Melbourne Conservatorium of Music - Research Publications
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ItemNo Preview AvailableMusic interventions for dementia and depression in elderly care (MIDDEL): The Australian part of an international cluster randomised controlled trial(Wiley, 2021-12-01)BACKGROUND: Dementia and depression are highly prevalent, comorbid conditions in older adults residing in care homes and are associated with individual distress and associated challenges for care staff. Music-based interventions are widely used and potentially effective nonpharmacological interventions, due to the relative preservation of the ability of people with dementia to respond to music even with disease progression. However, there is a lack of large-scale studies evaluating the effectiveness of music-based interventions in dementia care. Music Interventions for Dementia and Depression in the Elderly (MIDDEL) is the first large-scale international cluster-randomised controlled trial to investigate the effectiveness of small group music therapy (GMT), recreational choir singing (RCS) and their combination on levels of depression in residents with dementia. The trial is currently being conducted across six countries, and this presentation will outline the study outcomes from the Australian arm of the trial. METHOD: Between June 2018 and November 2019, 20 care home units were randomised to music interventions (GMT, RCS, GMT and RCS) or standard care delivered over 6 months. The primary outcome was level of depression as measured by the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included neuropsychiatric symptoms, quality of life, care staff burden and adverse events collected at baseline, 3-months, 6-months and 12-months post-randomisation. Outcomes were analysed as intention-to-treat, per-protocol, and with exploratory predictor analyses. RESULTS: 318 participants (215 female; 103 male) aged 65 years or more with diagnoses of dementia and at least mild depressive symptoms (as defined by score of 8 or above on MADRS) residing in care homes were recruited. In addition, 131 care staff (108 female; 23 male) answered questions regarding perceived care burden to search for potential ripple effects of the music interventions. We will present the main findings of the study including the predictive effects of clinical characteristics on efficacy. CONCLUSION: The presentation will include discussion of contextual factors and conditions that support efficacy, and clinical implications for safety and quality of life for people with dementia living in care homes.
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ItemNo Preview AvailableHOMESIDE-A home-based family caregiver-delivered music and reading intervention for people living with dementia: A randomised controlled trial.(Wiley, 2021-12)BACKGROUND: Pharmacological interventions to address behavioural and psychological symptoms of dementia (BPSD) can have undesirable side effects, therefore non-pharmacological approaches to managing symptoms may be preferable. Past studies show that music therapy can reduce BPSD, and other studies have explored how formal caregivers use music in their caring roles. However, no studies have examined the effects on BPSD of music interventions delivered by informal caregivers (CGs) in the home setting. Our project addresses the need for improved informal care by training cohabiting family CGs to implement music interventions that target BPSD, and the quality of life (QoL) and well-being of people with dementia and CGs. METHODS: An international three-arm parallel-group randomised controlled trial has so far randomised 130 of the target 495 dyads from Australia, Germany, UK, Poland and Norway. Dyads are randomised equally to standard care (SC), a home-based music programme plus SC, or a home-based reading programme plus SC for 12 weeks. The primary outcome is BPSD of people with dementia (measured using the Neuropsychiatric Inventory-Questionnaire). Secondary outcomes examine relationship quality between CG and people with dementia, depression, resilience, competence, QoL for CG and QoL for people with dementia. Outcomes are collected at baseline, at the end of the 12-week intervention and at 6 months post randomisation. Resource Utilisation in Dementia captures economic data across the life of the intervention and at 6-month follow-up. Our presentation will briefly outline the study protocol and describe the caregiver training protocol and interventions in detail with video footage illustrating how the intervention looks in practice.
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ItemNo Preview AvailableClinical Effectiveness of Music Interventions for Dementia and Depression in ELderly Care (MIDDEL) in Australia: Pragmatic Cluster-Randomised Controlled Trial( 2021)Background: Dementia and depression are highly prevalent and comorbid conditions among older adults living in care homes, and are associated with individual distress and rising societal costs. Effective, scalable, and feasible interventions are needed. Different music interventions have shown promising effects, but the current evidence-base is inconclusive.
Methods: We implemented a 2x2 factorial cluster-randomised controlled trial to determine whether 1) group music therapy (GMT) is more effective than standard care (SC) or 2) recreational choir singing (RCS) is more effective than SC, for reducing depressive symptoms and other secondary outcomes in people with dementia with mild to severe depressive symptoms living in residential aged care. Care home units with at least 10 residents were allocated to GMT, RCS, both GMT and RCS, or SC, using a computer-generated list with block randomisation (block size four). The protocolised interventions were delivered by music therapists (GMT) and community musicians (RCS). The primary outcome was Montgomery-Åsberg Depression Rating Scale score at 6 months, assessed by a masked assessor and analysed on an intention-to-treat basis using linear mixed-effects models, which examined the effects of GMT vs no-GMT and RCS vs no-RCS, as well as interaction effects of GMT and RCS. Trial registration: NCT03496675; ACTRN12618000156280.
