Music therapy for anxiety reduction in non-acute surgical fracture patients: A systematic review and meta-analysis

Table 1 Basic information of the included studies

Ref.	Method	Objects (mean ± SD)	Gender-specific counts by group (male/female)	Fracture mechanism	Intervention measures	Patient reported outcomes
Ortega et al[18], 2019	Randomized controlled, non-blinded	There were 17 cases in the experimental group, with an average age of 30.5 years old and an average disease course of 10.7 days; there were 19 cases in the control group, with an average age of 30.5 years old and an average disease course of 10.7 days	Experimental group (10/7); control group (12/7)	Displaced nasal bone fracture	Listening - based music therapy; the experimental group: Exposure time was 10 minutes before the intervention, during the intervention, and 10 minutes after the intervention.by the same over-the-ear Bluetooth headphones and set the music intensity themselves; the control group: Routine clinical treatment	1,2
Hu[19], 2022	Randomized controlled, non-blinded	There were 52 cases in the experimental group, with an age of 71.96 ± 8.62 years old; there were 53 cases in the control group, with an age of 71.92 ± 9.12 years old	Experimental group (18/34); control group (21/32)	Elderly patients with hip fractures	Traditional five - tones therapy; the experimental group: On the basis of the control group, when the Yu-mode music corresponding to the kidney was played, the ambient light was adjusted to green light (illuminance 15 lux); the control group: Select yang-mode pieces in the Yu mode, which corresponds to the kidney, and in the Jue mode, which corresponds to the liver. Edit them into a single 30-minute track, beginning with 15 minutes of Yu-mode music followed by 15 minutes of Jue-mode music, and save the file in lossless APE format on the playback device. Patients receive one session every day between 18:00 and 20:00, each lasting 30 minutes, 5 consecutive days per week. One treatment cycle is 2 weeks, and the study comprises two cycles	1,3,4
Bai et al[20], 2019	Randomized controlled, non-blinded	There were 50 cases in the experimental group, with an average age of 76.5 ± 5.14 years old; there were 50 cases in the control group, with an average age of 76.5 ± 6.90 years old	Experimental group (28/22); control group (26/24)	Elderly patients with hip fractures	Listening - based music therapy; the experimental group: Based on routine nursing care, implement music therapy as psychological nursing, using soothing melodies and adjusting the volume to 15-35 dB; the control group: Routine nursing intervention	1,3
Xia and Wang[23], 2020	Randomized controlled, non-blinded	There were 100 cases in the experimental group, with an average age of 7.12 ± 2.13 years old; there were 100 cases in the control group, with an average age of 6.65 ± 1.13 years old	Experimental group (57/43); control group (56/44)	Children with fractures	Visual music therapy; the experimental group: Awakening phase: Using a visual music-intervention device, select music and rhythms that match the child’s preferences and let the child listen quietly. Following phase: Shift to active music-therapy interventions. Leading phase: Place the child at the center; nurses increase interactive situational play with the child; the control group: Routine nursing intervention	1
Deng et al[25], 2019	Randomized controlled, non-blinded	There were 50 cases in the experimental group, with an average age of 6.32 ± 1.05 years old; there were 50 cases in the control group, with an average age of 6.12 ± 1.34 years old	Experimental group (25/25); control group (26/24)	Children with elbow fractures	Visual music therapy; the experimental group: Awakening phase: Using a visual music-intervention device, select music and rhythms that match the child’s preferences and let the child listen quietly. Following phase: Shift to active music-therapy interventions. Leading phase: Place the child at the center; nurses increase interactive situational play with the child; the control group: Routine nursing intervention	1
Li et al[21], 2020	Randomized controlled, non-blinded	There were 47 cases in the experimental group, with an average age of 8.40 ± 0.68 years old and an average course of disease of 6.99 ± 0.49 hours; there were 46 cases in the control group, with an average age of 8.43 ± 0.71 years old and an average disease course of 7.02 ± 0.51 hours	Experimental group (29/18); control group (27/19)	Children with elbow fractures	Visual music therapy; the experimental group: Awakening phase: A visual music-intervention device is used to select music and rhythms preferred by the child, who listens quietly; 15-30 minutes per session, 2 sessions daily. Following phase: Active music-therapy interventions dominate; 30 minutes per session, 1 session daily. Leading phase: The child is the focus; nurses engage in situational role-play with the child; 15-20 minutes per session, 1 session daily. Continuous intervention for 30 days; the control group: Routine nursing intervention. Continuous intervention for 30 days	1,2
Li and Xiao[24], 2021	Randomized controlled, non-blinded	There were 60 cases in the experimental group, with an average age of 35.63 ± 3.48 years old; there were 60 cases in the control group, with an average age of 35.14 ± 3.41 years old	Experimental group (37/23); control group (36/24)	Bone trauma and fracture	Listening - based music therapy; the experimental group: Psychological nursing combined with music therapy. Fifteen gentle, relaxing pieces were selected from each patient’s preferred background music to guide the therapy; the control group: Routine psychological nursing intervention	1,2,3,4
Huang and Fang[22], 2023	Randomized controlled, non-blinded	There were 100 cases in the experimental group, with an average age of 62.32 ± 9.45 years old; there were 100 cases in the control group, with an average age of 63.75 ± 9.72 years old	Experimental group (54/46); control group (53/47)	Patients with hypertension and limb fractures	Listening - based music therapy; the experimental group: Start listening relaxing music 20 minutes before surgery; the patient listens through headphones at 40-60 dB with the tracks on loop; the control group: Routine psychological nursing intervention	1,2
Ge et al[26], 2014	Randomized controlled, non-blinded	There were 45 cases in the experimental group, there were 45 cases in the control group. Ages ranged from 18 to 65 years old, with no statistically significant difference between groups	Not reported	Patients with lower limb fractures	Listening - based music therapy; the experimental group: Music intervention was administered separately after the morning meal, after the noon nap, and before bedtime at night; each session lasted 20-30 minutes and was delivered via headphones; the control group: Routine clinical treatment	1,3
Liu et al[27], 2012	Randomized controlled, non-blinded	There were 20 cases in the experimental group, there were 20 cases in the control group. The average age is 33 years old, with no statistically significant difference between groups	All participants (24/16)	Patients with orbital wall fractures	Listening - based music therapy; the experimental group: Each music-therapy session lasted approximately 40 minutes and was conducted on the day of admission, one day before the intervention, and one day after the intervention. Participants wore headphones, and the volume was kept below 70 dB; the control group: Routine clinical treatment	1,2
Li and Yang[28], 2018	Randomized controlled, non-blinded	There were 57 cases in the experimental group, with an average age of 62.9 ± 4.5 years old and an average course of disease of 4.7 ± 2.3 hours; there were 56 cases in the control group, with an average age of 62.4 ± 4.1 years old and an average course of disease of 4.3 ± 2.5 hours	Experimental group (28/29); control group (28/28)	Traumatic pelvic fracture	Listening - based music therapy; the experimental group: Post-breakfast each morning, patients were escorted by clinical staff to the music-oxygen lounge for a single 30-minute session; the control group: Conventional rehabilitation therapy	1,2,3
Lei et al[29], 2022	Randomized controlled, non-blinded	There were 30 cases in the experimental group, with an average age of 69.26 ± 5.35 years old; there were 30 cases in the control group, with an average age of 70.22 ± 5.68 years old	Experimental group (16/14); control group (15/15)	Patients with hip fractures	Traditional five - tones therapy; the experimental group: The mean nursing duration was 17.13 ± 0.57 days. On the basis of standard admission care, patients received syndrome-based traditional Chinese medicine treatment with five-element music therapy delivered via headphones at 40-50 dB; each session lasted 20-30 minutes and was administered once in the morning and once at noon; the control group: The mean nursing duration was 16.97 ± 0.62 days, during which routine nursing care was provided	1,2

