Music for Health Outcomes: How to Compose and Select Music for Perioperative Surgical Interventions

Abstract

This study is an investigation into how to compose and select music for health outcomes in a perioperative setting. Evidence shows that music can positively affect the physiology of a patient, resulting in faster healing and increasing patient comfort. Music interventions frequently attempt to adjust a patient’s heart rate, respiration rate, blood pressure, endocrine system, emotional state, and experience of pain. However, currently there are no clear guidelines on selecting or composing music for this context. This dissertation directly responds to this current gap in knowledge and literature, by drawing on insights from a mixed method study that addressed the topic through three key phases: (1) a systematic literature review; (2) a practice-led compositional investigation based on insights from Phase 1; and (3) an experimental testing of compositions from Phase 2. A systematic, critical literature review was conducted in Phase 1 of the project to investigate the reasoning and methods behind the selection and implementation of music in surgical interventions. This review examined English-language quantitative surgical intervention studies published within the last ten years, which utilised recorded music as an intervention. The results of this study revealed that there were considerable inconsistencies and lack of scientific rigour regarding music selection in this field. The ‘sophistication of the music selection’ and the ‘sophistication of the method’ was calculated for each of the studies reviewed. Scores averaged 3.33/11 and 3.23/13 respectively, and indicated that study sophistication has not improved over the past ten years. The reasons behind this lack of sophistication were numerous. Interventions frequently did not involve music experts, rarely considered participants’ music history and listening habits, and often relied on vague and subjective music descriptions. Although five primary theoretical frameworks underlying the effectiveness of music were identified in the literature (distraction, relaxation, emotional shift, entrainment, and endogenous analgesia), music was rarely selected to enhance any of these frameworks. As such, this dissertation concludes that further research is needed to ensure that music is selected for interventions according to rigorous, replicable, and scientific methodologies. Additionally, greater involvement of music experts would help to ensure that interventionists choose the most appropriate music, and describe it clearly and precisely. In Phase 2, the five theoretical frameworks identified in the systematic literature review were developed into distinct methods of composing or selecting music targeting specific health interventions. In order to provide insight into the writing process of health-related music for composers considering working in this field, several aspects of the development and trialling of these methods were investigated, first through a practice-led autoethnographic reflection of the process of writing a trial composition, and subsequently through the preliminary testing of the method guidelines by undergraduate composers. The findings of these investigations indicated that although some questions arose regarding which of the method instructions needed prioritising, the guidelines overall were feasible, with composers completing the compositions within a tight time frame. A sound understanding of the theoretical concepts underlying the methods strongly aided the compositional process. There were fears that certain factors would make writing music according to these methods unappealing. Such factors included the need to comply with the extensive list of strict instructions; the perceived inability to be creative and employ one’s compositional voice; and the fostered desires for musical complexity. Despite this, the project was received positively, with composers exhibiting a willingness to take on such work in the future. The feedback received from composers was incorporated into the revision of the five methods. Finally, in Phase Three of the project the effectiveness of two of the compositions created during the composer involvement study (designed to evoke either physiological entrainment or emotional shift) were tested in an experimental setting. First, a pilot study tested the effect of the music on heart rate, respiration, blood pressure, anxiety and mood. Second, a full-scale study then tested all the above with the addition of pain perception measures in a repeated measures design. Within the pilot study, it was shown that contrary to the popular belief that ‘all music is good music’, extremely unpredictable music increased state anxiety, especially in participants who resided in an urban area. Within the main study, several significant results occurred. While the entrainment method was hypothesised to cause physiological rhythms to entrain with the music and then lower as a result of a gradual reduction in tempo, it was the shorter, more noticeable tempo shifts in the music that had the most significant effect. This study demonstrated the importance of considering the participants’ music listening habits – physiological rhythms were more likely to increase as a result of listening to music in participants who exhibited a high emotional sensitivity to music, while relative entrainment to music was more likely in participants who did not typically express their identity to music. Additionally, it appeared that certain elements could override others, with tempo appearing to override intended emotional shifts. Overall, this dissertation demonstrates that writing music specifically for surgical interventions is a feasible endeavour for informed composers. Furthermore, it validates the hypothesis that specific musical devices can cause a significant effect on physiological and emotional measures, and indicates that future research – involving close collaboration between music experts and health experts – would improve the quality, effectiveness, and replicability of music-based surgical interventions.