Abstract: Since only one small study (n = 40) was included, no meta-analysis could be performed. The included randomised controlled study was of parallel design and undertaken at two paediatric hospitals in Australia. The study evaluated the effects of a singing program on the quality of life and respiratory muscle strength of hospitalised children with cystic fibrosis (mean age 11.6 years, 35% male). While the singing group received eight individual singing sessions, the control group participated in preferred recreational activities, such as playing computer games or watching movies. This study was limited by a small sample size (51 participants) and a high drop-out rate (21%). There were no differences between the groups at either post-intervention or follow-up; although by the end of treatment there were some improvements in some of the domains of the quality of life questionnaire Cystic Fibrosis Questionnaire-Revised (e.g. emotional, social and vitality domains) for both singing and control groups. For the respiratory muscle strength indices, maximal expiratory pressure at follow-up (six to eight weeks post-intervention) was higher in the singing group, mean difference 25.80 (95% confidence interval 5.94 to 45.66). There was no difference between groups for any of the other respiratory function parameters (maximal inspiratory pressure, spirometry) at either post-intervention or follow-up. No adverse effects were observed in the singing group; adverse events for the control group were not reported in the paper. There is insufficient evidence to determine the effects of singing on quality of life or on the respiratory parameters in people with cystic fibrosis. However, there is growing interest in non-medical treatments for cystic fibrosis and researchers may wish to investigate the impact of this inexpensive therapy on respiratory function and psychosocial well-being further in the future.

Plain-language summary: The review includes one study with 40 children with cystic fibrosis aged between seven and 17 years of age. This study compared a specially designed singing intervention with other non-physical leisure activities (recreation) and children were selected for the singing or the recreation program randomly. The study lasted two weeks and children were followed up for between six and eight weeks. The study assessed the impact of singing on respiratory muscle strength, quality of life and lung function tests. Participants from both the singing and recreation groups reported some improvement in quality of life measurements. Participants in the singing group showed a greater increase in maximal expiratory pressure (a substitute measure of respiratory muscle strength test), while there was no improvement in this outcome for those in the recreation group. No adverse events were reported. There is currently not enough evidence to assess the effect of singing on clinical outcomes in people with cystic fibrosis. Future studies using robust methods are needed to assess the possible effects of singing for people with cystic fibrosis The included study was limited by the small number of participants (only 51 participants enrolled and only 40 were analysed) and a high drop-out rate (21%). We also think the fact that the young people who were enrolled in the study were keen to sing, could have affected the study results.