¹Anxiety: Self-Rating Anxiety Scale; State - Trait Anxiety Inventory; Hamilton’s Anxiety Scale; Screen for Child Anxiety Related Emotional Disorders.

²Pain: Including the Visual Analogue Scale.

³Depression: Self-rating Depression Scale.

⁴Sleep: Pittsburgh Sleep Quality Index.

Table 2 Analysis of the efficacy of music therapy on anxiety

Intervention measures	The number of included studies	Sample size		Heterogeneity test			Meta-analysis results
		Intervention group	Control group	I2 (%)	P value	Effect model	SMD (95%CI)	P value
Musical therapy	12	628	629	93.00	< 0.001	Random	-2.09 (-2.63 to -1.55)	< 0.001
Listening - based music therapy	7	349	350	92.60	< 0.001	Random	-2.38 (-2.58 to -2.18)	< 0.001
Visual music therapy	3	197	196	79.30	0.008	Random	-1.95 (-2.19 to -1.71)	< 0.001
Traditional five - tones therapy	2	82	83	94.50	< 0.001	Random	-1.01 (-1.34 to -0.67)	< 0.001

SMD: Standardized mean difference; CI: Confidence interval.

Table 3 Analysis of the efficacy of music therapy on pain and depression

Intervention Measures	The number of included studies	Sample size		Heterogeneity test			Meta-analysis results
		Intervention group	Control group	I2 (%)	P value	Effect model	SMD (95%CI)	P value
Pain	7	331	331	97.10	< 0.001	Random	-2.22 (-3.39 to -1.05)	< 0.001
Depression	5	264	264	96.60	< 0.001	Random	-2.05 (-3.75 to -1.25)	< 0.001

SMD: Standardized mean difference; CI: Confidence interval.

Table 4 Meta-analysis bias test

Std_Eff	Coefficient	SE	t	P value > |t|	95%CI
Slope	-0.9803055	1.137004	-0.86	0.409	-3.51370 to 1.553098
Bias	-4.20985	4.588638	-0.92	0.381	-14.43397 to 6.014273

CI: Confidence interval.