Accepted Manuscript

Title: Feeling the sound – short-term effect of a vibroacoustic

music intervention onwell-being and subjectively assessed
warmth distribution in cancer patients—a randomized
controlled trial

Authors: Sarah Bieligmeyer, E. Helmert, Martin Hautzinger,

Jan Vagedes

PII: S0965-2299(17)30728-8
DOI: https://doi.org/10.1016/j.ctim.2018.03.002
Reference: YCTIM 1817

To appear in: Complementary Therapies in Medicine

Received date: 1-12-2017

Revised date: 2-3-2018
Accepted date: 2-3-2018

Please cite this article as: Bieligmeyer Sarah, Helmert E, Hautzinger Martin,
Vagedes Jan.Feeling the sound – short-term effect of a vibroacoustic music
intervention onwell-being and subjectively assessed warmth distribution in cancer
patients—a randomized controlled trial.Complementary Therapies in Medicine
https://doi.org/10.1016/j.ctim.2018.03.002

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Feeling the sound – short-term effect of a vibroacoustic
music intervention onwell-being and subjectively
assessed warmth distribution in cancer patients – a
randomized controlled trial

Dr. Sarah Bieligmeyer1

E. Helmert1
Prof. Dr. Martin Hautzinger2
Dr. Jan Vagedes*1,3

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1 ARCIM Institute (Academic Research in Complementary and Integrative Medicine),
Filderstadt, Germany

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2 Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Germany
3 Department of Neonatology, University Children’s Hospital Tuebingen, Germany,

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University of Tuebingen, Germany

*Corresponding author:
Tel.: +49 711 77031687.
Fax: 0711 77031380
Email: j.vagedes@arcim-institute.de U
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Highlights:
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 First RCT analyzing the efficacy of a sound-bed based on the

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TAO pentatonic scale in cancer patients

 Significant increase of overall well-being (with a significant

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time by condition interaction)

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 Improvement of distribution of warmth, current mood and

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satisfaction with the overall health status.

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Abstract/Summary
Objectives: So far, the effects of vibroacoustic music therapy in cancer patients are unknown.
However, used in anthroposophic medicine, it could be an approach to enhance well-being.
The goal of this study was to evaluate the immediate effects of a sound-bed music
intervention with respect to the subjective well-being as well as body warmth and pain.

Patients and Methods: We treated 48 cancer patients with 10 minutes of sound-bed

intervention in a cross-over design. Primary outcome was the total sum of the Basler Mood

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Questionnaire (BMQ), secondary outcomes were subscales of the BMQ and questions

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addressing body warmth and pain. The EORTC-QLQ C30 was used as baseline assessment
for quality of life (QOL).

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Results: Patients had lower QOL values than the EORTC reference samples (p<.001,
d=.90). The primary outcome increased after music (p<.001, d=.47), no changes were seen

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in the control condition (p=.73, d=.04), the time by condition interaction was significant
(p<.05). Secondary outcomes: Increase after music for the BMQ subscales inner balance
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(p<.001, d=.73), vitality (p<.001, d=.51) and vigilance (p<.001, d=.37) as well as for the
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additional questions satisfaction (p<.001, d=.43), current mood (p<.001, d=.43), body warmth
(p<.05, d=.44) and warmth distribution (p<.01, d=.49). No significant changes were seen in
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pain levels and social extroversion.

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Conclusion:
Sound-bed intervention improved momentary well-being and caused self-perceived
physiological changes associated with relaxation beyond the benefits of simple resting time
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(control condition). Thus, it might be a promising approach to improve well-being in cancer

patients.
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Keywords: Music therapy, cancer, palliative care, quality of life, well-being

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1. Introduction
In the oncology setting, quantity of life and quality of life (QOL) are interdependent and yet
often have to be weighed up against each other when making hard therapy decisions [1].
Symptoms most affecting QOL in cancer patients are fatigue, anxiety, pain, stress, nausea,
vomiting [2] and altered taste perception.
Different definitions of the term QOL make it difficult to compare research studies [3]. For

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example, with respect to the functional performance, QOL can describe the ability to walk one
block or climb stairs as well as having sufficient social support [4]. The World Health

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Organisation (WHO QOL group) defined QOL as an individual´s physical health, level of

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independence, psychological status and social relationships as well as the relationship to
salient features of their environment [5].

