Functionality or aesthetics?

 

What sort of science?

Complementary Therapies in Medicine (2005), 13, 25—33

Functionality or aesthetics?

A pilot study of music therapy in the treatment

of multiple sclerosis patients

D. Aldridgea, W. Schmidb, M. Kaederc, C. Schmidta, T. Ostermannd


Introduction: Neuro-degenerative diseases are, and will remain, an enormous public health problem. Interventions that could delay disease onset even modestly will have a major public health impact. The aim of this study is to see which components of the illness are responsive to change when treated with music therapy in contrast to a group of patients receiving standard medical treatment alone.

Material and methods: Twenty multiple sclerosis patients (14 female, 6 male) were involved in the study, their ages ranging from 29 to 47 years. Ten participants formed the therapy group, and 10 the matched control group matched by age, gender and the standard neurological classification scheme Expanded Disability Status Scale (EDSS). Exclusion criteria were pregnancy and mental disorders requiring medication. Patients in the therapy group received three blocks of music therapy in single sessions over the course of the one-year project (8—10 sessions, respectively). Measurements were taken before therapy began (U1), and subsequently every three months (U2—U4) and within a 6-month follow-up without music therapy (U5) after the last consultation. Test battery included indicators of clinical depression and anxiety (Beck Depression Inventory and Hospital Anxiety and Depression Scale), a self-acceptance scale (SESA) and a life quality assessment (Hamburg Quality of Life Questionnaire in Multiple Sclerosis). In addition, data were collected on cognitive (MSFC) and functional (EDSS) parameters.

Results: There was no significant difference between the music-therapy treatment group and the control group. However, the effect size statistics comparing both groups show a medium effect size on the scales measuring self-esteem (d, 0.5423), depression HAD-D (d, 0.63) and anxiety HAD-A (d, 0.63). Significant improvements were found for the therapy group over time (U1—U4) in the scale values of self-esteem, depression and anxiety. At follow-up, scale values for fatigue, anxiety and self-esteem worsen within the group treated with music therapy.

Discussion: A therapeutic concept for multiple sclerosis, which includes music therapy, brings an improvement in mood, fatigue and self-acceptance. When music therapy is removed, then scale scores worsen and this appears to intimate that music therapy has an influence.

A continuing thread running through my research has been choosing the appropriate methodology to investigate the therapy under consideration. If complementary therapies are to be considered as essential components within Integrated Medicine they will need to demonstrate their effects. However, how those effects are to be judged is a matter of discussion. When working with the dying, and on palliative care, there are therapeutic effects that are not immediately measurable but which are discernible to patients and their families, to the therapists involved and other members of the team. As you will read below, there was a moderate effect of music therapy using standardized scales. However, the patients involved in the music therapy began to see themselves as creative musicians rather than sick patients. This is not to deny the seriousness of the illness but emphasizes rather the ability of people to recover a sense of health and well-being even within the context of a degenerative disease. These people constructed identities that were positive; creative artists as opposed to degenerative patients.

We see a similar change in the case of Lois earlier. Although in pain and distress, through music she achieves a state of peace. When asked where she is, she replies, “I am in Beauty”. Qualitative research helps us to determine these therapeutic changes. While not being functional, they are aesthetic, and in terms of our human existence - being - they are vital. I have been very fortunate that my medical colleagues in palliative care have welcomed such input and encouraged my work to continue.Palliative_care.html

Outcome measures over time. U1—U4: treatment phase, U5: follow-up. Dashed line: control-group, full-line: music-therapy group. BDI: Beck Depression Inventory, HADS-A: Hospital Anxiety and Depression Scale—–anxiety,  SESA: Scale for self-acceptance (SESA),  IFFS: Incapacity and Fatigue Scale.

In a time of evidence-based medicine, we really have to continue to discuss the nature of what is evidence that healing has taken place. This is not simply a fiscal argument, nor solely scientific, but also existential. I am arguing here for a plurality of research perspectives.

David Aldridge

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