through device usage analytics and patient self-report.
Outcome Measurements
Primary Outcomes
Anxiety Assessment
The Hospital Anxiety and Depression Scale (HADS)-A was used to measure anxiety symptoms.[19] This 7-item subscale assesses anxiety-related thoughts and feelings over the past week, with each item scored 0–3 (total range: 0–21). Scores ≥8 indicate a possible anxiety disorder, and scores ≥ 11 suggest a high alert anxiety disorder. The Cronbach’s α for HADS-A is 0.79 in elderly surgical populations.[20]
Depression Assessment
The HADS-D evaluates depressive symptoms using 7 items with a similar scoring methodology.[19] The scale focuses on anhedonic symptoms of depression while avoiding somatic symptoms that may confound assessment in surgical patients. Scores ≥8 indicate possible depression, with scores ≥11 suggesting significant depressive symptoms. The Cronbach’s α for HADS-D is 0.66.[20]
Anxiety Severity
The Visual Analog Scale for Anxiety (VAS-A) provided a rapid anxiety assessment using a 100 mm horizontal line anchored by ‘no anxiety’ (0 mm) and ‘maximum possible anxiety’ (100 mm).[21] Patients marked their current anxiety level, with scores measured to the nearest millimetre. VAS-A scores >34 mm indicate clinically significant anxiety.[22]
Secondary Outcomes
Sleep Quality
The Pittsburgh Sleep Quality Index (PSQI) assesses sleep disturbances across seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications and daytime dysfunction.[23] Each component is given a score between 0 and 3, with a global score of 0–21. Scores >5 indicate poor sleep quality. The split-half reliability coefficient of the PSQI is 0.824, and the overall Cronbach’s α coefficient is 0.845.[12,24]
Patient Satisfaction
A validated 10-point Likert scale was used to assess the overall satisfaction with perioperative care, with scores ranging from 1 (completely dissatisfied) to 10 (completely satisfied).[25,26] The Likert scale demonstrated strong internal consistency, with a Cronbach’s α of 0.858, and its construct validity was supported by factor loadings ranging from 0.362 to 0.754.[27] Additional domains were used to evaluate satisfaction with pain management, nursing care, communication and likelihood of recommending the service to others.
Functional Assessment
The disability of the arm, shoulder and hand (DASH) questionnaire measures upper-extremity function and symptoms.[28] This 30-item instrument evaluates physical function; symptom severity and effect on social activities, work and sleep. Scores range from 0 to 100, with high scores indicating great disability. The DASH questionnaire demonstrated excellent reliability and validity, with a Cronbach’s α of 0.969 and good test–retest reliability (Intraclass correlation coefficient, ICC = 0.875) in the assessment of upper extremity dysfunction.[29]
Pain Assessment
Pain intensity was measured using an 11-point (Numeric Rating Scale [NRS] with anchors at 0 (no pain) and 10 (worst possible pain). Assessments were conducted at rest and during activity at specified timepoints. Test–retest reliability of the NRS was excellent (ICC = 0.95) and showed good validity with a significant correlation to VAS (r = 0.941).[30]
Physiological and Clinical Outcomes
Hospital length of stay: Calculated from admission to discharge and measured in days.
Medication usage: Total opioid consumption calculated as oral morphine equivalents (OME) during hospitalisation and first postoperative week.
Assessment Timeline
All psychological assessments were conducted at standardised timepoints: preoperation (within 24 hours of surgery), 24 hours postsurgery, hospital discharge, 2 weeks postoperation and 6 weeks postoperation. Trained research coordinators, blinded to group assignment, administered all questionnaires in standardised conditions to minimise bias. Functional assessments (DASH) were performed during discharge and 2 and 6 weeks postoperatively.
Statistical Analysis
Statistical analysis was performed using IBM SPSS Statistics 28.0 (IBM Corp., Armonk, NY, USA). Continuous variables were tested for normality using the Shapiro–Wilk test. Normally distributed continuous variables were expressed as mean ± standard deviation and compared between groups via independent t-tests. Categorical variables were presented as frequencies (percentages) and compared using chi-square tests. Within-group comparisons across timepoints were evaluated using repeated-measures analysis of variance. Statistical significance was P < 0.05 for all outcomes.