Findings: Between July 18, 2018, and November 26, 2019, 20 care home units were randomised (318 residents). Recruitment ceased in March 2020 due to COVID-19. The primary endpoint, available from 20 care home units (214 residents), suggested beneficial effects of RCS (mean difference: -4·25; 95% CI -7·89 to -0·62) but not GMT (mean difference -0·44; 95% CI -4·32 to 3·43). No related serious adverse events occurred.
Interpretation: Our study supports implementing group singing as a clinically relevant therapeutic intervention in reducing depressive symptoms for people with dementia in the Australian care home context.
Trial Registration: Trial registration: NCT03496675; ACTRN12618000156280.
Funding: National Health and Medical Research Council, Australia.
Declaration of Interest: We declare no competing interests
Ethical Approval: Ethical approval was obtained from the Medicine and Dentistry Human Ethics Sub-Committee at the University of Melbourne, Australia (January 12, 2018, Ethics ID 1750400). -
ItemExploring self-concept, wellbeing and distress in therapeutic songwriting participants following acquired brain injury: A case series analysis(Taylor & Francis, 2020-02-07)Acquired brain injury (ABI) presents a significant threat to sense of self and necessitates a complex process of psychosocial adjustment. Self-concept changes remain understudied in the early stages of inpatient rehabilitation. The aim of the current study was to examine changes in self-concept, distress, wellbeing and functional skills for five inpatients undertaking a music therapy intervention within a subacute rehabilitation centre in Victoria, Australia. Participants completed a six-week, 12-session therapeutic songwriting programme to produce past-, current- and future-self-focused songs. A range of self-concept, subjective wellbeing and distress measures were completed pre-, mid- and post-intervention. A descriptive case series approach was applied to determine trends in pre-post scores for five individual cases. Participants showing the greatest gains across self-concept and subjective wellbeing indices also showed the greatest functional gains on the Functional Independence Measure (FIM) from admission to discharge. The current study highlights the importance of examining early changes in self-concept, wellbeing and distress in subacute rehabilitation, and suggests that individualised songwriting programmes warrant further research attention in neurological populations.
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ItemParkinSong: Outcomes of a 12-Month Controlled Trial of Therapeutic Singing Groups in Parkinson's Disease(IOS Press, 2020-07-28)Background: Parkinson’s disease (PD) frequently causes progressive deterioration in speech, voice and cognitive aspects of communication. These affect wellbeing and quality of life and are associated with caregiver strain and burden. Therapeutic singing groups can ameliorate PD-related communication disorders and increase social interaction and wellbeing for caregivers and care recipients. Objective: To analyse the effects of ParkinSong group singing sessions on Parkinson’s communication and wellbeing outcomes for people with PD and caregivers over 12 months. Methods: A 4-armed controlled clinical trial compared ParkinSong with active non-singing control conditions over 12 months. Two dosage levels (weekly versus monthly) were available for each condition. ParkinSong comprised high-effort vocal, respiratory and speech exercises, group singing, and social interaction. PD-specific outcomes included vocal loudness, speech intelligibility, maximum phonation time, respiratory muscle strength, and voice related quality of life (QoL). Wellbeing outcomes were also measured for caregivers and care recipients. Results: We recruited 75 people with PD and 44 caregivers who attended weekly ParkinSong, monthly ParkinSong, weekly control or monthly control groups. We found significant improvements in the primary outcome of vocal loudness (p = 0.032), with weekly singers 5.13 dB louder (p = 0.044) and monthly singers 5.69 dB louder (p = 0.015) than monthly controls at 12 months. ParkinSong participants also showed greater improvements in voice-related QoL and anxiety. Caregivers who attended ParkinSong showed greater reductions in depression and stress scores. Conclusions: This 12-month controlled clinical trial of ParkinSong demonstrated improvements in speech loudness and voice-related QoL for participants with PD, and enhanced wellbeing for both caregivers and care recipients. No adverse effects were reported over 12 months and improvements were sustained.
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ItemLoneliness and Behavioral Changes During the COVID-19 Pandemic(Oxford University Press (OUP), 2021-12-17)Abstract Concerns for the health impact of loneliness, a risk factor for morbidity and mortality, have risen amid the COVID-19 pandemic. However, relationships between loneliness and behavioral changes remains unclear. Utilizing data from the National Health and Aging Trends Study COVID-19 Supplement, we examine the cross-sectional relationship between loneliness and self-reported increase in each of the following behaviors during the pandemic (n=2,924): walking, vigorous activity, eating, use of alcohol and tobacco, watching television and sleeping. Adjusting for age, race, education, activity of daily living limitations, and chronic conditions, loneliness was significantly associated with a higher odds of more eating (odds ratio- OR: 1.42, confidence intervals-CI: 1.24,1.62), sleeping (OR: 1.35, CI: 1.18,1.56), and watching television (OR: 1.45, CI: 1.30,1.61). These results indicate that during stressful times like our current pandemic, loneliness may lead to morbidity and mortality through sedentary behaviors.
