Music-based therapy in rehabilitation of people with multiple sclerosis: a systematic review of clinical trials

Lopes, Josiane; Keppers, Ivo Ilvan

doi:10.1590/0004-282X-ANP-2020-0374

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Arquivos de Neuro-Psiquiatria

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View and Review • Arq. Neuro-Psiquiatr. 79 (6) • June 2021 • https://doi.org/10.1590/0004-282X-ANP-2020-0374 copy

Music-based therapy in rehabilitation of people with multiple sclerosis: a systematic review of clinical trials

Terapia baseada na música na reabilitação de indivíduos com esclerose múltipla: revisão sistemática de ensaios clínicos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Multiple sclerosis (MS) is a major cause of chronic neurological disability in young adults. An increasing number of controlled studies have assessed the potential rehabilitative effects of new drug-free treatments, complementary to the standard care, including music-based therapy (MBT).

Objective:

To analyze the evidence for the effectiveness of MBT within the therapeutic approaches to individuals diagnosed with MS.

Methods:

A systematic review of clinical trials was performed with searches in the following databases: BIOSIS, CINAHL, Cochrane, EBSCO, ERIC, Google Scholar, IBECS, LILACS, LISA (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, SPORTDiscus and Web of Science. Clinical trials comparing MBT versus conventional therapy/no intervention were included.

Results:

From the 282 studies identified, 10 trials were selected. Among these, the total sample consisted of 429 individuals: 253 were allocated to the experimental group (MBT) and 176 to the control group (conventional therapies or no intervention). All the studies presented high methodological quality. Modalities of MBT were clustered into four groups: (1) Rhythmic auditory; (2) Playing musical instruments; (3) Dance strategy; and (4) Neurological music therapy. Overall, the studies consistently showed that MBT was better than conventional therapy or no intervention, with regard to gait parameters (double support time and walking speed), fatigue level, fatigability, coordination, dexterity, balance, walking endurance, lower extremity functional strength, emotional status and pain. Regarding mental fatigability and memory, the data were conflicting and the evidence was unclear.

Conclusion:

MBT is a safe and effective approach for clinical rehabilitation of MS patients that leads to positive results regarding both motor and non-motor functions.

