Letter to the Editor “Perioperative Music Therapy Enhances Pain Management and Sleep Quality in Patients Aged 50–70 Years Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial”[Letter]

Dear editor

We would like to express our appreciation to the authors, Yang Lin et al, for their meaningful contribution in evaluating the effect of music therapy as an adjunct to analgesia which is often unrecognized in the perioperative care in TKA patients.¹ We read with interest the randomized controlled trial, this study explores simple and low risk intervention of music therapy which could meaningfully enhance the subjective experience of pain management. The authors are to be commended for addressing an important non‑pharmacological adjunct to postoperative pain management and for standardizing anesthesia and PCA protocols in a vulnerable surgical population. However, there are some points that need to be discussed in addition to those the authors have previously noted.

First, the recruitment period and registration in design section states that the study ran from January 2023 to January 2024, whereas the Results describe inclusion of 86 patients “from June to December 2019”. This inconsistency makes it unclear when the recruitment actually occurred. The CONSORT guidelines clearly recommends reporting of recruitment dates and prospective registration to make sure transparency and reduce selective reporting.²

The authors mentioned the trial as single blinded study but did not specify who was blinded, nor how blinding was implemented and maintained. Given that the primary outcomes are subjective, patient‑reported measures (VAS pain, NVAS, PSQI components, and satisfaction), this incomplete description of blinding prevents readers from adequately judging the risk of performance and detection bias.³

In the Sample Size Calculation section, the authors’ reported using a two-sample t-test with S=0.9 and an expected between-group difference δ=0.47, yielding 39 participants per group, inflated to 43 for a 10% dropout rate. But clarification regarding which specific primary outcome these parameters were based on (eg, PCA presses at a defined time point, VAS, or a PSQI component) is not mentioned, the empirical source of S and δ (pilot data) and how δ=0.47 was determined represents a clinically meaningful or realistic effect size? such information would align with current guidance on specifying the target difference for randomized trials and help the readers in interpreting the satisfactory and clinical relevance of the sample size calculation.⁴

The authors mentioned that patients were “randomly assigned using a random number table” but did not describe any allocation concealment method, leaving the risk of selection bias unclear and falling short of CONSORT recommendations to report both sequence generation and allocation concealment.⁵

Last, sleep on the first postoperative night is assessed using elements of the Pittsburgh Sleep Quality Index (PSQI), and the authors interpret higher sleep duration and sleep efficiency scores and lower sleep disorders scores as better sleep. However, PSQI was originally developed and validated to assess sleep quality over a one-month time interval and is usually used as a global score rather than for a single night. Hence, any additional justification of this adaptation, or any validation performed for this acute perioperative context, would strengthen confidence in the sleep findings.⁶

We hope these comments are received in the intended constructive manner. Clarification of these issues would, in our view will further enhance the methodological transparency and clinical interpretation of this novel work done by the authors and provide helpful guidance for future trials of music therapy and other non‑pharmacological adjuncts in perioperative pain management.

Funding Statement

No funding to report for this study.

Disclosure

The authors report no conflicts of interest in this communication.