Supplementary Material for: Effects of Music-supported Therapy (MST) for Depression and Cognitive Disorders in People Living with Stroke and Its Impact on Quality of Life: A Systematic Evaluation and Meta-Analysis

Introduction: Stroke not only leads to physical dysfunction in patients, but also causes emotional and cognitive abnormalities, which significantly affect survival and quality of life. Prior research has shown that music-supported therapy (MST) has the ability to enhance mood and cognitive performance through stimulation of the central nervous system. Nevertheless, there is a dearth of rigorous systematic assessments of the effectiveness of MST in improving mood and cognitive impairments in stroke patients, as well as the impact of these benefits on their overall quality of life. This systematic review and meta-analysis aimed to assess the impact of MST on emotional and cognitive impairments in stroke patients, as well as its influence on their quality of life.
METHODS: The PRISMA 2020 guidelines were followed to search for articles on MST treating mood and cognitive issues in stroke patients in the PubMed, Embase, Web of Science, Wanfang, CNKI, CSTJ, and SinoMed databases, with a cut-off date of July 11, 2024. Two researchers utilized the revised Cochrane RoB-I risk of bias technique to evaluate the quality of all relevant literature obtained. They subsequently extracted and meta-analyzed the data using Review Manager 5.4.1 software.
RESULTS: Seventy-two studies involving a total of 5,543 patients were included, and the meta-analysis revealed that MST had a significant effect on mood and cognitive deficits in stroke patients (SMDHAMD=1.49, 95% CI:1.21-1.76, P<0.001, MDMMSE = 2.53 CI:1.60-3.45, P< 0.001, MDMoCA=3.59, CI:2.57-4.62, P<0.001), which took effect from 2 weeks of treatment and was accompanied by an increase in serum 5-HT level (SMD5-HT=2.22,CI:1.47-2.96, P<0.001) and improvements in mood and cognitive function, daily living abilities (SMDADL=1.72, CI:1.32-2.11, P<0.001), limb motor function (SMDFMA=1.25, CI:0.47-2.02, P<0.001), and neurological function(SMDNIHSS= −1.77，CI: −2.50- −1.04，P<0.001).
CONCLUSION: MST effectively enhances the mood and cognitive function of stroke patients, improves their ability to perform daily activities and limb motor function. Importantly, improvements in mood and cognitive function occur earlier than the those in daily life ability and neurological function. Additionally, the level of serum 5-HT may serve as a potential indicator for assessing the effectiveness of MST.

引言：脑卒中不仅会导致患者出现躯体功能障碍，还会引发情绪与认知异常，显著影响患者的生存状况与生活质量。既往研究表明，音乐支持疗法（music-supported therapy, MST）可通过刺激中枢神经系统改善情绪状态与认知表现。然而，目前尚缺乏针对音乐支持疗法改善脑卒中患者情绪与认知障碍的疗效，以及该类获益对其整体生活质量影响的严谨系统评价。本系统综述与荟萃分析旨在评估音乐支持疗法对脑卒中患者情绪与认知障碍的影响，及其对患者生活质量的作用。

方法：本研究遵循PRISMA 2020报告规范，在PubMed、Embase、Web of Science、万方、中国知网（CNKI）、中国科技期刊数据库（CSTJ）以及中国生物医学文献数据库（SinoMed）中检索关于音乐支持疗法治疗脑卒中患者情绪与认知问题的文献，检索截止日期为2024年7月11日。由2名研究人员采用修订版Cochrane RoB-I偏倚风险评估工具对纳入的所有相关文献质量进行评价；随后使用Review Manager 5.4.1软件进行数据提取与荟萃分析。

结果：本研究共纳入72项研究，涉及5543例患者。荟萃分析结果显示，音乐支持疗法可显著改善脑卒中患者的情绪与认知缺损：汉密尔顿抑郁量表（Hamilton Depression Rating Scale, HAMD）相关标准化均数差（standardized mean difference, SMD）=1.49，95%置信区间（confidence interval, CI）：1.21~1.76，P<0.001；简易精神状态检查表（Mini-Mental State Examination, MMSE）相关标准化均数差SMD=2.53，95%CI：1.60~3.45，P<0.001；蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）相关标准化均数差SMD=3.59，95%CI：2.57~4.62，P<0.001。该疗效于治疗2周后显现，同时伴随血清5-羟色胺（5-HT）水平升高（SMD=2.22，95%CI：1.47~2.96，P<0.001），以及情绪与认知功能、日常生活活动能力量表（Activities of Daily Living, ADL）相关标准化均数差SMD=1.72，95%CI：1.32~2.11，P<0.001、肢体运动功能Fugl-Meyer评估量表（Fugl-Meyer Assessment, FMA）相关标准化均数差SMD=1.25，95%CI：0.47~2.02，P<0.001和美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）相关标准化均数差SMD=-1.77，95%CI：-2.50~-1.04，P<0.001的改善。

结论：音乐支持疗法可有效改善脑卒中患者的情绪与认知功能，提升其日常生活活动能力与肢体运动功能。值得注意的是，患者情绪与认知功能的改善早于日常生活能力与神经功能的改善。此外，血清5-羟色胺（5-HT）水平或可作为评估音乐支持疗法疗效的潜在生物学指标。