Data Sheet 3_Music therapy embedded in the life of dementia inpatient care to help prevent and manage distress: a feasibility study to inform a future trial.docx

IntroductionMental health dementia wards in the National Health Service (NHS) in the UK provide specialist care for people with dementia experiencing acute levels of distress. There is little research into these settings, but music therapy may reduce distress in the short term. This co-designed, complex intervention development study aimed to test the feasibility of delivering a standardised music therapy protocol (MELODIC: Music therapy Embedded in the Life Of Dementia Inpatient Care) on these wards and the suitability of the research methods.
MethodsThe MELODIC intervention aims to support the personalised use of music to prevent and manage distress through: 1) embedding a music therapist in the multidisciplinary team, 2) delivering clinical music therapy sessions, 3) developing musical care plans for each patient, 4) and training and support for staff and families to implement care plans. Two NHS mental health dementia wards with differing experience of music therapy were recruited purposively. All patients, families and staff were eligible to participate subject to written consent. The intervention was delivered over four weeks. The interventionist kept a diary recording all interactions with patients, staff and families to measure treatment adherence. Questionnaires reporting patient, family and staff outcomes were collected twice before and twice after intervention delivery. Routinely collected data were gathered and interviews conducted post-intervention.
ResultsThe MELODIC intervention was acceptable with high levels of treatment adherence. The research methods were feasible with recruitment targets met (including 28 patients, 13 family members, 48 staff members) and all requested data collected with high levels of data completeness. Quantitative data showed no increase in distress symptoms or reported safety incidents during the intervention period. Interventionist diaries and qualitative data supported intervention refinement.
ConclusionIn a highly complex setting caring for some of the most vulnerable patients in the NHS it was possible to co-design and deliver a novel music therapy intervention. The research methods were feasible and acceptable. This protocolised intervention should be tested for clinical effectiveness in a controlled trial.
RegistrationISRCTN86317609

引言：英国国民保健服务（National Health Service, NHS）下属精神科痴呆病房，专为出现急性应激症状的痴呆患者提供专科照护。目前针对此类病房的研究较为匮乏，但音乐治疗或可在短期内缓解患者的应激状态。本项协同设计的复杂干预开发研究，旨在验证在上述病房推行标准化音乐治疗方案（MELODIC：Music therapy Embedded in the Life Of Dementia Inpatient Care，即嵌于痴呆住院照护日常中的音乐治疗）的可行性，以及本研究方法的适配性。

研究方法：MELODIC干预方案旨在通过以下方式支持个体化音乐应用，以预防和缓解应激状态：1）将音乐治疗师纳入多学科团队；2）开展临床音乐治疗疗程；3）为每位患者制定个性化音乐照护计划；4）为医护人员与家属提供培训与支持，协助落实照护计划。本研究采用目的抽样法，招募了两家在音乐治疗应用经验上存在差异的NHS精神科痴呆病房。所有患者、家属及医护人员在签署书面知情同意后均可参与本研究。干预周期为四周。干预实施者每日记录与患者、医护人员及家属的所有互动情况，以评估治疗依从性。在干预实施前后各两次收集针对患者、家属及医护人员结局指标的问卷数据。同时收集常规采集的临床数据，并在干预结束后开展访谈。

研究结果：MELODIC干预方案具备良好的可接受性，治疗依从性较高。本研究方法可行，完成了全部招募目标（共纳入28名患者、13名家属及48名医护人员），且所有预设数据均以高完整性完成采集。定量分析结果显示，干预期间患者的应激症状未出现加重，也未发生上报的安全事件。干预实施者的日记记录与定性数据均为干预方案的优化提供了支撑。

结论：在NHS体系下照护最为脆弱的痴呆患者的复杂临床场景中，协同设计并推行新型音乐治疗干预方案具备可行性。本研究方法兼具可行性与可接受性。该标准化干预方案需在对照试验中进一步验证其临床有效性。

注册信息：ISRCTN86317609