RESULTS
Baseline Characteristics
As shown in Table 1, baseline characteristics demonstrated no statistically significant differences between the standard-care and music-therapy groups (P > 0.050). These findings confirm the comparability of baseline profiles, which supports the validity of subsequent outcome comparisons. Both groups displayed similar distributions of gender, comorbidities, fracture patterns and surgical procedures.
Table 1.
Comparison of baseline characteristics between groups
| Characteristic | Standard-Care group (n = 92) | Music-Therapy group (n = 94) | Statistic | P |
|---|---|---|---|---|
| Age (years) | 72.34 ± 6.15 | 71.89 ± 5.87 | t = 0.524 | 0.601 |
| Female gender, n (%) | 68 (73.91%) | 71 (75.53%) | χ2 = 0.061 | 0.805 |
| Body mass index (kg/m2) | 26.84 ± 4.23 | 27.12 ± 4.45 | t = −0.449 | 0.654 |
| Comorbidities, n (%) | ||||
| Hypertension | 54 (58.70%) | 58 (61.70%) | χ2 = 0.171 | 0.679 |
| Diabetes mellitus | 23 (25.00%) | 27 (28.72%) | χ2 = 0.347 | 0.556 |
| Cardiovascular disease | 18 (19.57%) | 21 (22.34%) | χ2 = 0.214 | 0.644 |
| Osteoporosis | 41 (44.57%) | 45 (47.87%) | χ2 = 0.204 | 0.652 |
| Educational level, n (%) | ||||
| ≤High school | 48 (52.17%) | 47 (50.00%) | χ2 = 0.089 | 0.765 |
| >High school | 44 (47.83%) | 47 (50.00%) | ||
| Living Situation, n (%) | ||||
| Lives alone | 28 (30.43%) | 31 (32.98%) | χ2 = 0.135 | 0.713 |
| Lives with family | 64 (69.57%) | 63 (67.02%) | ||
| Fracture classification (AO), n (%) | ||||
| Type A (extra-articular) | 34 (36.96%) | 38 (40.43%) | χ2 = 0.537 | 0.764 |
| Type B (partial articular) | 29 (31.52%) | 27 (28.72%) | ||
| Type C (complete articular) | 29 (31.52%) | 29 (30.85%) | ||
| Surgical Procedure, n (%) | ||||
| Volar plate fixation | 67 (72.83%) | 71 (75.53%) | χ2 = 0.190 | 0.663 |
| External fixation | 15 (16.30%) | 13 (13.83%) | ||
| Combined procedures | 10 (10.87%) | 10 (10.64%) | ||
| Anaesthesia type, n (%) | ||||
| Regional anaesthesia | 54 (58.70%) | 59 (62.77%) | χ2 = 0.322 | 0.57 |
| General anaesthesia | 38 (41.30%) | 35 (37.23%) | ||
Note: Data presented as mean ± standard deviation or n (%).
Primary Outcomes: Anxiety and Depression
Psychological outcomes revealed progressive between-group differences over time [Table 2]. Baseline HADS-A, HADS-D and VAS-A scores showed no significant difference between groups (P > 0.050).
Table 2.
Comparison of psychological outcomes between groups
| Outcome | Timepoint | Standard care group (n = 92) | Music therapy group (n = 94) | Statistic | P |
|---|---|---|---|---|---|
| HADS-A | |||||
| Baseline | 9.94 ± 2.91 | 10.23 ± 2.87 | 0.684 | 0.495 | |
| Postop 24 hours | 10.25 ± 2.03 | 9.88 ± 2.42 | 1.128 | 0.260 | |
| Discharge | 8.98 ± 2.75# | 8.35 ± 2.48# | 1.641 | 0.102 | |
| 2 weeks | 8.12 ± 2.64# | 7.18 ± 2.39# | 2.547 | 0.012 | |
| 6 weeks | 7.34 ± 2.24# | 6.05 ± 1.98# | 4.164 | <0.001 | |
| HADS-D | |||||
| Baseline | 8.45 ± 2.73 | 8.76 ± 2.54 | 0.797 | 0.426 | |
| Postop 24 hours | 8.56 ± 2.81 | 8.15 ± 2.68 | 1.018 | 0.310 | |
| Discharge | 7.94 ± 2.43 | 7.28 ± 2.15# | 2.099 | 0.037 | |
| 2 weeks | 7.67 ± 2.49# | 6.59 ± 2.11# | 3.194 | 0.002 | |
| 6 weeks | 6.69 ± 2.53# | 5.86 ± 2.07# | 2.451 | 0.015 | |
| VAS-A (mm) | |||||
| Baseline | 47.12 ± 19.33 | 46.73 ± 18.25 | 0.142 | 0.888 | |
| Postop 24 hours | 47.56± 18.58 | 45.73 ± 17.85 | 0.685 | 0.494 | |
| Discharge | 41.14 ± 19.28# | 40.27 ± 16.14# | 0.334 | 0.739 | |
| 2 weeks | 38.58 ± 15.83# | 33.16 ± 13.37# | 2.525 | 0.012 | |
| 6 weeks | 33.47 ± 15.19# | 28.83 ± 12.94# | 2.244 | 0.026 |
Note: HADS, Hospital Anxiety and Depression Scale; VAS, Visual Analog Scale.