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Music or music therapy as one of the art therapies is a powerful and effective medium to reduce
fatigue, depression, anxiety, pain and stress [6-8] and enhance positive emotions. The specific

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use of music therapy to positively influence behaviour and mental status represents a field of
growing interest in music research. “Music therapy is an established healthcare profession that
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uses music to address physical, emotional, cognitive and social needs of individuals of all
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ages” [9]. Additionally, music therapy promotes resilience, control, comfort and peace for
people affected by life-threatening illnesses [10-12]. In cancer patients, the main goal is to
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stimulate physical, emotional and cognitive processes to influence the patients´ stress
physiology, alter individual coping behaviours and evoke positive emotions [13] to engage the
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individual’s full coping capacity.

Today, music therapy often consists of listening to or making music with different kinds of
instruments. This kind of music therapy mostly acts via the auditory experience. In contrast,
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the potential of vibroacoustic or tactile effects of music has hardly been studied systematically.
The idea is that the beneficial effects of musical as well as emotional experiences could be
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amplified if a person not only listens to music, but actually senses the tactile vibration [14].
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In clinics with an integrative approach, sound-beds are frequently used for vibroacoustic music
therapy, striving to enhance well-being and improve the body awareness of patients. Mainly
used in an anthroposophical setting, these are made with a set of 48 strings strung horizontally
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across the underside of the bed frame which is constructed as a wooden resonance body (Fig.
1). The strings are tuned in a special fifth tuning called TAO (tones D, E, A, B) over four
octaves. During treatment, the patient lies on the sound-bed while the therapist sits beside the
instrument and strokes evenly across the strings with the fingers of both hands, producing a
sound carpet. The patient hears the sound and perceives the vibration of the strings through
the full body contact with the wooden bed.

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In the last decades monochords are also increasingly used for vibroacoustic music therapy,
especially in German speaking countries, and have been the subject of a limited set of studies.
The monochord is a sound-bed version with approximately 30 strings tuned to one base tone
while nevertheless producing a variety of overtones. It has mainly been explored by a research
group of the Heidelberg School of Therapeutic Sciences. In the last years, they focused on the
therapeutic effects of the monochord with respect to psychological and physiological benefits
[14-18]. Sandler et al. (2016) examined for example whether the spontaneous EEG activity
during a relaxation state induced by monochord vibroacoustic stimulation differs from a state

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of relaxation induced by listening to audio CD relaxation music. The authors found that

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vibroacoustic stimulation with a monochord appears to induce states of relaxation which are
experienced as pleasant by a subset of patients and is associated with focused attention and

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a simultaneous release of control [19].
So far, the TAO-tuned sound-bed has often been used as a therapeutic instrument in the

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clinical context but to the best of our knowledge the effects of this approach have not been
systematically studied yet. We therefore did a randomized controlled trial to evaluate the

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immediate effects on the general well-being of oncology patients after 10 minutes of TAO-
tuned sound-bed intervention.
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2. Objectives
We hypothesized that oncological patients who receive the TAO-tuned sound-bed
intervention show a significantly greater short-term improvement in self-reported parameters
of well-being (as assessed by the BMQ total sum and subscales inner balance, vitality,
vigilance, social extroversion), body warmth, current mood and pain when compared to a
control group.

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2.1. Patients and Methods
2.1.1. Design

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We did a randomized controlled clinical trial with a two-group cross-over design to compare

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the effect of a sound-bed intervention on current well-being of patients with advanced cancer
to a control condition (lying on the sound-bed without music). The study was conducted from
November 2013 to May 2014. Based on a priori-G*power calculations for optimal sample size

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with a 20% drop-out rate included (significance =.05. 1-β=.80; estimated effect size of the
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primary outcome d=.45 was based on an uncontrolled pilot study we had conducted in advance
with 16 cancer patients using the same music intervention and questionnaires [unpublished]),
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a minimum of 48 participants was required. The primary outcome was the sum score of the
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Basler Mood-Questionnaire (BMQ) [20] indicating mental well-being. The study protocol was
reviewed and approved by the ethics committee of the University of Tuebingen and was
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recorded at the German Clinical Trials Register (DRKS00005411). Fig. 2 presents the flow
diagram for participant identification, temporal evolvement and compliance throughout the trial.
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2.1.2. Patients
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Study participants were recruited from the Filderklinik oncology inpatient department by the
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author (S.B., psychologist), regardless of the oncological diagnosis. Patients had to be aged
between 25 and 65 years and able to read, write and speak German. Exclusion criteria were
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extreme immobility, severe pain symptoms or previous experience with the sound-bed. Eligible
patients who agreed to participate gave written informed consent prior to completing the
baseline assessment forms (demographic data and case history, EORTC-QLQ C30). Using
opaque envelopes for the randomization procedure, participants were randomly assigned to
either music intervention followed by control intervention or control intervention followed by
music intervention. For every block of four participants, two envelopes were allocated to each

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arm of the trial to ensure groups of approximately the same size. Block size was unknown to
the participants so that the schedule was not predictable. The participants opened the
envelopes immediately before the first intervention so that at this moment the author was
informed about the actual sequence for the respective participant. Randomization was carried
out by the author.

