Music interventions in patients undergoing surgery: A systematic review using strict inclusion criteria

Background: Music interventions in healthcare have been proven effective. However, studies often are of low quality and lack adequate methodology. Our objective was to assess literature concerning the effect of music on pain, anxiety, subjective stress and patient satisfaction using narrowed inclusion criteria and assess their methodology (e.g. sample size calculation and randomization method). Methods: Seven databases were searched from 1980 until the 5th of July, 2024. Narrowed exclusion criteria were used. We included randomized controlled trials (RCT) which assessed recorded music versus standard of care in surgical patients. Bias was assessed using the Cochrane Risk-of-Bias 2 tool (RoB 2.0). Results: Ten studies were included (1114 patients). In six articles, anxiety was significantly reduced through a music intervention. Four articles reported a significant reduction of pain. Stress was assessed by one study, and was significantly lower in the intervention group compared to the control group. Patient satisfaction was assessed in three studies, all reporting higher satisfaction in the intervention group. Methodological quality was low, only three studies reported a sufficient sample size. Overall Risk of Bias was considered high. Conclusion: Music interventions pre-, during or post-surgery were associated with a significant decrease in pain, anxiety and a higher patient satisfaction. Despite our narrowed exclusion criteria, overall risk of bias was considered high in all studies. Reproducibility of sample size calculations was considered poor. Future systematic reviews should more strictly assess control groups procedures, randomization procedures and sample size calculations of RCT's. Future RCT's should sufficiently implement these methods.