Significant within-group change from baseline (P < 0.05).
For HADS-Anxiety scores, both groups exhibited gradual improvement from baseline for 6 weeks. During discharge and at 24 hours postoperation, no significant differences were observed between groups (P = 0.102 and P = 0.260, respectively). However, significant between-group differences emerged at 2 weeks (P = 0.012), and they were maintained at 6 weeks (P < 0.001), with the music-therapy group demonstrating superior outcomes (6.05 ± 1.98 vs. 7.34 ± 2.24).
HADS-D scores followed a similar pattern of gradual improvement in both groups. The first significant between-group difference appeared at discharge (P = 0.037), with further divergence observed at 2 (P = 0.002) and 6 weeks (P = 0.015). The music-therapy group consistently presented lower depression scores at later timepoints.
VAS-A scores demonstrated progressive reduction in both groups over the recovery period. No significant differences were observed at baseline, 24 hours postoperation or during discharge (P > 0.050). Significant between-group differences emerged at 2 (P = 0.012) and 6 weeks (P = 0.026), with the music-therapy group displaying greater anxiety reduction (28.83 ± 12.94 vs. 33.47 ± 15.19 at 6 weeks).
Secondary Outcomes
Sleep Quality
PSQI scores showed significant improvement in the music-therapy group compared with the standard care group [Table 3]. At 6 weeks, the music-therapy group achieved a substantially better sleep quality (6.15 ± 1.94 vs. 7.33 ± 2.18, P < 0.001). Analysis of individual PSQI components revealed the significant improvements of the music-therapy group across all seven sleep domains. The most pronounced effects were observed in sleep duration (0.79 ± 0.31 vs. 1.07 ± 0.41, P < 0.001), sleep latency (0.82 ± 0.28 vs. 0.95 ± 0.35, P = 0.006) and sleep medication use (0.64 ± 0.25 vs. 0.75 ± 0.26, P = 0.004). Additional significant improvements were found in sleep disturbances (P = 0.003), subjective sleep quality (P = 0.006), sleep efficiency (P = 0.046) and daytime dysfunction (P = 0.013).
Table 3.
Secondary outcomes and patient satisfaction
| Outcome | Standard care group (n = 92) | Music therapy group (n = 94) | Statistic | P |
|---|---|---|---|---|
| PSQI global score (6 weeks) | 7.33 ± 2.18 | 6.15 ± 1.94 | 3.902 | <0.001 |
| PSQI components (6 weeks) | ||||
| Subjective sleep quality | 1.19 ± 0.34 | 1.03 ± 0.44 | 2.771 | 0.006 |
| Sleep latency | 0.95 ± 0.35 | 0.82 ± 0.28 | 2.800 | 0.006 |
| Sleep duration | 1.07 ± 0.41 | 0.79 ± 0.31 | 5.261 | <0.001 |
| Sleep efficiency | 1.18 ± 0.42 | 1.07 ± 0.32 | 2.012 | 0.046 |
| Sleep disturbances | 1.14 ± 0.43 | 0.98 ± 0.33 | 2.851 | 0.003 |
| Sleep medication use | 0.75 ± 0.26 | 0.64 ± 0.25 | 2.941 | 0.004 |
| Daytime dysfunction | 1.01 ± 0.32 | 0.88 ± 0.38 | 2.521 | 0.013 |
| Patient Satisfaction (6 weeks) | ||||
| Overall satisfaction (1–10) | 7.93 ± 1.29 | 8.46 ± 0.94 | 3.207 | <0.001 |
| Pain management satisfaction | 7.98 ± 1.25 | 8.35 ± 1.12 | 2.127 | 0.025 |
| Nursing care satisfaction | 7.86 ± 1.24 | 8.39 ± 0.87 | 3.380 | <0.001 |
| Communication satisfaction | 8.01 ± 1.11 | 8.57 ± 1.03 | 3.568 | <0.001 |
| Satisfaction Categories, n (%) | ||||
| Excellent (≥9) | 22 (23.91%) | 63 (67.02%) | 45.890 | <0.001 |
| Good (7–8) | 35 (38.04%) | 28(29.79%) | ||
| Fair (5–6) | 28 (30.43%) | 3 (3.19%) | ||
| Poor (<5) | 7 (7.61%) | 0 (0.00%) | ||
Note: PSQI, Pittsburgh Sleep Quality Index; ϕ, phi coefficient.
