A role for music in cataract surgery: a systematic review

Methodological quality of the review: Low confidence

Author: Dahshan D, Kuzbel J, Verma V.

Region: Korea, India and UK

Sector: Service delivery

Subsector: Quality of clinical care

Equity focus: Not stated

Review type: Other review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable

Background:
A large number of patients experience anxiety prior to undergoing surgical procedures. Preoperative and intraoperative approaches have been employed to substantially reduce patient anxiety, including with and without the use of pharmacologics. Because patients are awake and aware of their surroundings during cataract surgery, it is imperative to identify factors to alleviate discomfort and prevent patient movement.

Objectives:
Examine the effect of music on patients undergoing cataract surgery without pharmacological anxiolytics.

Main findings:
Three studies were in the review, involving 523 patients undergoing cataract surgery with music interventions during the procedure. While all studies consisted of randomised controlled trials, one study was unique with a crossover randomised controlled trial. Locations included Korea, India and the UK . The types of music intervention involved included non-specified music, Korean traditional music, binaural beat embedded music, and no music. Risk of bias within included studies was low, as patients were randomly assigned to intervention groups, standardised scale assessments were used for reporting anxiety and pain, and appropriate control groups were included.

Authors noted that one study that assessed pain intensity with the visual analog scale (VAS) in delayed bilateral sequential cataract surgery, with blood pressure and pulse obtained both intraoperatively and postoperatively, reported that patients in the Korean traditional music interventional group had significant reduction of pain reported by VAS score compared to the control group (P=0.013), but there was no significant difference in blood pressure or pulse between the groups.

The second study included in the review collected measurements of vitals and a Likert scale anxiety rating at preoperative, perioperative and postoperative time points, found that blood pressure is significantly lower in patients with music intervention postoperatively compared to control group.

Based on the data of the third included study, authors noted a significant reduction of STAI state scores for anxiety in music intervention and binaural beat intervention compared to the control group (P<0.001), significant reduction in systolic blood pressure in the music intervention (P=0.043) and binaural beat intervention (P=0.040) compared to the control, and a significant reduction in heart rate seen in the binaural beat intervention compared to the control (P=0.004).

Authors conclude that the clinical implications of this review identify non-traditional approaches to reducing anxiety intraoperatively for cataract surgeries, offering clinicians alternatives to minimising benzodiazepine and medication use risks.

• Methodology:

Systematic literature search of three databases, Cochrane Library, PubMed, and Google Scholar, were performed by the authors. Inclusion criteria outlined randomised controlled trials involving patients undergoing cataract surgery with music as an intervention during the procedure, with outcomes measured using at least one assessment of anxiety level, pain score, satisfaction or vital sign measurements.

Studies older than 20 years, published before 2000, or using anxiolytics or additional pain-relieving medications besides local anesthetic, were excluded. Standard methodology for systematic reviews was implemented, and articles were independently screened and evaluated by two review authors. Risk of bias was assessed for the individual included studies based on study methodology, method of randomisation and controls, as well as adequate sample size.

Authors did not perform a meta-analysis because of variability in study design and variables of interest. Statistical data included in this review are from reported individual studies included in this review.

Applicability/external validity:
Authors did not discuss the generalisability of findings, but mention that a small number of studies (three studies from three different countries) were included which were heterogenous in terms of comparison, methods and setting.

Geographic focus:
The review included studies conducted from Koera, India and in the UK, however, authors did not discuss the applicability of findings to low and middle income countries.

Summary of quality assessment:
Low confidence was attributed to this study, as important limitations were identified. The authors did not specify the search period, nor do they make clear the method by which risk of bias was determined, or to which studies. There was additionally no independent data extraction or avoidance of language or publication bias in their search.