Keywords:
Multiple Sclerosis; Music Therapy; Rehabilitation

Author	Sample	Description	Outcomes
Aldridge et al.³⁷37. Aldridge D, Schmid W, Kaeder M, Schmidt C, Ostermann T. Functionality or aesthetics? A pilot study of music therapy in the treatment of multiple sclerosis patients. Complement Ther Med. 2005 Mar;13(1):25-33. https://doi.org/10.1016/j.ctim.2005.01.004 https://doi.org/10.1016/j.ctim.2005.01.0...	n=20 14 females: 6 males 29‒47 years old Clinical form: PP, SP EDSS: 2.5±1.5 Disease duration: 11 years	EG (n=10): Nordoff-Robbins approach: music-making on instruments or singing. (three blocks of music therapy in single sessions (8–10 per block) over the course of 1 year. CG (n=10): no intervention	Depression, anxiety and quality of life.
Conklyn et al.³¹31. Conklyn D, Stough D, Novak E, Paczak S, Chemali K, Bethoux F. A Home-based walking program using rhythmic auditory stimulation improves gait performance in patients with multiple sclerosis: a pilot study. Neurorehabil Neural Repair. Nov-Dec 2010;24(9):835-42. https://doi.org10.1177/1545968310372139 https://doi.org10.1177/1545968310372139...	n=10 Gender: not mentioned 50.2±5.45 years old Clinical form: PP, SP, RR EDSS: not mentioned Disease duration: 16.6±10.43 years	EG (n=5): rhythmic auditory stimulation (mp3 playing). (20 min per day every day for 4 weeks) CG (n=5): no intervention	Gait performance and improvement of walking speed.
Gatti et al.³⁴34. Gatti R, Tettamanti A, Lambiase S, Rossi P, Comola M. Improving hand functional use in subjects with multiple sclerosis using a musical keyboard: a randomized controlled trial. Physiother Res Int. 2015 Jun;20(2):100-7. https://doi.org/10.1002/pri.1600 https://doi.org/10.1002/pri.1600...	n=19 12 females: 7 males 46±9.6 years old Clinical form: not mentioned EDSS: not mentioned Disease duration: not mentioned	EG (n=9): playing musical keyboard (turned on) (half an hour per day for 2 weeks) CG (n=10): playing music keyboard (turned off) (half an hour per day for 2 weeks)	Hand dexterity.
Geel et al.¹1. Geel FV, Asch PV, Veldkamp R, Feys P. Effects of a 10-week multimodal dance and art intervention program leading to a public performance in persons with multiple sclerosis - A controlled pilot-trial. Mult Scler Relat Disord. 2020 Jun;44:102256. https://doi.org/10.1016/j.msard.2020.102256 https://doi.org/10.1016/j.msard.2020.102...	n=17 16 females: 1 male 29‒65 years old Clinical form: RR EDSS≤4.5 Disease duration: 3‒21 years	EG (n=7): dance (twice a week for ten weeks, 90 min per session) CG (n=10): art activities (poetry, paintings and photography) (twice a week for ten weeks, 90 min per session)	Fatigue and motor and mental fatigability, walking endurance and walking ability speed, balance, lower limb strength and manual dexterity.
Impellizzeri et al.²2. Impellizzeri F, Leonardi S, Latella D, Maggio MG, Cuzzola MF, Russo M, et al. An integrative cognitive rehabilitation using neurologic music therapy in multiple sclerosis. A pilot study. Medicine. 2020 Jan;99(4):e18866. https://doi.org/10.1097/MD.0000000000018866 https://doi.org/10.1097/MD.0000000000018...	n=30 11 females: 19 males 51.33±10.1 years old Clinical form: PP, SP, RR EDSS: 5±1.5 Disease duration: 9‒10 years	EG (n=15): NMT techniques, performed 3 times a week for 8 weeks. All the participants were subjected to the same amount of treatment (3 times a week for 8 weeks plus) CG (n=15): conventional cognitive rehabilitation (6 times a week for 8 weeks)	Cognitive abilities (attention, orientation, spatial abilities, memory and language), quality of life and depression.
Moore et al.³⁶36. Moore KS, Peterson DA, O'Shea G, Mclntosh GC, Thaut MH. The Effectiveness of music as a mnemonic device on recognition memory for people with multiple sclerosis. J Music Ther. 2008 Fall;45(3):307-29. https://doi.org/10.1093/jmt/45.3.307 https://doi.org/10.1093/jmt/45.3.307...	n=38 30 females: 8 males 53.33±10.07 years old Clinical form: not mentioned EDSS: 4.88±1.26 Disease duration: not mentioned	EG (n=20): Music as mnemonic device using an adapted version of Rey's Auditory-Verbal Learning Test (AVLT) (immediate and after 15 min) CG (n=18): Hearing as mnemonic device using an adapted computer program using spoken words (immediate and after 20 min)	Learning and short memory.
Seebacher et al.³³33. Seebacher B, Kuisma R, Glynn A, Berger T. Effects and mechanisms of differently cued and non-cued motor imagery in people with multiple sclerosis: A randomised controlled trial. Mult Scler. 2019. Oct;25(12):1593-604. https://doi.org/10.1177/1352458518795332 https://doi.org/10.1177/1352458518795332...	n=101 85 females: 16 males 44.1±12 years old Clinical form: not mentioned EDSS: 2.0±1.5 Disease duration: not mentioned	EG (n=34): rhythmic cued motor imagery. (17 min of motor imagery, six times per week, for 4 weeks, with music) EG (n=34): metronome-cued motor imagery (17 min of motor imagery, six times per week, for 4 weeks, with metronome) CG (n=33): conventional physiotherapy (six times per week, for 4 weeks).	Walking speed, walking perception, fatigue and quality of life.
Seebacher et al.³²32. Seebacher B, Kuisma R, Glynn A, Berger T. The effect of rhythmic-cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosis: A randomised controlled trial. Mult Scler. 2017 Feb;23(2):286-96. https://doi.org/10.1177/1352458516644058 https://doi.org/10.1177/1352458516644058...	n=59 46 females: 13 males 44.4±15.4 years old Clinical form: not mentioned EDSS: 2.5±2.0 Disease duration: not mentioned	EG (n=19): music-cued and verbally cued motor imagery (six times per week, for 4 weeks) EG (n=20): music-cued MI (six times per week, for 4 weeks) CG (n =20): motor imagery (six times per week, for 4 weeks)	Fatigue and walking speed.
Thaut et al.¹⁸18. Thaut MH. The discovery of human auditory-motor entrainment and its role in the development of neurologic music therapy. Prog Brain Res. 2015;217:253-66. https://doi.org/10.1016/bs.pbr.2014.11.030 https://doi.org/10.1016/bs.pbr.2014.11.0...	n=54 38 females: 16 males 53.3±9.3 years old Clinical form: RR EDSS: 4.9±1.3 Disease duration: not mentioned	EG (n=27): music-assisted learning: single list of 15 words associated with melody of an originally composed song (sung). (single session of 10 trials, 20 minutes). CG (n=27): music-assisted learning: single list of 15 words associated with melody of an originally composed song (spoken). (single session of 10 trials, 20 minutes).	Verbal learning and short term memory improvements.
Young et al.³⁵35. Young H-J, Mehta TS, Herman C, Wang F, Rimmer JH. The effects of M2M and adapted yoga on physical and psychosocial outcomes in people with multiple sclerosis. Arch Phys Med Rehabil. 2019 Mar;100(3):391-400. https://doi.org/10.1016/j.apmr.2018.06.032 https://doi.org/10.1016/j.apmr.2018.06.0...	n=81 42 females: 11 males 49.67±10.33 years old Clinical form: not mentioned EDSS: not mentioned Disease duration: not mentioned	EG (n=27): movement to music (multiple movement routines accompanied with music). (three 60-min per week for 12 weeks) EG (n=26): Yoga fit (three 60-min per week for 12 weeks) CG (n=28): no intervention	Mobility, balance, walking endurance, strength, fatigue and pain.

