Yu Haitong, Foss Angelique, Segall Tracy L, Block Seneca, Risser Kayleigh, Razzak Rab, Zacharias Michael, Teba Catalina V, Rodgers-Melnick Samuel N
Connor Whole Health, University Hospitals of Cleveland, Cleveland, OH, 44106, USA.
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
BMC Complement Med Ther. 2025 Apr 14;25(1):139. doi: 10.1186/s12906-025-04887-x.
Chronic obstructive pulmonary disease (COPD) and heart failure (HF) pose significant challenges to patients and the health systems that care for them. Music therapy has the potential to address these challenges, but its impact on readmission rates and quality of life remains largely underexplored. This study evaluated the feasibility, fidelity, and acceptability of a hybrid music therapy intervention as a precursor to a randomized controlled trial (RCT).
Using a single-arm, mixed-methods approach, inpatients aged 30 - 89 with COPD or HF and access to home videoconferencing technology, a mobile device with a data plan, and a reliable support person were recruited during their hospitalizations. Patients with significant hearing/visual impairments, severe psychological comorbidities, terminal medical conditions, stage IV HF, or end-stage COPD were excluded. The intervention included 2 inpatient in-person sessions and 2 virtual sessions following discharge. Feasibility was assessed by rates of recruitment, retention, session attendance, and measure completion. Fidelity was evaluated by adherence to the session protocol, while acceptability was assessed through semi-structured interviews with randomly selected participants.
Of 113 patients approached, 20 (17.7%) were enrolled, and 85% were retained. Median participant age was 61.5 years, with 80% having HF and participants having high rates of anxiety (50%) and depression (35%). Overall session attendance was 57.5%, with higher rates for in-person (75%) compared to virtual sessions (40%). Adherence to the intervention protocol was > 80% across all monitored sessions. Challenges with the trial included difficulty reaching participants following discharge, frequent virtual session rescheduling, and participants' challenges using technology. Semi-structured interviews supported the acceptability of the intervention with three emerging themes (1) the therapeutic relationship facilitated a positive intervention experience, (2) need for strategies to improve post-discharge engagement in the intervention, and (3) impacts on mental health.
Findings support the feasibility of hybrid music therapy among patients with COPD or HF. However, challenges in post-discharge communication and virtual session attendance were noted. These issues will be addressed in a subsequent feasibility RCT through implementing secure text-based communication in addition to phone communication to reach participants post-discharge, refined eligibility criteria (e.g., excluding patients on dialysis), and in-person technology instruction.
ClinicalTrials.gov NCT06214325. Registered on January 9, 2024.
慢性阻塞性肺疾病（COPD）和心力衰竭（HF）给患者以及照料他们的医疗系统带来了重大挑战。音乐疗法有可能应对这些挑战，但其对再入院率和生活质量的影响在很大程度上仍未得到充分探索。本研究评估了一种混合音乐疗法干预作为随机对照试验（RCT）前奏的可行性、保真度和可接受性。
采用单臂、混合方法，招募年龄在30 - 89岁、患有COPD或HF且可使用家庭视频会议技术、有数据套餐的移动设备以及可靠支持人员的住院患者。排除有严重听力/视力障碍、严重心理合并症、终末期疾病、IV期HF或终末期COPD的患者。干预包括2次住院面对面治疗和出院后的2次虚拟治疗。通过招募率、保留率、治疗参与率和测量完成率评估可行性。通过遵守治疗方案评估保真度，同时通过对随机选择的参与者进行半结构化访谈评估可接受性。
在113名被邀请的患者中，20名（17.7%）被纳入研究，85%的患者被保留。参与者的中位年龄为61.5岁，80%患有HF，参与者焦虑（50%）和抑郁（35%）的发生率较高。总体治疗参与率为57.5%，面对面治疗（75%）的参与率高于虚拟治疗（40%）。在所有监测的治疗中，对干预方案的依从性>80%。该试验面临的挑战包括出院后难以联系到参与者、频繁重新安排虚拟治疗时间以及参与者使用技术方面的困难。半结构化访谈支持了该干预的可接受性，出现了三个新主题：（1）治疗关系促进了积极的干预体验；（2）需要采取策略提高出院后对干预的参与度；（3）对心理健康的影响。
研究结果支持混合音乐疗法在COPD或HF患者中的可行性。然而，注意到出院后沟通和虚拟治疗参与方面存在挑战。在后续的可行性RCT中，将通过实施基于文本的安全沟通以及电话沟通以联系出院后的参与者、完善纳入标准（如排除透析患者）和提供面对面技术指导来解决这些问题。
ClinicalTrials.gov NCT06214325。于2024年1月9日注册。