Patient Satisfaction
The music-therapy group achieved significantly higher patient satisfaction scores across all assessed domains [Table 3]. Overall satisfaction reached 8.46 ± 0.94 in the music-therapy group versus 7.93 ± 1.29 in the standard-care group (P < 0.001). Satisfaction with pain management, nursing care and communication showed similar patterns of improvement. The proportion of patients rating their experience as ‘excellent’ (score ≥9) was significantly higher in the music-therapy group (P < 0.001).
Clinical Outcomes
Pain and Medication Usage
The music-therapy group demonstrated significantly lower postoperative pain scores and reduced analgesic requirements [Table 4]. At 6 weeks, NRS pain scores at rest reached 2.42 ± 0.53 in the music-therapy group versus 2.62 ± 0.67 in standard care (P = 0.025). Pain during activity showed similar improvement (3.01 ± 0.43 vs. 3.22 ± 0.55, P = 0.004). Total opioid consumption during hospitalisation was significantly lower in the music-therapy group (23.59 ± 11.67 vs. 34.56 ± 13.89 OME, P < 0.001), and it represents a 32% reduction in hospital opioid use. This pattern continued into the first postoperative week, with the music-therapy group requiring significantly less opioid medication (28.98 ± 12.58 vs. 42.51 ± 18.26 OME, P < 0.001).
Table 4.
Clinical outcomes and functional recovery
| Outcome | Standard care group (n = 92) | Music therapy group (n = 94) | Statistic | P |
|---|---|---|---|---|
| Pain Scores (NRS 0–10) | ||||
| Pain at rest (6 weeks) | 2.62 ± 0.67 | 2.42 ± 0.53 | 2.260 | 0.025 |
| Pain with activity (6 weeks) | 3.22 ± 0.55 | 3.01 ± 0.43 | 2.904 | 0.004 |
| Medication Usage | ||||
| Hospital opioid use (OME) | 34.56 ± 13.89 | 23.59 ± 11.67 | 5.837 | <0.001 |
| Week 1 opioid use (OME) | 42.51 ± 18.26 | 28.98 ± 12.58 | 5.895 | <0.001 |
| Healthcare Utilisation | ||||
| Hospital length of stay (days) | 4.12 ± 1.23 | 3.21 ± 0.89 | 5.790 | <0.001 |
| Readmissions (30-day), n (%) | 3 (3.26%) | 1 (1.06%) | 1.067 | 0.246 |
| Functional Outcomes | ||||
| DASH score (2 weeks) | 52.34 ± 18.67 | 43.78 ± 15.23 | 3.430 | <0.001 |
| DASH score (6 weeks) | 38.87 ± 13.78 | 28.01 ± 11.34 | 5.874 | <0.001 |
| Return to activities (days) | 28.45 ± 8.76 | 22.34 ± 6.89 | 5.293 | <0.001 |
Note: DASH, disability of the arm, shoulder and hand; NRS, Numeric Rating Scale; OME, oral morphine equivalents.
Hospital Length of Stay
The music-therapy group had a significantly shorter mean hospital stay compared with the standard care group (3.21 ± 0.89 vs. 4.12 ± 1.23 days, P < 0.001). This outcome represented a 22% reduction in length of stay, with significant healthcare utilisation implications. The 30-day readmission rate showed no significant difference between groups (1.06% vs. 3.26%, P = 0.246).