Reference	Item											Score
Reference	Eligibility^* * Item not scored.	1-Randomized Allocation	2-Allocation Concealment	3-Similar prognosis	4-Blinding of participants	5-Blinding of therapists	6-Blinding of examiners	7-Outcome measurement	8-Intention to treat	9-Inter-group comparisons	10-Variability and precision	Score
Aldridge et al.³⁷37. Aldridge D, Schmid W, Kaeder M, Schmidt C, Ostermann T. Functionality or aesthetics? A pilot study of music therapy in the treatment of multiple sclerosis patients. Complement Ther Med. 2005 Mar;13(1):25-33. https://doi.org/10.1016/j.ctim.2005.01.004 https://doi.org/10.1016/j.ctim.2005.01.0...	0	1	1	1	0	0	0	1	1	1	1	7/10
Conklyn et al.³¹31. Conklyn D, Stough D, Novak E, Paczak S, Chemali K, Bethoux F. A Home-based walking program using rhythmic auditory stimulation improves gait performance in patients with multiple sclerosis: a pilot study. Neurorehabil Neural Repair. Nov-Dec 2010;24(9):835-42. https://doi.org10.1177/1545968310372139 https://doi.org10.1177/1545968310372139...	1	1	1	1	0	0	0	1	0	1	1	6/10
Gatti et al.³⁴34. Gatti R, Tettamanti A, Lambiase S, Rossi P, Comola M. Improving hand functional use in subjects with multiple sclerosis using a musical keyboard: a randomized controlled trial. Physiother Res Int. 2015 Jun;20(2):100-7. https://doi.org/10.1002/pri.1600 https://doi.org/10.1002/pri.1600...	1	1	1	1	0	0	0	1	1	1	1	7/10
Geel et al.¹1. Geel FV, Asch PV, Veldkamp R, Feys P. Effects of a 10-week multimodal dance and art intervention program leading to a public performance in persons with multiple sclerosis - A controlled pilot-trial. Mult Scler Relat Disord. 2020 Jun;44:102256. https://doi.org/10.1016/j.msard.2020.102256 https://doi.org/10.1016/j.msard.2020.102...	1	1	1	1	0	0	0	1	1	1	1	7/10
Impellizzeri et al.²2. Impellizzeri F, Leonardi S, Latella D, Maggio MG, Cuzzola MF, Russo M, et al. An integrative cognitive rehabilitation using neurologic music therapy in multiple sclerosis. A pilot study. Medicine. 2020 Jan;99(4):e18866. https://doi.org/10.1097/MD.0000000000018866 https://doi.org/10.1097/MD.0000000000018...	1	1	1	1	0	0	1	1	1	1	1	8/10
Moore et al.³⁶36. Moore KS, Peterson DA, O'Shea G, Mclntosh GC, Thaut MH. The Effectiveness of music as a mnemonic device on recognition memory for people with multiple sclerosis. J Music Ther. 2008 Fall;45(3):307-29. https://doi.org/10.1093/jmt/45.3.307 https://doi.org/10.1093/jmt/45.3.307...	1	1	1	1	0	0	0	1	0	1	1	6/10
Seebacher et al.³³33. Seebacher B, Kuisma R, Glynn A, Berger T. Effects and mechanisms of differently cued and non-cued motor imagery in people with multiple sclerosis: A randomised controlled trial. Mult Scler. 2019. Oct;25(12):1593-604. https://doi.org/10.1177/1352458518795332 https://doi.org/10.1177/1352458518795332...	1	1	1	1	0	0	0	1	1	1	1	7/10
Seebacher et al.³²32. Seebacher B, Kuisma R, Glynn A, Berger T. The effect of rhythmic-cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosis: A randomised controlled trial. Mult Scler. 2017 Feb;23(2):286-96. https://doi.org/10.1177/1352458516644058 https://doi.org/10.1177/1352458516644058...	1	1	1	1	0	0	0	1	1	1	1	7/10
Thaut et al.¹⁸18. Thaut MH. The discovery of human auditory-motor entrainment and its role in the development of neurologic music therapy. Prog Brain Res. 2015;217:253-66. https://doi.org/10.1016/bs.pbr.2014.11.030 https://doi.org/10.1016/bs.pbr.2014.11.0...	1	1	0	1	0	0	1	1	0	1	1	6/10
Young et al.³⁵35. Young H-J, Mehta TS, Herman C, Wang F, Rimmer JH. The effects of M2M and adapted yoga on physical and psychosocial outcomes in people with multiple sclerosis. Arch Phys Med Rehabil. 2019 Mar;100(3):391-400. https://doi.org/10.1016/j.apmr.2018.06.032 https://doi.org/10.1016/j.apmr.2018.06.0...	1	1	1	1	0	0	1	1	1	1	1	8/10

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[1] Correspondence: Josiane Lopes; E-mail: jolopes@unicentro.br.