Effect of Classical Music on Physiological Characteristics and Observational and Behavioral Measures of Pain in Unconscious Patients Admitted to Intensive Care Units

I 1. Department of Nursing, University of Social Welfare and Rehabilitation Science, Tehran, Iran. 2. Department of Nursing, Faculty of Nursing and Midwifery, Islamic Azad University, Tehran Medical Branch, Tehran, Iran. 3. Department of Nursing, Faculty of Nursing, Islamic Azad University, Khorram Abad Branch, Khorram Abad, Iran. Abolfazl Rahgoi1 , Shahla Mohammadzadeh Zarankesh2 , *Sedeigheh Sadat Kasaeizadeghan2 , Mehran Naghibeiranvand3 Citation: Rahgoi A, Mohammadzadeh Zarankesh Sh, Kasaeizadeghan SS, Naghibeiranvand M. [Effect of Classical Music on Physiological Characteristics and Observational and Behavioral Measures of Pain in Unconscious Patients Admitted to Intensive Care Units (Persian)]. Complementary Medicine Journal. 2021; 10(4):368-379. https://doi.org/10.32598/cmja.10.4.1016.1 : https://doi.org/10.32598/cmja.10.4.1016.1 Use your device to scan and read the article online


Introduction
ntensive Care Units (ICUs) are among the specialized wards of the hospital, which with its special-ized personnel and professional equipment is a suitable place for the care and treatment of critically ill patients with lifethreatening diseases. Evaluation and management of pain in patients who are under artificial respiration due to changes in the consciousness level following sedation, head trauma, or physiological status and are hospitalized in ICUs is dif-ficult and delayed, and it is less considered by physicians and nurses. Music therapy is a special type of psychotherapy that uses music for communication along with verbal communication. According to the World Federation of Music Therapy (WFMT), "Music therapy is the professional use of music and its elements as an intervention in medical, educational, and everyday environments with individuals, groups, families, or communities who seek to optimize their quality of life and improve their physical, social, communicative, emotional, intellectual, and spiritual health and wellbeing. Research, practice, education, and clinical training in music therapy are based on professional standards according to cultural, social, and political contexts". The current study aims to evaluate the effect of classical music on physiological characteristics, and observational and behavioral measures of pain in unconscious patients admitted to ICUs.

Materials and Methods
This is a quasi-experimental study with pretest/posttest design using a control group that was conducted in 2019 on 30 unconscious patients admitted to ICU of Shohadaye Haft-e-Tir Hospital in Tehran, Iran, who were selected using a convenience sampling method and based on the inclusion criteria. They were divided into two groups using a random number table. In addition to receiving routine care, the intervention group received classical music including the relaxing classical symphonies of Beethoven ("For Elise" for 2.56 min and "Violin Sonata" for 6.29 min), Mozart's works ("Symphony No. 21" for 6.29 min and "Adagio in E major" for 6.45 min), Bach's works for 7.36 min and Symphony No. 248 for 5.38 min (total duration= 33 min), for 3 consecutive days and, then, the average score of 3 days was recorded. Pain was assessed immediately after playing the music. The songs were played to the patients in the intervention group using MP3Player and via headphones. To prevent transmission of the infection after each use, the headphones were disinfected or their pads were replaced. No music was played for the control group and only routine nursing and medical care was provided to them. Data collection tools were a demographic/physiological form, Critical Care Pain Observation Tool (COPT) and Behavioral Pain Scale (BPC).

Results
The Mean±SD age of patients in the intervention and control groups was 40.33±14.01 and 46±15.70 years, respectively. Comparison of their physiological characteristics before and after intervention showed that there was no statistically significant difference except in the Glasgow Coma Scale score ( Table 1). Comparison of the mean scores of COPT and BPC showed a statistically significant difference in the intervention group before and after music therapy (P<0.05) ( Table 2).

Conclusion
This study showed that classical music reduces the observational and behavioral scale of pain in unconscious patients admitted to the ICU; therefore, it is recommended that nurses provide the conditions for classical music to be used as a low-cost and easy method for these patients. It is suggested that additional studies with a larger sample size using classical and preferential music be performed on unconscious patients admitted to different ICUs to examine the effect of music on physiological parameters more accurately. Nursing officials are also advised to consider this issue in the in-service training of nurses and educational planning for nursing students.

Compliance with ethical guidelines
This study obtained its ethical approval from Islamic Azad University, Tehran Medical Branch (Code: IR.IAU.TMU.REC.1398.146). All ethical principles were observed in this study.

Funding
This study was extracted from the MA. thesis of first author at the Department of Nursing, University of Social Welfare and Rehabilitation Science, Tehran.

Conflicts of interest
The authors declareed no conflict of interest.