Functional Outcomes
DASH scores at 6 weeks demonstrated superior functional recovery in the music-therapy group compared with the standard-care group (28.01 ± 11.34 vs. 38.87 ± 13.78, P < 0.001). The 10.22-point difference exceeded the established minimal clinically important difference threshold for DASH scores, which indicates that the observed improvement represents substantial functional benefit. Return to activities occurred significantly earlier in the music-therapy group (22.34 ± 6.89 vs. 28.45 ± 8.76 days, P < 0.001), with an average acceleration of 6 days in functional recovery.
Complications
Postoperative complications were infrequent in both groups, with no significant between-group differences. Minor complications included superficial wound healing issues (three patients in each group) and transient neuropraxia (two patients in standard care, one in the music-therapy group, P = 0.567).
DISCUSSION
This retrospective cohort study demonstrated that music therapy provides crucial benefits for elderly patients undergoing distal radius fracture surgery, encompassing psychological, clinical and functional outcomes. Our findings reveal substantial reductions in perioperative anxiety and depression, improved sleep quality, enhanced patient satisfaction, reduced pain and opioid consumption, shorter hospital stays and superior functional recovery. The magnitude of psychological benefits observed in our study is particularly noteworthy. Previous meta-analyses of surgical populations indicated that music therapy can typically reduce anxiety.[31] Our study showed that incorporating music therapy into the perioperative care for elderly patients with distal radius fractures can effectively alleviate anxiety. This enhanced responsiveness may reflect the specific stressors faced by elderly orthopaedic patients, including fears about functional independence, social isolation and age-related vulnerability.
The relationship between depression and distal radius fracture outcomes has been well-established, with depressed patients showing poorer functional scores and prolonged recovery times. Our study demonstrated that music therapy can effectively address this modifiable risk factor and potentially break the cycle of depression-mediated poor outcomes. The improvement in HADS-D score suggests that music therapy may offer a valuable adjunctive treatment for perioperative depression in elderly surgical patients. While residual anaesthetic effects can potentially influence patient self-reporting in the immediate postoperative period, several factors support the validity of these early findings. Firstly, the divergent trajectories between groups − with the music-therapy group showing improvement, and the standard care group revealing no significant changes − suggest genuine treatment effects rather than a uniform anaesthetic influence. Secondly, the neurobiological mechanisms of music therapy provide plausible explanations for the rapid onset of benefits. Music listening activates endogenous opioid systems and modulates stress hormone release within minutes to hours of exposure.[32] The immediate postoperative period represents a critical window of heightened stress and pain perception, where music therapy’s anxiolytic and analgesic effects may be pronounced. In addition, the preoperative music therapy sessions in our protocol might have established a conditioned relaxation response that persisted into the postoperative period. Nevertheless, future studies incorporating objective physiological markers alongside subjective assessments would help validate these early psychological improvements and better delineate the interplay between anaesthetic recovery and music therapy effects.
Sleep disturbances dominate postoperative patients.[33,34] Our study showed a marked improvement in sleep quality with music therapy, as evidenced by reductions in PSQI scores and improvements across all sleep domains. The neurobiological mechanisms underlying these sleep benefits likely involve music’s effects on the regulation of the autonomic nervous system, stress hormone reduction and promotion of relaxation responses.[35] The pain reduction and decreased opioid consumption observed in our research align with those of previous research on surgery.[36] Music therapy can reduce postoperative pain scores and analgesic requirements, which is particularly important for elderly patients who are at increased risk for opioid-related adverse effects.
Patient satisfaction in orthopaedic surgery refers to a complex construct influenced by multiple factors, including pain management, communication and perceived empathy from healthcare providers. Our study suggests that music therapy enhances satisfaction across all these domains, possibly by demonstrating institutional commitment to comprehensive, patient-centred care. The reduced hospital length of stay observed in the music-therapy group has important healthcare system implications. With increasing emphasis on value-based care and patient-reported outcomes in orthopaedic surgery, treatment methods that simultaneously improve patient experience and reduce costs are notably valuable. The shortened hospital stay likely reflects improved pain control, better sleep quality, reduced anxiety and enhanced patient engagement in recovery activities. The 10.86-point difference in DASH scores exceeds the established minimal clinically important difference (10.83), which suggests meaningful functional benefits.[37] However, the specific mechanisms linking music therapy to improved upper-extremity function require further investigation and potentially involve enhanced pain control, reduced kinesiophobia and improved therapy engagement.[38]
Our study encountered several limitations that warrant discussion. The retrospective design introduced potential selection bias, as group allocation was based on clinical practice patterns rather than randomisation. However, the similarity of baseline characteristics between groups suggests that major confounding was minimised. The single-centre design may limit the generalisability to other healthcare settings with various patient populations or care practices. The inability to blind participants to music therapy represents an inherent limitation that may introduce performance and detection bias. Participants’ awareness of receiving an additional treatment can influence self-reported outcomes through placebo effects or altered expectations. Our reliance on self-report measures, while using validated instruments (HADS, VAS-A and PSQI) specifically validated for elderly surgical populations, represents an inherent methodological limitation. Patient-reported outcomes may be influenced by response bias, social desirability effects and individual interpretation of scale items. The subjective nature of these assessments can potentially amplify or diminish the perceived treatment effects. In addition, the assessment of patient satisfaction used institution-specific measures that may limit comparability with other studies. Future studies should incorporate objective physiological markers, such as heart rate variability, cortisol levels or inflammatory biomarkers, to complement subjective assessments and provide a comprehensive evaluation of treatment effects.
