Effectiveness Of Music Based Relaxation Therapies In Control Of Diabetes

Rationale

Diabetes has become one of the most prevalent non communicable diseases affecting a vast majority of people (American Diabetes Association 2014). There is mounting evidence that suggests that diabetes has become an epidemic of the 21^st century. As discussed by the World Health Organization, there are more than 400 million people that are living with diabetes in the world and the rates have multiplied at least four times since the last couple of decades (Who.int. 2018). Although the rising rates of diabetes is centred in the low and middle income countries more, Australia is experiencing an extreme rise of diabetes. 280 Australians have been reported to develop diabetes every day, which calculates to one person being diagnosed with diabetes every minute. Recent statistics data states that 1.7 million Australian to be living with diabetes and in just the past year 100000 Australian have been diagnosed with either type 1 or type 2 diabetes (Diabetesaustralia.com.au. 2018).

Even with the advanced treatment modalities, controlling and adequately managing diabetes has become a very crucial challenge. Al-Alawi et al. (2018) have mentioned that diabetes is a disease which is associated with not just physical complexities, but the diseases is associated with psychosocial disturbance as which, which cumulatively affects the quality of life of the patients and their family members. The non-pharmacological relaxation techniques have gained a considerable popularity for the effectiveness in better management of the disease when used in conjunction with standard treatment for diabetes (Pouwer, Mezuk and Tab 2017). This essay will explore the range of evidence available on the effectiveness of music based relaxation therapies in control of diabetes.

Diabetes can be defined as a health disorder which is associated with the inability of the body to process blood glucose, either by complete inability to produce insulin in case of type 1 or juvenile diabetes, or altering the ability of the cells to use insulin or respond to it effectively as in the case for type 2 diabetes (Selvakumar et al. 2017). Diabetes management can be defined as a group of activities carried out by the patients suffering from diabetes to be able to control the adverse effects of the diseases and control the blood sugar levels in the body (van der Steen et al. 2018). As discussed by Warth et al. (2015), the elements encompassing the list of diabetes self-management activities includes monitoring the blood sugar levels, dietary modifications, regular exercise regimen, medication and therapies, and frequent check-ups and doctor visits. Along with that, it has to be mentioned in this context, diabetes, especially the type 2 diabetes, is almost always associated with obesity or overweightness. The additional challenge of dealing with body image insecurities, bullying and social discrimination associated with the diagnosis and coping with Diabetes and assorted co-morbidities can become a huge psychological distress giving rise to irritation, hopelessness, frustration and lack of self-worth, affecting the health status and wellbeing tremendously and also interfering with the effectiveness of the diabetes self-management modalities (Burns et al. 2018).

Main Concept

Relaxation techniques for the diabetes patients help to nurture their psychosocial health and be able to cope with all the challenges and restrictions associated with this disease helps in better disease management and can also lead to better outcome (Croom 2015). There is mounting evidence that suggests that the youngsters dealing with diabetes face the most challenges in adjusting with the lifestyle of dealing with diabetes and be able to cope with the diseases effectively. Similarly, for those that have been just diagnosed with the disease, the concept of proper and effective management of the diseases and the lifestyle modifications appears slightly daunting and exhaustive (Zhou et al. 2015). For these two particular patient groups, the various relaxation techniques have been very effective.

Among the different relaxation techniques that can be applicable for the diabetics, the music therapy represents a very important technique. Researchers are of the opinion that music helps in relaxation of blood vessels, especially for the music type that invokes joyful feeling in the recipients. As cardiovascular diseases are common in the diabetes patients, the self-management incorporates precautionary measures to ward off risk of arthrosclerosis and hypertension with medication and exercise. Although with music therapy the patients can achieve better management of these risks as well. Similarly, music therapy has tremendous benefits in metabolism and improving the sleep cycle and sleep quality of the patients, which is a very important aspect associated with various health benefits and also has been reported to improve outcome of treatment modalities as well (Ghezeljeh et al. 2017). Another study has confirmed music based relaxation to boost immunity and facilitate better exercise abilities and outcome, which is associated with better self-management of diabetes as well. Although there is various benefits associated with music therapy or music based relaxations, there is very little evidence available on how it improves health outcomes and facilitates better self-management in diabetics. As a primary care nursing professional, introducing better coping strategies to assist in self-management and better adjusting to the diseases for the patients with new diagnosis is a very important aspect of care delivery.  Hence, this topic has been chosen for this research study.

