Music therapy : an intervention effecting quality of life and health in children going through hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation (HSCT) is an established treatment for several types of leukemic, hematopoietic, and metabolic diseases. The child is isolated during 4-6 weeks, followed by extensive follow-up for 3-6 months. The huge psychological and physiological burden of HSCT requires careful supportive intervention. Music therapy can be applied in paediatric healthcare to help the child through difficult experiences and increase overall feelings of wellbeing. The aim of this thesis is to evaluate the experiences of music therapy in children undergoing HSCT. Music therapy intervention included both expressive and receptive methods. Choice was in focus, where the child could choose to play different musical instruments, sing and/or listen to music along with the music therapist with an option of parent and/or sibling participation.

Study 1 and 2, included a randomized clinical trial (RCT) of 38 children (age range 2 months to 17 years) randomized in two groups. The music therapy group received music therapy twice a week during inpatient treatment, whereas the control group received music therapy post-discharge. Study 1 included 24 patients, whose physiological parameters including blood pressure, heart rates and saturation were recorded morning and evening at intervention, twice a week for both music and control groups. The evening heart rate decreased significantly in the music therapy group compared to the control group (p < 0.001), potentially indicating prevention of post-traumatic stress disorder (PTSD). Study 2 analysed 29 patients, where we compared health related quality of life (HRQoL) using the validated questionnaires PedsQL 4.0 generic core scales and PedsQL 3.0 cancer module. Questionnaires were issued at admission, discharge and 6 months follow up. In the music therapy group, an improvement of physical function was observed at time of discharge (adjusted p = 0.04). The control group showed improved results in all domains of PedsQL 4.0 generic core scales after music therapy was initiated at 6 months follow up (p = 0.015).

Study 3 included six children and their parents, who had previously participated in the RCT. The aim was to explore the experiences of the interactive processes of children and parent during music therapy intervention. The data sampling method was a collaborative research method. An independent psychologist conducted the interviews with the children, parents and music therapist and performed the analysis. Three themes emerged; experiences of competency and recognition of self, interactive affect regulation as change potential, and importance of the therapeutic relationship. Study 4 was a qualitative focus group study, which included 7 members of the medical team. An independent psychologist facilitated the interviews, with analysis performed by the thesis author and an independent researcher. Emerging themes included the importance of music therapy, expressed both physically and mentally by the children and a sense of satisfaction in both child and family. Parents could choose either actively or non-actively participation, thus, providing the possibility of a rest period. The staff were an integral part of the treatment and music therapy addressed the children in an unsecure and isolated situation.

Conclusion: The lowered heart rate values 4-8 hours after music therapy in the intervention group as well as higher HRQoL estimations described by both groups suggests that music therapy can be a complementary, effective intervention during and after HSCT. Along with the support and dedication of the medical team, music therapy was found to be an important factor in managing the treatment period at the hospital. Our results suggest that music therapy should become an integrated part of the supportive care children undergoing HSCT.

List of scientific papers

I. Music therapy can lower the heart rates of severely sick children. Uggla L, Bonde LO, Svahn BM, Remberger M, Wrangsjö B, Gustafsson B. ACTA Paediatrica. 2016 Oct; 1225-30.
https://doi.org/10.1111/apa.13452

II. Music therapy supported the health-related quality of life for children undergoing haematopoietic stem cell transplants. Uggla L, Bonde LO, Hammar U, Wrangsjö B, Gustafsson B. ACTA Paediatrica. 2018 Nov; 1986-1994.
https://doi.org/10.1111/apa.14515

III. An Explorative Study of Qualities in Interactive Processes with Children and Their Parents in Music Therapy during and after Pediatric Hematopoietic Stem Cell Transplantation. Uggla L, Mårtenson Blom K, Bonde LO, Gustafsson B, Wrangsjö B. Medicines (Basel). 2019 Feb; 6(1):28
https://doi.org/10.3390/medicines6010028

IV. Staff experiences from music therapy intervention for children undergoing hematopoietic stem cell transplantation. Uggla L, Wrangsjö B, Bonde LO, Gustafsson B, Adolfsson A. [Manuscript]