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Randomized Controlled Trial
. 2022 Oct 1;101(10):937-946.
doi: 10.1097/PHM.0000000000001938. Epub 2021 Dec 6.

Music Upper Limb Therapy-Integrated Provides a Feasible Enriched Environment and Reduces Post-stroke Depression: A Pilot Randomized Controlled Trial

Anna Palumbo  1 , Viswanath Aluru, Jessica Battaglia, Daniel Geller, Alan Turry, Marc Ross, Adrian Cristian, Caitlin Balagula, Gbenga Ogedegbe, Latika Khatri, Moses V Chao, Robert C Froemke, Jacek K Urbanek, Preeti Raghavan
Affiliations
Randomized Controlled Trial

Music Upper Limb Therapy-Integrated Provides a Feasible Enriched Environment and Reduces Post-stroke Depression: A Pilot Randomized Controlled Trial

Anna Palumbo et al. Am J Phys Med Rehabil. .

Abstract

Objective: This study's aims were to refine Music Upper Limb Therapy-Integrated (MULT-I) to create a feasible enriched environment for stroke rehabilitation and compare its biologic and behavioral effects with that of a home exercise program (HEP).

Design: This was a randomized mixed-methods study of 30 adults with post-stroke hemiparesis. Serum brain-derived neurotrophic factor and oxytocin levels measured biologic effects, and upper limb function, disability, quality of life, and emotional well-being were assessed as behavioral outcomes. Participant experiences were explored using semistructured interviews.

Results: MULT-I participants showed reduced depression from preintervention to postintervention as compared with HEP participants. Brain-derived neurotrophic factor levels significantly increased for MULT-I participants but decreased for HEP participants, with a significant difference between groups after excluding those with post-stroke depression. MULT-I participants additionally improved quality of life and self-perceived physical strength, mobility, activity, participation, and recovery from preintervention to postintervention. HEP participants improved upper limb function. Qualitatively, MULT-I provided psychosocial support and enjoyment, whereas HEP supported self-management of rehabilitation.

Conclusions: Implementation of a music-enriched environment is feasible, reduces post-stroke depression, and may enhance the neural environment for recovery via increases in brain-derived neurotrophic factor levels. Self-management of rehabilitation through an HEP may further improve upper limb function.

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Conflict of interest statement

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Figures

Figure 1:
Figure 1:
CONSORT flow diagram demonstrating participant enrollment, allocation, and occasions of withdrawal or loss to follow up prior to analysis.
Figure 2:
Figure 2:
Pre- to post-intervention changes with significant differences between the MULT-I and HEP intervention arms. Effects for BDNF exclude those with baseline levels of depression consistent with post-stroke depression. MULT-I: Music Upper Limb Therapy – Integrated, HEP: Home Exercise Program, PHQ-9: Patient Health Questionnaire-9, BDNF: Brain Derived Neurotrophic Factor.
Figure 3:
Figure 3:
Pre- to post-intervention changes within the MULT-I and HEP intervention arms. MULT-I: Music Upper Limb Therapy – Integrated, HEP: Home Exercise Program, SIS: Stroke Impact Scale, FMS: Fugl Meyer Scale.
Figure 4:
Figure 4:
Exploratory within-group correlations between baseline PHQ-9 and pre- to post-intervention change in outcomes. Within the MULT-I arm higher baseline depression on the PHQ-9 was associated with improvements across the outcomes shown with the intervention. Within the HEP arm, higher baseline depression on the PHQ-9 was associated with worsening of outcomes shown. MULT-I: Music Upper Limb Therapy – Integrated, HEP: Home Exercise Program, PHQ-9: Patient Health Questionnaire-9, BDNF: Brain Derived Neurotrophic Factor, SIS: Stroke Impact Scale, WHO-5: World Health Organization 5 item well-being index, QLI: Stroke Quality of Life Index, FMS: Fugl Meyer Scale, and mRS: modified Rankin Scale.
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References

    1. Northcott S, Moss B, Harrison K, Hilari K. A systematic review of the impact of stroke on social support and social networks: Associated factors and patterns of change. Clin Rehabil 2016;30:811–831 - PubMed
    1. Otto CM. Heartbeat: Social isolation is associated with increased mortality after acute myocardial infarction or stroke. Heart 2018;104:1471–1473. - PubMed
    1. Ayerbe L, Ayis S, Wolfe CDA, Rudd AG. Natural history, predictors and outcomes of depression after stroke: Systematic review and meta-analysis. Br J Psychiatry 2013;202:14–21 - PubMed
    1. Ayerbe L, Ayis SA, Crichton S, Wolfe CDA, Rudd AG. Natural history, predictors and associated outcomes of anxiety up to 10 years after stroke: The south london stroke register. Ageing 2014;43:542–547 - PubMed
    1. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery. Stroke 2016;47 - PubMed

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