Research question:

What is the evidence on the effectiveness of music based relaxation on health outcome and self-management of diabetes in patients as compared to standard treatment?

Population	Diabetics
Intervention	Music based relaxation
Comparison	With standard treatment
Outcome	Better health outcome and enhanced self-management

Search strategy can be defined as the systematic and organized account of the steps that have been followed by the researcher in a secondary study to derive article resources for the study (Glaser and Strauss 2017). In this case, Google scholar, CINAHL and Cochrane library had been used for the researching purposes. Google scholar had been used to conduct a preliminary research for the topic area and gain an overall understanding of the topic and structure the paper. After that the rest of the mentioned databases were used to derive the articles. First and foremost, the research question was divided into different parts or phrases to be searched on the database and three phrases were selected for the initial researching purposes, which were “Music based relaxation”, “health outcomes”, and “diabetics”. The initial search resulted in 273 results. The second limiter was language as English which further narrowed down the results to 177 results. The next limiter had been full text only and abstract available which further narrowed down the results into 88 results. In order to further narrow down of the results an additional limiter was applied such as human subject based research which narrowed the results to 35. Lastly the date limit of the research had been reduced to the range of 2013 to 2018 which narrowed the results to 10 studies. Lastly the research was limited to peer reviewed article which ultimately narrowed the results to 4. The articles that did not match any of the criteria was excluded and the last 4 articles were chosen for the review study.

Search Strategy

Music based relaxation can help in improving the health-related outcomes in diabetes education:

The first article that is to be reviewed in this paper is by Mandel, Davis and Secic (2013) titled “Effects of music therapy and music-assisted relaxation and imagery on health-related outcomes in diabetes education: a feasibility study”. As evident from the title of the article, it is a feasibility study and the research design of the 3-group, parallel, randomized controlled trial. A randomized control trial is considered to be the highest level of evidence as it is the most reliable and authentic evidence pertaining from a quantitative analysis of data. The study also had sampling population of 199 patients and sampling of aged 30 to 85 years with type 1, type 2, or prediabetes was employed. The sample size is moderate although the article has eliminated the age group of adolescents which contributes to a large population of type 2 diabetes patients. Considering the findings of the research study that significant changes observed in blood pressure levels, glycosylated haemoglobin, body mass index, trait and state anxiety and stress of the diabetic patients for the group that was given music therapy in conjunction with diabetic self-management education or training (Mandel, Davis and Secic 2013). Hence, it can be stated that music therapy helps in calming the patients, helps them focus more on their self-management education and also has relation with better health outcomes of arthrosclerosis and anxiety or stress, instilling better coping mechanism for the patients.

Music therapy improves energy conservation and reduces stress:

The second article is “The effect of active and silent music interventions on patients with type 2 diabetes measured with electron photonic imaging technique” by Rao and Nagendra (2014). This study uses a novel interesting approach of electron photonic imaging technique to measure the effect of active and silent music therapy on patients with type 2 diabetes. The research design of this study is single group repeated measures pre-post design using two kinds of music based relaxation, active and silent. Hence, this is a quasi-experimental research design and relates to level three evidence, as this is a well-designed control trial study which is just lacking randomization. Although this evidence is lacking in evidence quality as compared to RCTs, the evidence provided by these studies are also of high quality, relevance and authenticity, hence, this was selected in the study as well. The sample population of the study is 29 participants involving both men and women, and data collected had been analysed using the SPSS method. The data findings of the research indicates at the fact that both of the music intervention techniques had significant impact on the Gas Discharge Visualization (GDV) of the participants. Furthermore, the results also hint at the fact that the active music intervention yielded better results than the silent music intervention with the difference of p = 0.007. The authors here have justified that the active music intervention yielded better results than the silent music intervention due to the fact that it led to higher levels of boredom. Moreover, the active music participation is associated with higher energy preservation, concentration and optimism which in turn improved the psychosocial health of the diabetics (Rao and Nagendra 2014). Considering the impact of practice area, it has to be mentioned that if an additional intervention can reduce stress, depression and anxiety level of the patients and helped in better optimism and energy can help the patient adhere better to the diabetes management activities like therapies, exercise and other such lifestyle modifications.

