The Effect of Music Therapy in COVID-19 Patients Given Prone Position
Condition: Music Therapy; Anxiety; Respiratory Distress Syndrome; Intensive Care Units; Nursing
MeSH terms: COVID-19; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn
Study type: Interventional

Summary: 
      Almost half of the patients diagnosed with COVID-19 pneumonia develop ARDS and most of these
      patients are treated in the intensive care unit. In the management of COVID-19 ARDS, prone
      position is applied to improve physiological parameters by facilitating better distribution
      of tidal volume and drainage of secretions. It has been reported that awake patients in COVID
      clinics could not adapt their prone position due to anxiety . Jiang et al (2020) reported
      that awake patients may not tolerate the prone position and may experience anxiety due to
      posture habits and discomfort.

      It was determined that anxiety developed on the second day of hospitalization in the
      intensive care unit, state anxiety was associated with trait anxiety and pain, and anxiety
      was low in patients receiving mental health care/treatment . And also not to change position
      himself of patient in prone position due to care equipment etc it can cause loss of
      self-control and anxiety. Twelve-sixteen hour prone position recommendation for clinical
      improvement, positioning difficulties in patients who cannot position themselves may also
      trigger anxiety in awake patients It has been suggested that music therapy may be effective
      in reducing anxiety related to weaning from mechanical ventilation in COVID-19 patients.
      Music therapy intervention in ICU has been tested in sessions of at least 30 minutes, 1-30
      days, with options such as western music, classical Chinese music, nature-based music. In the
      study of Chu and Zhang (2021), it was shown that the recovery time for tomography findings,
      the number of days of hospital stay and the rates of transfer to the intensive care unit were
      lower in the patient group who received holistic mode including traditional Chinese medicine,
      music therapy, and emotional support in COVID-19 patients. Studies evaluating the
      effectiveness of music therapy alone in the COVID-19 intensive care process could not be
      reached. It is thought that music therapy applied in the prone position in the COVID-19
      intensive care unit will reduce the anxiety of the patients, adapt to the prone position and
      improve their clinical parameters.
    

Detailed description: 
      The Corona virus disease 2019 Pandemic (COVID-19) has caused a psychosocial depression in the
      world. Acute severe or critical condition has been observed in 20% of individuals diagnosed
      with COVID-19. It is stated that viral pneumonia or Acute Respiratory Distress Syndrome
      (ARDS) and organ failures develop in these individuals. Almost half of the patients diagnosed
      with COVID-19 pneumonia develop ARDS and most of these patients are treated in the intensive
      care unit. In the management of COVID-19 ARDS, prone position is applied to improve
      physiological parameters by facilitating better distribution of tidal volume and drainage of
      secretions. It is thought that the prone position will be more effective in the early stages
      of the disease and awake patients. It is recommended that the prone position especially in
      moderate to severe ARDS cases be applied for at least 12 hours after symptoms stabilize.
      Elkattawy and Noori (2020) reported that at least 6-8 hours of prone position improves
      oxygenation in the COVID-19 case without ARDS criteria. Mac Sweeney et al. (2020) reported
      that clinical parameters improved, intubation and ventilator requirement were delayed in an
      awake, self-prone COVID-19 case. However, Somagutta et al (2021) reported anxiety, back pain,
      adjustment and tolerance problems in awake and not mechanically ventilated patients. Bastoni
      et al, in the study which they evaluated prone adapt at emergency department in Italy; it is
      reported positioning could not be maintained in four out of ten patients due to unconformity,
      pain, and rejection of prone position. It has been reported that awake patients in COVID
      clinics could not adapt their prone position due to anxiety. Jiang et al (2020) reported that
      awake patients may not tolerate the prone position and may experience anxiety due to posture
      habits and discomfort.

      It was determined that anxiety developed on the second day of hospitalization in the
      intensive care unit, state anxiety was associated with trait anxiety and pain, and anxiety
      was low in patients receiving mental health care/treatment. And also not to change position
      himself of patient in prone position due to care equipment etc it can cause loss of
      self-control and anxiety. Twelve-sixteen hour prone position recommendation for clinical
      improvement, positioning difficulties in patients who cannot position themselves may also
      trigger anxiety in awake patients.

      Music therapy is applied as a non-pharmacological nursing intervention in the anxiety
      management of patients in intensive careIt is stated that music therapy is effective in
      stress-anxiety management, improves vital signs and sleep quality, and may have a muscle
      relaxant effect in interventions applied in covid-19. It has been suggested that music
      therapy may be effective in reducing anxiety related to weaning from mechanical ventilation
      in COVID-19 patients. Music therapy intervention in ICU has been tested in sessions of at
      least 30 minutes, 1-30 days, with options such as western music, classical Chinese music,
      nature-based music. It has been reported that music therapy applied with all types of music
      provides normal heart rate, respiratory recovery and muscle relaxation. Golino et al.
      listened to music for 30 minutes according to the preferences of the patients in the
      intensive care unit and their vital signs, pain and anxiety were evaluated. While there was
      an improvement in heart rate and respiration, oxygen saturations did not change. At the same
      time, patients reported less pain and anxiety. In the study of Chu and Zhang (2021), it was
      shown that the recovery time for tomography findings, the number of days of hospital stay and
      the rates of transfer to the intensive care unit were lower in the patient group who received
      holistic mode including traditional Chinese medicine, music therapy, and emotional support in
      COVID-19 patients. Studies evaluating the effectiveness of music therapy alone in the
      COVID-19 intensive care process could not be reached. It is thought that music therapy
      applied in the prone position in the COVID-19 intensive care unit will reduce the anxiety of
      the patients, adapt to the prone position and improve their clinical parameters.

      Objective: The aim of this study is to evaluate the effect of music therapy applied in the
      prone position on anxiety, compliance with the prone position, and vital signs in patients
      diagnosed with COVID-19 in the intensive care unit.
    

Intervention name(s): musıc therapy
Intervention type(s): Other
Intervention description(s): After the prone position was given to the patients, according to the randomization table, the intervention group was given 30 minutes by the nurse. nature-based music therapy will be applied.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A triple-blind randomized controlled clinical trial
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: COVID-19; Prone position