2.1.3. Intervention

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Each patient received one music and one control intervention carried out individually according

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to the random order assignment at intervals of 24 hours. The sound-bed is located in a
separate room of the Filderklinik. On the trial day, the author met the patients in their hospital

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rooms. They completed the BMQ and five additional questions addressing currently perceived
body warmth, pain level and general mental state before the intervention (t1)and were then

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escorted to the sound-bed room. During an introduction and preparation phase (4 min) the
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patients occupied a supine position on the sound-bed and were covered with a blanket if
desired. They were asked to remain awake during the intervention time and listen to the music
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without doing anything else. This was followed by a five-minute silence period. Then the actual
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intervention began, consisting of 10 minutes of music or control condition. Another five-minute

silence period followed, after which the patients left the sound-bed and were escorted back to
their rooms where they completed the questionnaires (BMQ and additional questions) again
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(t2). The sound-bed was played by the author, who had been trained by a music therapist with
many years of sound-bed experience in palliative and end-of-life care prior to the study. The
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48 strings of the sound-bed are tuned in a TAO tuning as a precursor of pentatonics (tones D,
E, A, B) over four octaves. The sound-bed was constructed by the manufacturer of musical
instruments Robert Benedek (https://www.benedeks.net); a sound sample is available at
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https://www.benedeks.net/tao-leier-tao-klangliege-tao-klangkabine/die-tao-
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klangliege/klangbeispiele-tao-klangliege/.
In the control condition, participants underwent the same process but without any music.
Participants were included in the final analysis if they completed both sessions.
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2.1.4. Outcome Measures

The BMQ is a self-rating polarity profile to assess the current state of mood, resulting in total
sum and the subscales inner balance, vitality, vigilance, social extroversion. It consists of 16

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items with a total sum score of 112 (range 16-112). Answers are given on seven-category
bipolar scales. High scores indicate greater values corresponding with better well-being.
(Cronbach’s α for the subscales between α=.63 and α=.77, total sum: α=.76). The BMQ is
suitable to assess the immediate effects of an intervention with respect to a healthy or ill
person’s situational subjective well-being [21, 22]. It has been used in cancer patients and has
proven to be a feasible and significant tool [23]. The additional questions we devised were
based on the long-term experience of sound-bed therapists and were measured on seven-
category bipolar rating scales (questions 1, 2, 4, 5) or on a visual analogue scale (VAS;

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question 3, pain intensity). They were as follows: 1. What is your current perception of your

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body warmth (bipolar response options: warm/cold)? 2. How do you perceive your body
warmth distribution (even/uneven)? 3. How severe is your pain at the moment (no pain/worst

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pain imaginable)? 4. What is your current mood (good/bad)? 5. How satisfied are you with your
general state of health at the moment (satisfied/dissatisfied)? It took an average of 10 minutes

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for participants to complete the questionnaires at each time point.
The EORTC-QLQ C30, designed by the EORTC (European Organization for Research and

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Treatment of Cancer), was used in this study in order to address the quality of life of cancer
patients (Cronbach’s α: 0.65 (nausea and vomiting) to 0.89 (global health/quality of life)). The
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QLQ C30 (Quality of Life Questionnaire) consists of 30 items rated on a nominal scale from 1
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(not correct at all) to 4 (I strongly agree). The items include ratings of overall QOL, functional
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dimension (cognitive, social, physical, emotional and role functioning) and symptom dimension
(fatigue, nausea and vomiting, pain). Six single items (dyspnoea, constipation, diarrhoea,
appetite loss, insomnia, financial difficulties) frequently encountered by advanced cancer
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patients are also assessed.