Results

Music therapy can target cognitive functioning impairment due to high HbA1c in diabetics:

The third study to be explored is by Tumuluri, Hegde and Nagendra (2017), which suggests that the impact of music based relaxation can not only better control hyperglycaemia, but can also help in targeting cognitive functioning. This is an exploratory study which suggests that stress, anxiety, frustration and fear often leads to cognitive deficits on the patients dealing with diabetes. Exploratory studies refer to the level 2 evidence which indicates at considerable value for the evidence of the article used in here. The music therapy was used for 20 sessions on the population sample which had been three patients with type two diabetes. It has to be mentioned that the sample population is exceptionally small for this article and can be a huge limitation for the generalizability and transferability of the study. Serum cortisol, perceived stress, Color Trail Test (1 and 2), and verbal n-back (1 and 2) tests were used as outcome measurements and the data findings indicated at music therapy being able to reduce the level of stress and cortisol hormone in the participants. The results also indicate at the fact that focused attention and working memory of the participants improved significantly but in varying degrees (Tumuluri, Hegde and Nagendra 2017). This a revolutionary research on the effect of music therapy to improve cognitive function in type 2 diabetes patients which can be reduced due to high HbA1c, even with the inconsistent results and very small sampling.

Music based relaxation can improve exercise tolerance in elderly diabetics:

The fourth article focuses on “Effect of combining music media therapy with lower extremity exercise on elderly patients with diabetes mellitus” by Ji et al. (2015). Lower extremity exercise is a very important aspect of diabetes self-management especially for the elderly diabetics. This helps not just in the foot ulcer prevention, blood circulation and blood glucose level maintenance, but this exercise is also associated with better range of motion, physical activity and also improving the exercising capabilities of the individual as well. This article is a randomized controlled trial study which falls into the level 1 of evidence with respect to the highest level of evidence. The sample population chosen for the study includes 72 elderly diabetic patients who have been suffering from type two diabetes. While the control group was given the lower extremity exercise, the intervention group received the extremity exercise in addition to the music media (Ji et al. 2015). The intervention was continued for 3 months and the data findings indicated at the fact that lower extremity exercise regimen adherence in the intervention group was significantly higher (p< 0.05) than that of the control group. Hence, music media treatment combined with lower extremity exercise can improve the level of exercise compliance of patients and in turn lead to better outcomes of self-management.

Themes from Research Articles

 4 interconnected themes had been identified from the research related to the impact of music therapy in improving adherence in diabetic self-management protocol and better health outcomes, and each of themes can be aligned to the future practice scenario. First and foremost, the first theme discusses that music based relaxation can help in better adherence to the self-management techniques and improve anxiety and stress. Based on this evidence, music based relaxation can be recommended to every diabetic patient dealing with stress and anxiety of recent diagnosis or any other challenges with coping with the diseases (Stige 2017). The second and fourth theme can be co-aligned to some extent, second theme discusses the ability of the music based relaxation techniques to improve the energy level along with stress reduction, whereas the fourth theme discusses the impact of music therapy on better lower extremity exercise in older diabetics. Hence, in relation to these findings, exercise regimens can be co-aligned with music therapy sessions with help from certified music therapists to encourage better performance and adherence, especially for older adult diabetic population. The third theme discusses the music therapy can even improve working memory which has extreme advantage for warding off the risk of early onset dementia is certain patient groups. Hence, for target groups with risk of Alzheimer’s or dementia, the music therapy in the treatment regimen can help in improving cognitive functioning and memory. Although, there is need for more research to understand the exact trajectory via which this therapy can help in relation to cognitive functioning (Croom 2015).

Conclusion:

On a concluding note, diabetes is one of the prevalent health disorders which is rising in incidence rate across all age groups in both developing and developed nations. It also needs to be mentioned in this context that the global rate of diabetes has been rising alarmingly and it has not been exhibiting any signs of reducing in the near future even with the many efforts both locally and globally to control the rate of diabetes. Diabetes management is associated with considerable challenges and issues, especially when concerning the aspects of diabetes self-management. It has to be mentioned in this context that the people living with diabetes have to cope with a long to do list. The never ending list of restrictions and tasks that the diabetics have to perform throughout the day can be very tedious and exhausting, which inevitably has a detrimental effect on their health and recovery process. The essay researched the use of music therapy as a relaxation technique and its impact on improving health outcomes and adhering to diabetes self-management. The study identified four themes with respect to the positive impact that music therapy can bring on improving the quality of life of the diabetics. Hence, a series of recommendations has also been incorporated in accordance with the themes identified, which if incorporated in the practice setting can be of extreme benefits and advantages.

