Effectiveness of Music Therapy in Decreasing Parental Anxiety At A Pediatric Outpatient Department Presented by Johanes Prabowo MD (3 rd year PCMC Resident) Philippines Children’S Medical Center

Background of Study The Outpatient department is an extremely stressful place. Bringing a sick child to the Out-Patient Department is a major factor for parental anxiety, because the outcome is often uncertain. Eur J Emerg Med.Eur J Emerg Med Jun;13(3): High level of parental anxiety due to sick children in medical literature have already been recognized. Paediatr Child Health March; 6(3): 139–143.

Background of Study Several ways to decrease high levels of parental anxiety and one of them is Music Therapy. Music is an easy and useful way to decrease the anxiety of visitors in an emergency department waiting area. Clin Pediatr (Phila).Clin Pediatr (Phila) Apr;38(4): Music therapy is currently practiced in over 30 countries. In some, it has developed into a professional discipline accepted alongside other paramedical professions. Thesis for the degree of PhD at Aalborg University. 2009

Background of Study Music therapy, divided into two types: 1.Active music therapy 2. Passive (receptive) music therapy

Objectives General Objectives To determine the effectiveness of music therapy in decreasing anxiety of parents who have children with acute febrile illness. Specific Objectives To determine the level of worry, tension, apprehension, and nervousness of parents. To determine physiological effects of music therapy in Parental anxiety (HR, Blood pressure, RR). To compare the level of anxiety between parents who receive music therapy and those who do not.

Methodology Research Design Randomized Controlled Trial Target Population Among parents who have acute febrile children (1-10 years old) who seek consult at Philippine Children’s Medical Centre Outpatient Department.

Methodology Inclusion Criteria Parents who have children with Acute Febrile illness (<7days) Ages 1-10 years old Exclusion Criteria Parents who have known case of Neurotic disorder and anxiety disorder Parents with age <18 years old Patient with Life threatening condition Only Caregiver or distant guardians (helper, uncle, aunt) are accompanying the child. Illiterate patients

Methodology Variables Independent Variable Music Therapy (Approved by PFSM)  Intervention or Exposure No Matter What (Boyzone) The Long and Winding Road (Barry Manilow) Blue Eyes (ColdReaver) Yesterday (the beatles) I Have A Dream Ticket To Ride Love Me Tender (Elvis Presley) How Deep is Your Love (Richard Clayderman)

Methodology Dependent Variable Parents who have acute febrile children (less than 7 days febrile episode) Confounding > Number of Children > Unwanted pregnancy > Broken Family > Dysfunctional Family

Methodology There will be 3 groups : Case group: Parents of febrile children listening to music. Control group 1 : Parents of febrile children and no music intervention. Control group 2 : Parents of afebrile children (well babies for immunization) and no music intervention.

Methodology (Implementation) Duration implementation Of Study July 5 to September 3, 2013 Validation of Consent Forms and Questionnaire STAI-Y Questionnaire in tagalog version was translated by Sentro ng Wikang Fiilipino, University of Philippines. It has been pretested in linguistic validation which need for 20 subject. When the questionnaire was validated among 20 samples, a cronbachs alpha of was achieved denoting that the questionnaire is reliable. (Any value above 0.6 means good reliability)

Methodology (Implementation) OPD TRIAGE 162 subjects 1. Consent Obtained 2. Randomization by drawing lots, and do batch systems Case Group Control Group 1 Control Group 2

Methodology (Implementation) STAI-Y & Physiologic Assessment Music Intervention No Intervention 15 minutes Baseline as passive control

Location ER Pharmacy OPD Office (OLD) Waiting Room OPD (OLD) Waiting Room (New OPD) CPUG2G3G4G5G6

Room & Equipment ROOM EQUIPMENT

Methodology Outcome Measures The primary outcomes were STAI-Y scoring, and physiologic assessment. STAI-Y questionnaire is be divided into 2 type (S-Scale and T-Scale). Each type has range score from 20-80, which 20 is most relax condition and 80 is most anxious condition. State anxiety (S-anxiety) can be defined as fear, nervousness, discomfort, etc. and the arousal of the autonomic nervous system induced by different situations that are perceived as dangerous (Chronic Anxiety)autonomic nervous system Trait anxiety (T-anxiety) can be defined as feelings of stress, worry, discomfort, etc. that one experiences on a day to day basis (Acute Anxiety)

Result

Discussion Medical illness (diabetes mellitus, hypertension, anxiety disorder) and unwanted pregnancy  have no significant role in this study STAI- S, and STAI-T assessment, pre and post intervention revealed significant difference in both groups. Two parameters (heart rate) and respiratory rate showed significant decrease post-intervention in case group. And blood pressure showed no significant difference post-intervention. For comparison of 3 major groups post intervention in case group, control group 1, and control group 2, using ANOVA, revealed no significant effect. It might be cause by few factors that may affect result.

Conclusion This study revealed that music therapy has significant role to decrease parental anxiety through decrease anxiety score in STAI-Y, and decrease heart rate, respiratory rate post-intervention in each group, case group and control group 1. Although in comparison of major 3 groups is likely no significant difference post intervention

Recommendation Music therapy room should be localized not far from waiting area at OPD. Most of subjects are very worried if they will be missed from queue number Using head-phone or ear-phone is better way, because subject will be relax and they will not distract with other sounds. Music type should be adjusted with background of community. Like in our setting, most of subjects suggest modern song, and it will be better if “tagalog” song was played. For the duration of music intervention should be extended more than 15 minutes.

Thank You