Associate Professor, Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
SYNOPSIS: Listening to music may lower preoperative anxiety in patients undergoing pelvic reconstructive surgery.
SOURCE: Chen YB, Barnes H, Westbay L, et al. Preoperative music listening in pelvic reconstructive surgery: A randomized trial. Female Pelvic Med Reconstr Surg 2021;27:469-473.
The main objective of this study was to determine the effect of music listening compared to usual care on preoperative anxiety scores in patients undergoing pelvic reconstructive surgery. This was a randomized controlled trial of women undergoing pelvic reconstructive surgery over one year at one academic center. Subjects included women 18 years of age or older scheduled for surgery within the Division of Female Pelvic Medicine and Reconstructive Surgery and who were enrolled on the day of surgery. Women scheduled with other surgical departments were excluded, as were women with hearing impairments or women who were unable to complete study questionnaires. The primary study outcome was the change in preoperative anxiety state score as measured by the State-Trait Anxiety Inventory Form Y1 (STAI-Y1). The STAI-Y1 is a self-reported measure of the patient’s current state of anxiety and consists of 20 four-point Likert items. Scores range from 20 to 80, with higher scores signifying higher symptoms of anxiety. The STAI-Y1 was administered at baseline before surgery. Subjects then were assigned randomly to music listening vs. usual care. Both groups repeated the STAI-Y1 prior to proceeding to surgery. The music listening intervention consisted of having the ability to listen to music of choice, consisting of preloaded tracks of multiple music genres, via noise-canceling headphones and an MP3 player for 30 minutes prior to surgery. Subjects were able to listen for however long they wanted within the 30 minutes and were instructed to stop when necessary to speak with providers.
The secondary outcome included six-week postoperative patient satisfaction as measured by a global patient satisfaction question with a five-point scale. The authors enrolled 70 subjects. Sixty-nine were randomized, 35 to the usual care group and 34 to the music intervention group. Fifty-four percent of subjects had pelvic prolapse as an indication for surgery. Other indications included stress incontinence (39%), urge incontinence (7%), fistula (4%), and other (19%). Baseline STAI-Y1 scores were similar between the music and usual care groups. After 30 minutes, the decrease in STAI-Y1 scores was greater in the music group (-6.69; standard deviation [SD], 6.98) than for participants assigned to the control group (-1.32; SD, 8.03; P = 0.01). Postoperative satisfaction at six weeks was higher in the music group than in the usual care group. Additionally, no associations were found between changes in STAI-Y1 scores and pelvic floor symptoms at baseline.
Women with pelvic floor disorders experience a variety of emotional and mood states, including depression and anxiety. A recent Cochrane review reports that women with incontinence are more likely to have symptoms of depression and anxiety. Pham et al described women’s anxiety at the time of initial pelvic floor evaluation.1,2 Ai et al reported a 19% prevalence of anxiety in women with stage 2 prolapse or greater.3 Collins et al found that 35% of women tested prior to surgery for pelvic organ prolapse had scores consistent with anxiety state.4 Often, patients preparing for surgery experience anxiety associated with the uncertainty of surgery and its outcomes. Elevated anxiety can result in psychological effects as well as physiological effects, including increased heart rate and blood pressure. These, in turn, can have effects on immune response and wound healing. Typically, patients may receive anxiolytics or sedatives in the preoperative period to help decrease anxiety symptoms, but these can be associated with side effects. There has been increasing interest in identifying nonpharmacologic interventions to reduce preoperative anxiety symptoms. Research on the effects of music and music therapy for patients has been an area of significant growth over the last two decades.5 Music medicine (music administered by medical healthcare professionals) and music therapy (music administered by trained music therapists) both have been shown to aid patient anxiety in the preoperative period.5 Chen and colleagues sought to determine the effect of music listening (music medicine) on preoperative anxiety scores and found that the ability to listen to music in the 30 minutes prior to surgery decreased anxiety scores. This is one of the first studies of music medicine in women with pelvic floor disorders, and its results are similar to other studies of preoperative anxiety. Additional studies are needed to determine the short- and long-term effects of music interventions on women undergoing major vs. minor surgical pelvic reconstructive procedures. However, in the meantime, asking women at preoperative appointments about pre-procedural anxiety, checking in on the morning of surgery, and offering the opportunity to listen to music prior to surgery may improve our patients’ wellbeing, outcomes, and satisfaction.
- Pham TT, Chen YB, Adams W, et al. Characterizing anxiety at the first encounter in women presenting to the clinic: The CAFÉ study. Am J Obstet Gynecol 2019;221:509.e1-509.e7.
- Cheng S, Lin D, Hu T, et al. Association of urinary incontinence and depression or anxiety: A meta-analysis. J Int Med Res 2020;48:300060520931348.
- Ai F, Deng M, Mao M, et al. Screening for general anxiety disorders in postmenopausal women with symptomatic pelvic organ prolapse. Climacteric 2018;21:35-39.
- Collins AF, Doyle PJ, Duecy EE, et al. Do anxiety traits predict subjective short-term outcomes following prolapse repair surgery? Int Urogynecol J 2019;30:417-421.
- Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. Cochrane Database Syst Rev 2013; Jun 6:CD006908.