The Research Of Music Intervention-based Pain Management Stratedy During Functional Exercises For Burn Patients

Pain is a basic feeling,which has a great significance for human beings.It has been generally accepted as one of the five vital signs for human beings.However,pain has brought tremendous suffering and economic loss.Pain management has become one of the important issues for global public health.With the development of society,the limitation of the pain management model,which is dominated by drug analgesia,is becoming more and more prominent.Completed pain management is not only the key factor of ensuring patient compliance and optimizing medical means,but also the fundamental purpose of improving the quality of medical service.Exploration and research on new models to promote the development of pain management is required.Fire burns is a kind of special pains especially in functional exercises.Mismanagement of fire burns will lead to a series of physiological and psychological issues,thus impacting treatment effects.Drug analgesia is the main way for the treatment of fire burns,but it has limitations in the functional exercises for burned patients due to its sedative and other side effects.Currently as a non-drug analgesic method,music intervention has been widely and successfully used in many kinds of pain management.However,the use of music intervention in the management of fire burns is still very limited as the effect of pain management is still not clear.Therefore,it is of great practical significance to explore pain management strategies for applying music intervention in the functional exercises of burned patients.This article will systematically study the pain management strategy of applying music intervention in the functional exercises of extremities for burned patients.Research Purpose:1.To evaluate the current situation of the application of music intervention in burn treatment in the existing research;2.To explore the foundation and condition of music intervention-based pain management stratedy during functional exercises for burn patients;3.To construct the core index system and content of music intervention-based pain management stratedy during functional exercises for burn patients;4.To evaluate the effect of music intervention-based pain management stratedy during functional exercises for burn patients;5.To explore the ways of promoting the music intervention-based pain management stratedy during functional exercises for burn patients in medical service;Research Methods:1.Literature research on the application of music intervention in burn treatmentThe systematic evaluation and Meta analysis of the application effect of music intervention in burn area.All randomized controlled trials on the application of music intervention in burn treatment were searched through the databases of MEDLINE(by PubMed),EMBASE、Psychinfo,Cochrane Library,CNK,VIP,etc.,and the time limit was from database foundation to February 2016.The screening,data extraction and quality assessment of literature were performed independently by two researchers according to inclusion and exclusion criteria.Heterogeneity tests were conducted using Q-test and I2,and outcome indexes were combined into standardized mean difference(SMD)and 95%CI.Publication bias was analyzed by Begg’s test and Egger’s test.Meta analysis was conducted by STATA 11.0.The current situation of the application of music intervention in burn treatment and its effect were discussed through the system evaluation and Meta analysis of included literature.2.Formative research on music intervention-based pain management stratedy during functional exercises for burn patientsThe acceptance of doctors and patients for adjuvant analgesia through music therapy in burn treatment was investigated using mixed methods as well as both qualitative and quantitive research methods.The acceptance of patients was surveyed by a modified “acceptance questionnaire for assistant analgesia through music therapy of burn patients”.The influence of gender,income,educational level,marital status,place of residence,type of medical insurance,course of disease,burn area and burn degree on the acceptance of music therapy was explored by single factor analysis method.If the data followed the normal distribution,variance analysis or t-test was used;if not,Mann-WhitueyU rank sum test was adopted.The multivariate analysis of covariance was used in multiple-factor analysis to analyze the influence of multiple factors on the acceptance of music therapy.After data reduction,statistical analysis was performed with SPSS21.0.Eight key medical workers in the burn department were interviewed using the method of “purposive sampling”,and qualitative research data were analyzed using internationally recognized framework analysis method,so as to understand medical workers’ acceptance situation of music therapy and its influencing factors,and provide guidance for further clarifying the foundation and condition of the clinic application of music intervention in burn treatment.3.Strategy research on music intervention-based pain management stratedy during functional exercises for burn patientsBased on the literature research,the evidence related to music intervention was extracted.The items extracted from the literature and related to music analgesia were screened by the method of brainstorming,and they were classified and summarized in accordance with seven items,thus forming a draft of intervention strategy and also formulating an expert questionnaire.A research group was established by twelve experts in the fields of burn,music therapy,psychology,health service management,pain,rehabilitation,etc.The important values,such as mean value,standard deviation,variable coefficient,expert enthusiasm coefficient,expert judgment criterion coefficient(Ca),and expert degree of familiarity(Cs)were evaluated using the Delphi method to determine the importance of each item