Music During Paediatric Outpatient Wound Dressing Changes: Impact on Anxiety, Pain and Patient Satisfaction
Condition: Wound Heal
MeSH terms: Wounds and Injuries
Study type: Interventional

Summary: 
      Background: Wound dressing changes can be painful and distressing for children and the
      consequences of poorly managed pain and anxiety can be lifelong. Multiple sessions are
      usually required, and recurrent painful episodes can trigger significant anxiety and
      behavioural changes with subsequent escalation on re-exposure. Music has been shown to
      improve relaxation and reduce autonomic activity in paediatric oncology outpatients and have
      significant positive effect on postoperative pain, anxiety and distress.

      Aims: The investigators propose using music listening as a complement to alleviate anxiety,
      reduce pain and improve the experience of surgical outpatients undergoing wound dressing
      changes. Investigators will also evaluate the impact on physiological parameters, such as
      heart rate and blood pressure.

      Hypothesis: That pain and anxiety are significantly reduced and patient satisfaction is
      significantly improved when wound dressings are accompanied by music intervention.

      Methodology: A prospective crossover randomised controlled trial recruiting 88 surgical
      outpatients aged 9 years and above undergoing multiple wound dressing changes. Patients will
      be randomised to receive music intervention either during the first or subsequent dressing
      change, with the alternate dressing change not accompanied by music. Patient selected music
      will be chosen with the input of a trained music therapist. Participants will complete post
      session self-assessment questionnaires on pain, anxiety and satisfaction. Physiological
      parameters will be measured pre and post session.

      Importance: If proven feasible and effective, this intervention may improve patient
      experience by reducing pain and anxiety associated with outpatient wound dressing changes,
      improve patient satisfaction by taking advantage of the relaxing and calming effects of music
      listening, and improve clinical efficiency by using a cost-effective method for alleviating
      pain and anxiety

      Risks/benefits: There is minimal risk as usual standard treatment protocols for wound
      management continues. Patients may benefit from the soothing effects of music.
    

Detailed description: 
      Music intervention - The music intervention used in the study will be a patient selected list
      of songs or other music delivered to the participant by passive listening via in-ear or
      on-ear headphones. They will be given the choice of using their own personal headphones or
      use a pair provided by the hospital. If choosing to use a hospital device, the earphones
      provided will be disposable to minimise infection risk from re-use.

      Patient preferred music has shown to be more effective than preselected, or prescriptive
      music. Prescriptive music, if not of the patient's preference, could cause further
      discomfort, distress or anxiety. Therefore, investigators will use streaming services to
      provide a bank of music containing a wide range of music and genres to suit the majority of
      music preferences. Music will also be curated based on feedback from age-appropriate sources
      to identify common and popular music in the target participant age group.

      Participants will work with the music therapist to make their selections. Music therapists
      will provide input on how best to synchronise type, tempo and genre of music to the wound
      dressing procedure. As musical preference is very personal, the choice of music provided will
      try to strike a balance of providing what is acceptable to patients while not exposing them
      to music with known stimulatory effects.

      Patients will be given the opportunity to look to music therapists for support in choosing or
      creating a playlist to accompany their procedure.Through a brief questionnaire the music
      therapists will gather pertinent information such as favourite styles, experience playing
      instruments, favourite artists/songs as well as the challenges related to their first
      experience. The music therapist will help to identify possible song choices/playlists for
      various parts of the procedure that may decrease their perception of pain by refocusing their
      attention.

      Randomisation - This will be a randomised crossover study. Patients will be randomised into 2
      groups:

      Group 1: One dressing change or procedure after recruitment will be accompanied by music
      intervention. Subsequent dressing change or procedure will NOT be accompanied by music
      intervention.

      Group 2: One dressing change or procedure after recruitment will NOT be accompanied by music
      intervention. Subsequent dressing change or procedure will be accompanied by music
      intervention.

      With this crossover design, all recruited participants will have the opportunity to
      experience the music intervention.
    

Intervention name(s): Music intervention
Intervention type(s): Other
Intervention description(s): Participants will work with the music therapist to make their selections. Music therapists will provide input on how best to synchronise type, tempo and genre of music to the wound dressing procedure. As musical preference is very personal, the choice of music provided will try to strike a balance of providing what is acceptable to patients while not exposing them to music with known stimulatory effects.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Wound dressing