Music therapy, although protocol-driven and delivered by certified music therapists, inherently involves variability in implementation. Individual patient experiences may differ based on the therapist style, quality of patient–therapist rapport and degree of music selection personalisation. This variability in therapeutic delivery can affect treatment method consistency across patients, which potentially influences outcomes. However, this variability also reflects real-world clinical implementation, where strict standardisation may compromise the therapeutic relationship and personalised care that contribute to music therapy’s effectiveness. The requirement for certified music therapists may also limit widespread implementation, although the post-discharge component using portable devices suggests potential for scalable delivery models. Finally, the 6-week follow-up period, although appropriate for acute recovery assessment, failed to capture long-term functional outcomes or the sustainability of psychological benefits. An extended follow-up will be valuable in determining whether the observed benefits persist beyond the immediate recovery period and whether continued music-therapy practice is necessary to maintain improvements. The mechanism of music therapy’s benefits likely involves multiple pathways. Neurobiologically, music listening activates reward circuits in the brain, which results in the stimulation of endogenous opioid release and promotion of dopamine and serotonin production while reducing cortisol levels.[39,40] These effects directly address the pathophysiological changes associated with surgical stress, pain and anxiety. The social interaction component of music therapy sessions may also contribute to benefits through enhanced patient–provider relationships and reduced feelings of isolation. Recent bibliometric analyses have identified music therapy for surgery as an emerging field with growing research interest and clinical applications.[41] Our study contributes to this expanding evidence base by focusing on an understudied population − elderly patients with specific orthopaedic conditions. Future research should prioritise randomised controlled trials with long follow-up periods to assess sustainability of benefits and effect on long-term functional outcomes. Investigation of dose–response relationships, optimal timing of treatment methods and identification of patient characteristics that predict treatment response will enhance clinical implementation. Studies examining cost-effectiveness, including healthcare utilisation, medication costs and productivity outcomes, will provide valuable economic data for healthcare decision-makers.The integration of technology, such as smartphone applications with biometric monitoring, can enhance personalisation and assessment of music therapy. Research on the cultural adaptation of music selections and protocols for diverse populations will improve accessibility and effectiveness. Moreover, investigation of music therapy’s effects on family caregivers and its role in comprehensive geriatric care will expand comprehension of its broader effects.
CONCLUSION
Music therapy significantly improves psychological, clinical and functional outcomes in elderly patients undergoing distal radius fracture surgery, which demonstrates excellent safety and acceptability. These findings support its implementation as an evidence-based adjunctive treatment in geriatric orthopaedic care.
Availability of Data and Materials
The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.
Author Contributions
Qing Pan: Led the research design and execution, managed data collection and analysis, and authored the initial draft of the manuscript.
Wei Wei: Contributed to the research design, supported data analysis, and made initial revisions to the manuscript.
ChengJie Tang (corresponding author): Oversaw the overall research design and supervision, offered technical and theoretical expertise, and conducted the final review and approval of the manuscript.
Ethics Approval and Consent to Participate
This study was approved by the Sichuan Province Orthopedic Hospital, KY2025-048-01. Written informed consent was obtained from all participants.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgment
The authors thank the patients and their family for participating in this research.
Funding Statement
A Study on the Efficacy and Safety of Ultrasound-Guided Selective Cervical Nerve Root Blockade Combined with Auricular Acupuncture for the Treatment of Cervical Radiculopathy, Study Number: 2023MS619.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.
