A framework for the assessment and management of post-traumatic symptomatology in the aftermath of critical illness through music and sound interventions
Creators:  Pant, Usha
Publisher: name: University of Alberta Library
Year: 2022

<p>Background: Post-intensive care syndrome (PICS) is a major long-term complication of critical illness for both patients and their families, causing significant loss of function and worsening quality of life. Therefore, early detection and treatment of PICS morbidities is required to minimize long-term sequelae, reduce the rate of re-hospitalization, and optimize functional recovery. To date, there is no unified approach to either assessment or management of PICS. Moreover, despite the effectiveness of music interventions for the improvement of outcomes in the ICU, no such interventions have been tested for PICS.<br>
Aim: This thesis aims to delineate a framework for the assessment and management of post-traumatic symptomatology after critical illness through music and sound interventions. Specific objectives included to a) Summarize neurobiological evidence on the pathophysiology of PTSD and the areas of the brain involved, as well as some of the effects of music on PTSD and ICU survivors to highlight potential mechanisms and effects of music on individuals suffering from post-ICU PTSD. b) Identify existing tools for screening of PTSD and PICS in ICU survivors and their families, and to examine evidence on the validity, reliability, and feasibility of existing tools, as reflected in published peer-reviewed studies.<br>
Methods: The first phase employed a critical narrative review to elucidate an evidence-based neurobiological framework to inform the study of music interventions for PTSD post-ICU. This review was directed by methodological recommendations by Ferrari and the Scale for the Assessment of Narrative Review Articles guided reporting. The second phase employed scoping review methodology to synthesize evidence on tools assessing PTSD and PICS in ICU survivors and their families. The review was directed by a protocol based on current guidance for scoping reviews and reporting was guided by Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.<br>
Results: Key structures in PTSD symptomatology include: the prefrontal cortex, the amygdalae, and the hippocampus. A dysfunctional HPA axis feedback loop, an increased amygdalic response, hippocampal atrophy, and a hypoactive prefrontal cortex contribute to PTSD symptoms. Playing or listening to music can stimulate neurogenesis and neuroplasticity, enhance brain recovery, and normalize stress response. Additionally, evidence supports effectiveness of music to improve coping and emotional regulation, decrease dissociation symptoms, reduce depression and anxiety levels, and overall reduce severity of PTSD symptoms. However, no studies on music interventions post-ICU were identified. The scoping review revealed a) a limited number of tools addressing all 3 domains of PICS, b) unclear validity of the tools in the post-ICU population, especially for the recommended time-frame of assessment at 2-4 weeks post-discharge, c) limitations with some tools’ feasibility in the post-ICU population, d) low diagnostic accuracy of cognitive assessment tools, e) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools, and g) only two tools addressing PICS in families of ICU survivors.<br><br>
Conclusion and Implications: Overall, this thesis highlights important considerations for future research in the development of assessment tools for PICS, as well as music as a potential approach to manage post-traumatic symptomatology in ICU survivors.</p>