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

Lopes, Josiane; Keppers, Ivo Ilvan

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

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

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

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Introdução:

A esclerose múltipla (EM) é a maior causa de incapacidade neurológica crônica em adultos jovens. Um crescente número de estudos controlados avalia a reabilitação por meio de tratamentos não medicamentosos, cuidados complementares incluindo a terapia baseada na música (TBM).

Objetivo:

Analisar a evidência de efetividade da TBM na abordagem terapêutica de indivíduos diagnosticados com EM.

Métodos:

Foi realizada uma revisão sistemática de ensaios clínicos com busca nas bases de dados Biosis, Cinahl, Cochrane, Ebsco, Eric, Google Scholar, Ibecs, Lilacs, Lisa (ProQuest), Medline, PEDro, PsycINFO (APA), Psychological & Behavioral, PubMed, SciELO, Scopus, Sportdiscus e Web of Science. Foram incluídos ensaios clínicos comparando TBM versus terapia convencional/sem intervenção.

Resultados:

Dentre os 282 estudos identificados, 10 ensaios foram selecionados. Desses, a amostra total consistia em 429 indivíduos (253 alocados no grupo experimental (TBM) e 176 no grupo controle (terapias convencionais ou sem intervenção). Todos os estudos apresentaram elevada qualidade metodológica. Modalidades da TBM foram reunidas em quatro grupos: (1) Audição rítmica; (2) Tocar instrumentos musicais; (3) Dança como estratégia; e (4) Terapia neurofuncional baseada na música. A maioria dos estudos identificou que a TBM é melhor que a terapia convencional ou nenhuma intervenção nos parâmetros da marcha (duplo apoio e velocidade), níveis de fadiga, fatigabilidade, coordenação, destreza, equilíbrio, força de membros inferiores, estado emocional e dor. Os dados sobre fatigabilidade mental e memória foram conflitantes e as evidências são incertas.

Conclusão:

A TBM é uma abordagem segura na reabilitação clínica de indivíduos com EM e propicia resultados positivos nas funções motoras e não motoras.

Palavras-chave:
Esclerose Múltipla; Musicoterapia; Reabilitação

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.