Integrated Rehabilitation Post-stroke: Combined Music Therapy and Occupational Therapy Group for Physical, Emotional, and Social Well-being

A. Palumbo

Journal

Archives of Physical Medicine and Rehabilitation

Year

2019

Abstract

Objective: To test the efficacy of a collaborative approach to stroke rehabilitation, called Music Upper Limb Therapy Integrated (MULT-I), that combines music therapy and occupational therapy in a group setting to improve physical, emotional and social well-being. Design: A mixed-methods randomized controlled trial was performed, with participants randomly assigned to either the MULT-I treatment intervention or a self-led home exercise program (HEP), which served as the control intervention. Physical, emotional and social well-being were evaluated pre- and post-intervention. Setting: Participants were recruited from a rehabilitation hospital. The MULT-I intervention took place at the hospital, and the control intervention took place at the participant's home. Participants (or Animals, Specimens, Cadavers): Thirty adults post stroke were recruited and randomly assigned to either the MULT-I intervention or the HEP control intervention. Of these, 25 participants (n=13 for MULT-I and n=12 for HEP) completed the pre- and post-intervention assessments and the assigned intervention. Interventions: Participants in the MULT-I intervention received combined music therapy and occupational therapy twice a week for 6 weeks in groups of five. Participants in the HEP control group received a regimen of self-led exercises to improve physical function, to be completed twice a week for 6 weeks. Main Outcome Measure(s): We hypothesized that the synergistic effects of combined music therapy and occupational therapy would lead to greater improvement in physical function in the MULT-I group as compared to the HEP control group, as measured by the upper limb Fugl-Meyer Scale (FMS). We expected secondary gains in emotional and social well-being (assessed using the Patient Health Questionnaire (PHQ)-9, World Health Organization (WHO) well-being index, the stroke-specific quality of life scale (SS-QOL), and the stroke impact scale (SIS)) for the MULT-I group. Results: Despite randomization, the HEP control group showed lower depression on the PHQ-9 and disability on the modified Rankin Scale compared with the MULT-I group pre-intervention. Controlling for pre-intervention depression and disability, the mean improvement on the FMS did not show significant between group differences. However, there was a significant interaction between group and baseline depression such that higher depression scores at baseline were associated with increased improvement in outcomes for the MULT-I group compared with the HEP group on the upper limb FMS (p = 0.017), PHQ-9 (p < 0.0001), WHO well-being index (p = 0.042), SS-QOL (p = 0.035), and self-perceived mobility on the SIS (p = 0.035), while controlling for pre-intervention depression and disability. Qualitative analysis of pre- and post-assessment interviews corroborated these results and revealed that MULT-I participants benefited from emotional support, social interaction and enjoyment of therapy, which were not experienced by participants in the HEP control group. Conclusions: The experience of physical activity in an emotionally supportive and enjoyable social environment created by the MULT-I intervention may contribute to greater improvement in individuals with baseline emotional impairment. Author(s) Disclosures: The authors do not have any conflicts of interest. Key Words: Stroke, Music Therapy, Occupational Therapy, Quality Of Life, Post Stroke Depression

Music and Health Institute Terms

Depression; Emotional Functioning; Engagement Level; Hospital Setting; Medication Use; Mobility; Music Medicine; Occupational Therapy; Quality of Life; Rehabilitation Exercises; Stroke; Subjective Measures; Wellness and Well-Being ((Outcome))

Indexed Terms

occupational therapy; post-stroke depression; wellbeing; cadaver; clinical article; conference abstract; conflict of interest; controlled study; drug combination; EMBASE keywords; exercise; human; interview; Patient Health Questionnaire 9; physical activity; qualitative analysis; quality of life; randomization; randomized controlled trial; Rankin scale; rehabilitation center; social environment; social interaction; synergistic effect; upper limb; World Health Organization

Study Type

Mixed Methods; Randomized Controlled; Trial; Quantitative Methods

Document Type

Article

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