in the draft of music intervention strategy.Statistical analysis was carried out with SPSS21.0,and the indexes were modified,added,or deleted according to experts’ evaluation,comment and suggestion,thus establishing the core index system and intervention strategy for music intervention on pain suffered by burn patients during functional training.4.Effects on music intervention-based pain management stratedy during functional exercises for burn patientsThe effect of music intervention strategy on pain suffered by burn patients was observed using a prospective,randomized and controlled design.The patients with joint dysfunction caused by hyperplastic scar after burn on the joints of the four limbs and with the degree of limited joint mobility ≤ 90% normal joint mobility were chosen as research objects,and they were randomly divided into three groups: music therapy group(MT),background music group(BM),and usual care group(UC).They received an intervention program with the duration of 30 days,10 times in total,3 days per time,and 30 minutes per time.The effect and safety of pain intervention of music therapy combined with routine functional training in the elongation of patients’ joints of the four limbs were evaluated through measuring their pain,anxiety,vital sign,joint mobility,pain degree,satisfaction of pain control and taking routine functional training as controls.During the statistical analysis of data,the comparison among groups was done with χ2-test or Fisher’s exact test when necessary.If differences between groups were significant,chi-square test was used to compare them in pairs.If the data followed the normal distribution,variance analysis was used;if not,nonparametric rank sum test was adopted.The covariate analysis of variance was used to analyze the influence of single factor.If differences between groups were significant,SNK-q test was used to compare them in pairs.Mixed linear model was adopted to analyze the data of the repeated measures,and possible influencing factors were corrected.All the statistical calculations were handled with SAS9.4,and all the tests were supposed to be a two-sided test.Research Results1.Music intervention had a remarkable analgesic effect in the process of burn debridement,dressing change,etc.,but had an unclear effect in pain relief during functional training17 articles were included in the system evaluation and Meta analysis,which contained 804 burn patients.The results showed that there was a significant difference in pain relief between the music intervention group and the non-music intervention group(SMD =-1.26,95% CI [-1.83,-0.68]),indicating that music intervention played a positive role in pain relief of burn patients.The results also showed that music intervention had an evident effect in easing patients’ anxiety compared with the non-music intervention group(SMD =-1.22,95% CI [-1.75,-0.69]).Accordingly,the heart rate in the music intervention group was obviously lower than in the non-music intervention group(SMD =-0.60,95% CI [-0.84,-0.36]).The research found that music intervention was positively correlated with pain relief,reduction of anxiety,and decrease of heart rate for burn patients.However,the study of music in pain intervention in the included literature mainly focused on the therapeutic process of debridement,dressing change,cold therapy and hospitalization.Only one article did not be included in Meta analysis due to its lack of sufficient data,and the Meta analysis indicated that music had an unclear intervention effect in pain relief of burn patients during functional training.So,lots of high-quality studies were required to further clarify the effect of music intervention on pain suffered by burn patients during functional training.2.Both doctors and patients had a high acceptance of music therapy used for assistant analgesia,thus there were foundation and condition for carrying out music therapyBurn patients were mainly young people(average age 33.26)with mild and moderate burn(accounting for 69.4%).The average score of the most severe pain degree in the past 24 hours was 6.67±2.01,and the average score of mean pain degree was 4.27±1.8,indicating that the real effect of pain control for these burn patients was not very good,and there were large demands for adjuvant analgesia,so it was necessary to strengthen pain management.There were 76.3% patients expressing their willingness to receive music therapy,55.8% patients preferring to listen /sing music,and 49.81% patients preferring music instruments.Furthermore,the results of single factor analysis showed that patients’ gender,income,educational level,marital status,place of residence,type of medical insurance,course of disease,burn area and burn degree did not have an influence on the acceptance of music therapy,and meanwhile multifactor analysis of variance suggested that there was no statistical significance in the influencing results of multiple factors on the acceptance of music therapy,indicating that these burn patients possessed the foundation and condition for carrying out music therapy.The investigation of medical workers on the acceptance of music therapy discovered that they had a very high acceptance of music therapy and considered that music therapy enriched the approaches of clinic therapy,and was very helpful to adjuvant analgesia,but they knew little about the clinical effect of music therapy,indicating that the publicity and promotion of music therapy were not sufficient in clinic because of lacking abundant,high-quality,persuasive clinical evidence and standardized implementation plans for music therapy.3.The core index system and intervention strategy with four steps were established for music intervention-based pain management stratedy during functional exercises for burn patientsThrough reviewing the literature and combining preliminary results of the formative research,the items related to music analgesia in the literature