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ItemCREATIVE ARTS INTERVENTIONS IN ADDRESSING DEPRESSION IN OLDER ADULTS: A SYSTEMATIC REVIEW(OXFORD UNIV PRESS, 2021)Abstract Depression experienced by older adults is proving an increasing global health burden, with rates as high as 27% in the USA. This is likely to increase in coming years as the number and proportion of older adults in the global population rises. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama, and music, are utilized internationally to reduce depressive symptoms in older adults and promote wellbeing. This includes interventions led by trained arts therapists as well as other health and arts professionals. This presentation will include a report of findings from a recent systematic review of the outcomes of four creative arts modalities (art, dance movement, drama, and music) with particular attention paid to processes of change documented in each modality.
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ItemHow Singing can Help People With Dementia and Their Family Care-Partners: A Mixed Studies Systematic Review With Narrative Synthesis, Thematic Synthesis, and Meta-Integration(FRONTIERS MEDIA SA, 2021-10-11)Background: Recent research on the efficacy of music-based interventions for people with dementia have focused on specific outcomes and methods, and singing has been noted as a particularly beneficial activity. However, due to heterogeneity of research methods, there is a need to synthesise the findings of both quantitative and qualitative research in order to better understand both the impact and potential mechanisms of singing for people in this population. Method: This systematic review included quantitative, qualitative and mixed-methods studies, and analysed these using a systematic mixed-studies synthesis (with a results-based convergent approach). Quantitative and qualitative data were initially synthesised using a narrative synthesis and thematic synthesis method, respectively, before a final meta-integration method was used to synthesise common themes across the two data forms. Results: Electronic and hand search strategies revealed 1,815 relevant studies, 40 of which met the full eligibility criteria. Narrative synthesis of quantitative data revealed six key outcome areas (quality of life; psychological well-being; cognition; engagement; activities of daily living; care-partner well-being), and thematic synthesis of qualitative data generated seven themes relating to the impact and mechanisms of singing (pragmatic elements; social benefits; mood; identity; memory; flow-on effects; and relationships). Meta-integration identified four key areas relating to the impact and mechanisms of singing for people with dementia and care-partners: psychological well-being, quality of life, cognition, and care-partner well-being. Conclusion: Results from the syntheses suggest that singing can positively impact the lives of people with dementia and their care-partners, although due to heterogeneity of study design and outcome measures, it is difficult to draw conclusions based on quantitative data alone. Qualitative data provides further context and insights from participant perspectives, and when integrated with quantitative data, contextual factors that may influence the benefits that participants experience from singing are revealed.
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ItemNo Preview AvailableUsing group therapeutic songwriting to support the dyadic relationship between people living with dementia and their family caregivers: Perspectives from music therapists(Australian Music Therapy Association, 2021)This study explored how music therapists may use group therapeutic songwriting (TSW) to support the dyadic relationships between people living with dementia and their family caregivers. Three registered music therapists (RMTs) with relevant clinical and/or research experience participated in semi-structured interviews. A thematic analysis of the interview data found five key concepts that may contribute to how music therapists use group TSW to support the dyadic relationship: supporting identity in context; responsiveness to diverse needs and wishes; the importance of the group; the creative process; and human rights. Findings contribute understandings about creative and supportive ways of working with people living with dementia and their family caregivers to promote relationship quality, quality of life and wellbeing. This study highlights the complexity and need for flexibility in facilitating group TSW and contributes insights into how the personal values of music therapists may influence how they work with people living with dementia and family caregivers.
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ItemParkinSong Online: protocol for a telehealth feasibility study of therapeutic group singing for people with Parkinson's disease(BMJ PUBLISHING GROUP, 2021-12)INTRODUCTION: Parkinson's disease can be associated with speech deterioration and low communication confidence which in turn compromises social interaction. Therapeutic singing is an engaging method for combatting speech decline; however, face-to-face delivery can limit access to group singing. The aim of this study is to test the feasibility and acceptability of an online mode of delivery for a Parkinson's singing intervention (ParkinSong) as well as remote data collection procedures. METHODS AND ANALYSIS: This ParkinSong Online feasibility trial is a single-arm, pre-post study of online singing delivery and remote data collection for 30 people living with Parkinson's. The primary outcome measure is feasibility: recruitment, retention, attendance, safety, intervention fidelity, acceptability and associated costs. Secondary outcomes are speech (loudness, intelligibility, quality, communication-related quality of life) and wellbeing (apathy, depression, anxiety, stress, health-related quality of life). This mode of delivery aims to increase the accessibility of singing interventions. ETHICS AND DISSEMINATION: Ethics approval was obtained from The University of Melbourne Human Research Ethics Committee (2021-14465-16053-3) and the trial has been prospectively registered. Results will be presented at national and international conferences, published in a peer-reviewed journal, and disseminated to the Parkinson's community, researchers and policymakers. TRIAL REGISTRATION NUMBER: ACTRN12621000940875.