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Tu1057 THE EFFECTS OF MUSIC THERAPY IN THE PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS UNDERGOING COLONOSCOPY

      Music has been shown to reduce stress among elderly undergoing colonoscopy. This effect may vary between the patient’s characteristics.

      Aim

      To evaluate the effect of music in patients with functional bowel symptoms.

      Method

      Consecutive elderly patients who required colonoscopy were recruited and randomized into: A)No music, B)Thai music with lyrics music (The most favorable music among Thai elderly from the survey in 45 patients), and C)Instrumental music. The music was broadcasted from the central system of the endoscopy unit. Patients with hearing problem, dementia, severe comorbidities and history of colorectal surgery were excluded. History of gastrointestinal (GI) symptoms and pre-endoscopy psychological status (fear, nervous and anxiety) were assessed. During colonoscopy, vital signs were monitored and behavioral pain assessment (BPA) scale was evaluated. All patients used the same starting dose of midazolam and pethidine and were titrated up 2.5 mg and 25 mg, respectively when BPA scale increased ≥2 points.

      Results

      199 patients (M:F=124:75, age 63±1 years) were enrolled. Colorectal cancer screening was the most common indication (68.3%). Colonoscopy demonstrated polyps (48.2%), diverticulum (13.6%), hemorrhoid (8%) and normal findings (30.7%). 129 patients (64.8%) reported having ≥ 1 GI symptoms and 114 patients (57.3%) had bowel symptoms (constipation, diarrhea, abdominal pain improved with defecation) without endoscopic findings that responsible for their GI symptoms. Only these patients with functional bowel were analyzed. At 10 minutes after registration, baseline characteristics, heart rate, blood pressure, and psychological status were similar between the 3 interventions (p>0.05). 58.5-79.4% of the patients in each intervention had mild degree of nervous, fear, and anxiety (score 0-3 of VOS 0-10). At the time before starting the procedures, physiologic status were also similar comparing between groups but there was more proportion of patients with moderate anxiety (score 4-6 of VOS 0-10). in Thai music group compared to instrumental group. However, the median changes of nervous, fear, and anxiety scores from baseline were 0 of all groups (Table1). During colonoscopy, there was no patient in Thai music group who got the severe pain score (BPA=2) in every subscores (Table2). Also, there were no differences in midazolam and pethidine dosage among the intervention groups.

      Conclusion

      Music therapy for elderly patients with functional bowel symptoms did not significantly reduce nervous, fear, and anxiety at pre-endoscopy period. The patients’ favorable music was associated with less pain during colonoscopy. The lack of psychological benefit of music in this study may relate to the mild baseline stress. Further study especially on the patients with more stress is needed.
      Tabled 1Table 1: Baseline physiological and psychological status in participants who had bowel symptoms and at time before starting procedure (N=114).
      OutcomesNo music

      (n=34)
      Thai music

      (n=41)
      Instrumental music

      (n=41)
      Age (years)62.2 ± 7.864.0 ± 6.863.6 ± 6.6
      Gender (Female), n(%)22 (64.7)27 (65.9)29 (74.4)
      Underlying disease, n(%)
      -Hypertension3 (8.8)1 (2.4)6 (15.4)
      -Coronary heart disease6 (17.6)13 (31.7)5 (12.8)
      Pre-endoscopy (10 minutes after registration)
      Baseline physiological status;
      -Systolic Blood pressure(mmHg)141 ± 21142 ± 25150 ± 29
      -Diastolic Blood pressure(mmHg)81 ± 1484 ± 1283 ± 17
      -Heart rate(per minute)69 ± 1271 ± 1370 ± 9
      Baseline psychological status (VOS 0-10), n(%)
      ○Nervous (0-10)
      -Mild 0-327 (79.4)32 (78.0)30 (76.9)
      -Moderate 4-66 (17.6)6 (14.6)7 (17.9)
      -Severe 7-101 (2.9)3 (7.3)2 (5.1)
      ○Fear (0-10)
      -Mild 0-324 (70.6)27 (65.9)29 (74.4)
      -Moderate 4-66 (17.6)13 (31.7)8 (20.5)
      -Severe 7-104 (11.8)1 (2.4)2 (5.1)
      ○Anxiety (0-10)
      -Mild 0-321 (61.8)24 (58.5)29 (74.4)
      -Moderate 4-69 (26.5)14 (34.1)7 (17.9)
      -Severe 7-104 (11.8)3 (7.3)3 (7.7)
      At the time before starting procedure
      Physiological status; mean±SD
      -Systolic Blood pressure(mmHg)142 ± 21142 ± 24145 ± 25
      -Diastolic Blood pressure(mmHg)81 ± 1483 ± 1183 ± 14
      -Heart rate(per minute)72 ± 1272 ± 1674 ± 14
      Psychological status (VOS 0-10), n(%)
      ○Nervous (0-10)
      -Mild 0-324 (70.6)24 (58.5)26 (66.7)
      -Moderate 4-67 (20.6)10 (24.4)7 (17.9)
      -Severe 7-103 (8.8)7 (17.1)6 (15.4)
      ○Fear (0-10)
      -Mild 0-325 (73.5)26 (63.4)25 (64.1)
      -Moderate 4-64 (11.8)10 (24.4)9 (23.1)
      -Severe 7-105 (14.7)5 (12.2)5 (12.8)
      ○Anxiety (0-10)
      -Mild 0-321 (61.8)18 (43.9)*27 (69.2)*
      -Moderate 4-66 (17.6)16 (39.0)*7 (17.9)*
      -Severe 7-107 (20.6)7 (17.1)5 (12.8)
      Data expressed as mean ± SD *p0.05).
      Tabled 1Table 2: Physiological and psychological status during procedure.
      OutcomesNo music

      (n=34)
      Thai music

      (n=41)
      Instrumental music

      (n=41)
      Physiological status during procedure
      -Systolic Blood pressure(mmHg)130 ± 18132 ± 23124 ± 18
      -Diastolic Blood pressure(mmHg)78 ± 1478 ± 1977 ± 13
      -Heart rate(per minute)65 ± 1368 ± 1268 ± 9
      Behavioral pain assessment score
      Face expression (score 0-2), n (%)
      023 (67.6)24 (58.5)19 (48.7)
      110 (29.1)17 (41.5)17 (43.6)
      21 (2.9)03 (7.7)
      Restlessness (score 0-2), n (%)
      028 (82.4)36 (87.8)30 (76.9)
      14 (11.8)5 (12.2)9 (23.1)
      22 (5.9)00
      Muscle tones (score 0-2), n (%)
      029 (85.3)37 (90.2)30 (76.9)
      13 (8.8)4 (9.8)9 (23.1)
      22 (5.9)00
      Vocalization (score 0-2), n (%)
      026 (76.5)31 (75.6)31 (79.5)
      18 (23.5)10 (24.4)8 (20.5)
      2000
      Consolability (score 0-2), n (%)
      027 (79.4)33 (80.5)32 (82.1)
      16 (17.6)8 (19.5)6 (15.4)
      21 (2.9)01 (2.6)
      Total dose of midazolam required (mg)3.3 ± 1.23.2 ± 1.13.4 ± 1.2
      Total dose of pethidine required (mg)29.4 ± 9.729.4 ± 11.232.4 ± 11.6
      Data expressed as mean ± SD No statistical significant difference of these shown parameters between no music vs. Thai music, no music vs. instrumental music, Thai music vs. instrumental music (p>0.05)