were screened,and they were classified and summarized in accordance with relevant definition,evaluation tool,music intervention technology,intervention process,music type,and music selection.Also,the level of evidence and the strength of recommendation were determined.The experts in the strategy research group were from 6 different fields,including 7 females and 5 males,and they were 2 with primary titles,4 with intermediate titles,4 with deputy senior titles,and 2 with senior titles.Then,21 indexes were retained through 2-round expert consultation,and statistical analysis was conducted to the important value of these indexes,with the average value of 4.51,which was bigger than 4.14 in the first round,and the average variable coefficient of 0.147,which was smaller than 0.198 in the first round.The 2-round expert enthusiasm coefficients were both greater than 90%,and the overall average expert authority score was 0.776,indicating that the experts had a high concern level and cooperation degree,with high authority and good consistency,so their advisory opinions were creditable.Finally,through adopting expert opinions and discussion results,the strategy with four steps,that is,music evaluation,making plans,field implementation and effect evaluation,was established for music intervention on pain suffered by burn patients during functional training.4.The music intervention strategy used in the functional training of burn patients had an obvious relief effect on pain and anxiety during the elongation of their joints of the four limbsThe effect of music intervention on pain during the elongation of joints was evaluated through taking 51 patients(73 affected limbs were measured)from the burn department of a teaching hospital in southwest China as research objects.The results showed that the average pain scores during the process of total treatment in MT group,BM group,and UC group were 2.57,3.37,and 3.69,respectively.The average pain score in MT group was lower than in UC group,and the difference was statistically significant.The repeated measures analysis showed that treatment time also had an influence on pain score,which would be low with the increase of treatment time(p<0.0001).The average anxiety scores during the process of total treatment in MT group,BM group,and UC group were 1.09,1.46,and 2.06,respectively.The average anxiety score in MT group was significantly lower than in UC group,and it remarkably decreased with the increase of treatment time(p<0.0001).In addition,the research results suggested that the application of music therapy in the treatment process of burn patients had an obvious improving effect on their respiratory rate and blood pressure(diastolic pressure).However,there was no statistical significance on the improvement of heart rate,blood pressure(systolic pressure)and oxyhemoglobin saturation by music therapy,and it also had an unclear improving effect on joint mobility,compliance and satisfaction of pain control.Therefore,more research was still needed.Conclusion: Pain has become a public health issue with great impact on social development,and pain management has become a priority in medical service.The complexity of fire burns management urges the exploration of a new model in non-drug pain management.This article will narrow on applying music intervention in the functional exercises of extremities for burned patients to study pain management due to complexity of fire burns and unclear effect of music intervention in pain management.Literatures show that music intervention mainly relieves patents’ pain in the process of debridement and wound dressing,while it is still unclear if being applied in functional exercises of burned patients.The existing treatment of drug analgesia is not sufficient to meet the burned patients’ request,and the analgesic effect is not so optimistic.Assisting analgesia by music intervention has been widely recognized by burned patients and medical staffs,furthermore,the basis and conditions are now available for burned patients to apply music intervention.The use of music intervention in pain management is highly accepted and authorized by strategic experts,and is further proved through clinical trials that it has obviously relieved the pain and anxiety of burned patients when they are doing functional exercise of the extremities.However,the clinical application of music intervention is very limited due to lack of understandings among patients and doctors.It is necessary to enhance publicity and education about music therapy,to further explore the effect of applying music intervention in pain management with large amount of sample studies,and to establish a standardized mode of intervention to promote its clinical applications in the future.To summarize,this article puts forward following recommendations:(1)To enhance publicity and promotion among medical staffs of music intervention application in pain management;(2)To emphasis the psychlogical effect of music intervention in pain management among burned patients;(3)To follow the standards of evidence-based medicine to promote the standardized development of music intervention in pain management;(4)To set up a multidisciplinary,professional clinical team to apply music intervention in pain management;(5)To vigorously promote the application of music intervention in pain management in some other fields;(6)To seize the opportunity in medical education stage to popularize relative knowledge of music intervention in pain managementInnovation of this study include:(1)Explored new model of pain management with music intervention application in the functional exercises of burned patients;(2)Provide music intervention-based pain management stratedy,protocol and techniques for burn patients during functional exercises;(3)Apply music intervention and physical therapy combined techniques to pain management for burn patients,to explore multi-disciplinary based pain management mode.