An investigation into the use of recorded music as a surgical intervention: A systematic, critical review of methodologies used in recent adult controlled trials

Context: While music is being increasingly used as a surgical intervention, the types of music used and the reasons underlying their selection remain inconsistent. Empirical research into the efficacy of such musical interventions is therefore problematic.

Objective: To provide clear guidelines for musical selection and employment in surgical interventions, created through a synthesis of the literature. The aim is to examine how music is implemented in surgical situations, and to provide guidance for the selection and composition of music for future interventions.

Methods: English language quantitative surgical intervention studies from Science Direct, ProQuest, and Sage Journals Online, all published within the last 10 years and featuring recorded music, were systematically reviewed. Variables investigated included: the time the intervention was performed, the intervention length, the outcomes targeted, music description (general and specific), theoretical frameworks underlying the selection of the music, whether or not a musical expert was involved, participant music history, and the participants' feedback on the chosen music.

Results: Several aspects contribute to the lack of scientific rigour regarding music selection in this field, including the lack of a theoretical framework or frameworks, no involvement of musical experts, failure to list the music tracks used, and the use of vague and subjective terms in general music descriptions. Patients are frequently allowed to select music (risking both choosing music that has an adverse effect and making study replication difficult), and patient music history and listening habits are rarely considered. Crucially, five primary theoretical frameworks underlying the effectiveness of music arose in the literature (distraction, relaxation, emotional shift, entrainment, and endogenous analgesia), however music was rarely selected to enhance any of these mechanisms.

Conclusions: Further research needs to be conducted to ensure that music is selected according to a theoretical framework and more rigorous and replicable methodology. Music interventions can be made more effective at improving psychological states and reducing physiological arousal by selecting music conducive to specific mechanisms, and also by considering at what point during the surgical experience the music would be most effective. Greater involvement of music experts in interventions would help to ensure that the most appropriate music was chosen, and that it is clearly and precisely described.