Enhancement of Future Practice

References:

Al-Alawi, K., Norberg, M., Al, M.A. and Johansson, H., 2018, May. Where is the hitch in our interdisciplinary approach? Perceptions of health care providers towards the challenges at diabetes management clinics in Oman. In 20th European Congress of Endocrinology (Vol. 56). BioScientifica.

American Diabetes Association, 2014. Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), pp.S81-S90.

Ansdell, G., 2016. How music helps in music therapy and everyday life. Routledge.

Burns, K., Farrell, K., Myszka, R., Park, K. and Holmes?Walker, D.J., 2018. Access to a youth?specific service for young adults with type 1 diabetes mellitus is associated with decreased hospital length of stay for diabetic ketoacidosis. Internal medicine journal, 48(4), pp.396-402.

Croom, A.M., 2015. Music practice and participation for psychological well-being: A review of how music influences positive emotion, engagement, relationships, meaning, and accomplishment. Musicae Scientiae, 19(1), pp.44-64.

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Ghezeljeh, T. N., Kohandany, M., Oskouei, F. H., & Malek, M. (2017). The effect of progressive muscle relaxation on glycated hemoglobin and health-related quality of life in patients with type 2 diabetes mellitus. Applied Nursing Research, 33, 142-148.

Glaser, B.G. and Strauss, A.L., 2017. Discovery of grounded theory: Strategies for qualitative research. Routledge.

Ji, L., Bai, J.J., Sun, J., Ming, Y. and Chen, L.R., 2015. Effect of combining music media therapy with lower extremity exercise on elderly patients with diabetes mellitus. International Journal of Nursing Sciences, 2(3), pp.243-247.

MacDonald, R., Kreutz, G. and Mitchell, L. eds., 2013. Music, health, and wellbeing. Oxford University Press.

Mandel, S.E., Davis, B.A. and Secic, M., 2013. Effects of music therapy and music-assisted relaxation and imagery on health-related outcomes in diabetes education: A feasibility study. The diabetes educator, 39(4), pp.568-581.

Pouwer, F., Mezuk, B. and Tab, A.G., 2017. Diabetes mellitus. In The Routledge International Handbook of Psychosocial Epidemiology (pp. 215-246). Taylor and Francis.

Rao, T.I. and Nagendra, H.R., 2014. The effect of active and silent music interventions on patients with type 2 diabetes measured with electron photonic imaging technique. Int J Humanit Soc Sci, 3, pp.7-14.

Selvakumar, D., Al?Sallami, H.S., de Bock, M., Ambler, G.R., Benitez?Aguirre, P., Wiltshire, E., Tham, E., Simm, P., Conwell, L.S., Carter, P.J. and Albert, B.B., 2017. Insulin regimens for newly diagnosed children with type 1 diabetes mellitus in Australia and New Zealand: A survey of current practice. Journal of paediatrics and child health, 53(12), pp.1208-1214.

Stige, B., 2017. Where music helps: Community music therapy in action and reflection. Routledge.

Tumuluri, I., Hegde, S. and Nagendra, H.R., 2017. Effectiveness of music therapy on focused attention, working memory and stress in Type 2 diabetes: An exploratory study. International journal of yoga, 10(3), p.167.

van der Steen, J.T., Smaling, H.J., van der Wouden, J.C., Bruinsma, M.S., Scholten, R.J. and Vink, A.C., 2018. Music?based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews, (7).

Warth, M., Keßler, J., Hillecke, T. K., & Bardenheuer, H. J. (2015). Music therapy in palliative care: A randomized controlled trial to evaluate effects on relaxation. Deutsches Ärzteblatt International, 112(46), 788.

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Zhou, K., Li, X., Li, J., Liu, M., Dang, S., Wang, D. and Xin, X., 2015. A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: results on depression, anxiety and length of hospital stay. European journal of oncology nursing, 19(1), pp.54-59.