2.1.5. Data analysis

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Statistical analyses were performed using the Statistical Package for Social Sciences, version
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22 (IBM SPSS Statistics). Missing values were replaced by the mean imputation method.
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Baseline comparisons between the two groups with respect to demography were calculated
with Χ2-tests or independent t-tests as required. To exclude interaction of treatment and
carryover effects we used Mann-Whitney U tests for each participant corresponding to
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statistician recommendations [24]. If no carryover effects exist, both conditions can be included
in the analysis. For baseline comparisons of both conditions t-tests were calculated. To test
changes in the primary outcome parameter (total sum of BMQ) we did a 2 x 2 factor ANOVA
with time point (pre vs. post) as the dependent variable and condition (music vs. control) as
the between factor and analysed time x condition interactions. To avoid problems attributable
to multiple testing, post-hoc tests were alpha-adjusted for the primary outcome with the

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Bonferroni-Holm method. Supplementary evaluations of changes in BMQ subscales involved
comparisons of average change from the different time points across groups via t-tests. The
additional questions were treated as exploratory testing. EORTC QLQ C-30 results were
compared with the reference samples of the questionnaire (a general population sample [25]
and an oncology reference sample [EORTC Manual, p. 15 ff., “All cancer patients: all stages”
[26]]) calculating t-tests. Effect sizes were calculated for each parameter using Cohen´s d. The
statistical significance was set at p<.05; all reported p values are two-tailed.

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3. Results

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3.1. Demographic data

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Baseline characteristics were balanced across treatment arms. There were no statistically
significant differences between the groups in the baseline demographic and medical

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parameters (Table 1 and Table 2). Data were obtained from 31 female and 13 male patients
(aged 29.3-65.6 yrs, mean age: 54.4 yrs, SD=7.7). Twelve patients (27%) had breast cancer,
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the others had different cancer diagnoses (Table 3). Almost 30 percent (29.5%) reported
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previous experience with relaxation techniques and 34 percent often listen consciously to
music. During the study, twenty-three patients (52%) underwent chemotherapy, four of these
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with Carboplatin, three with Doxorubicin, three were treated according to the Folfox scheme.
The remaining patients received other chemotherapeutics such as Bortezomib, Capecitabin
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and the PCV and PEB schemes. Antibiotics were administered to 18% of all patients (n=8),
Cortisone to 23% (n=10). Eight patients underwent full-body hyperthermia, five had local
applications and two received full-body as well as local hyperthermia. Bisphosphonates were
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administered to three patients. Almost two thirds (n=28) of all patients received mistletoe
therapy with Abnoba viscum fraxini (68% of all mistletoe treatments), Iscador Q (11%), Helixor
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M (7%), Iscador M (7%), Iscador U or Helixor P (7%).

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3.2. BMQ Outcomes and additional questions

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For the primary outcome (total sum of BMQ), there was a significant time effect (F(1,86)=6.96,
p<.01) and a significant interaction of time x condition (F(1,86)=9.74, p<.01). Post-hoc tests
indicate greater gain in well-being in the music-condition (d=.47) than in the control-condition
(d=.04). The values of the subscales inner balance (p<.001, d=.73), vitality (p<.001, d=.51)
and vigilance (p<.05, d=.37) of the BMQ increased only after the music intervention (Table 4).
We found no change in social extroversion in either of the two groups (Fig. 5).

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Among the additional questions, significant improvements in the perception of body warmth
(p<.05, d=.44), warmth distribution (p<.01, d=.49), present mood (p<.001, d=.43) and overall
satisfaction (p<.001, d=.43) were observed (Fig. 6 and Table 4) only for the music intervention
group. Pain intensity increased marginally significantly in the control group (Table 4). No other
adverse effects were reported.

3.3. Quality of life (EORTC QLQ C-30)

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At baseline, we found a significantly lower QOL global score for our participants compared to

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a general population reference sample [25](t(3062)=-6.37,p<.001, d=-.90). With respect to the
subscales, all values of the functional dimension were significantly lower (Fig. 3), whereas

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symptom dimension values (Fig. 4) were higher than those of the reference sample, indicating

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lower quality of life. For pain, the difference between our study population and the general
population sample was only a trend (t(3062)=1.91, p≤.10 (*)) which can be explained by the fact
that our patients received pain medication if required.

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4. Discussion
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To the best of our knowledge, this is the first randomized controlled study to compare the
immediate effects of a TAO-tuned sound-bed intervention on cancer patients with a control
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condition. We determined overall well-being measured by the Basler Mood Questionnaire as

our primary outcome (BMQ total sum). Compared to the control condition, the total sum of the
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BMQ scored higher after the sound-bed intervention indicating greater well-being. The BMQ
subscales (secondary outcomes) inner balance, vitality and vigilance enhanced only in the
music intervention group. Furthermore, significant improvements in body warmth, warmth
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distribution, present mood and overall satisfaction were observed in the music intervention
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group (additional questions, secondary outcomes). However, no changes were found with
respect to social extroversion which is in line with the results of Baumann and Schüle who
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used the BMQ to evaluate effects of physical activity in cancer patients [23]. A marginally
significant increase in pain intensity (additional questions) was reported in the control group.
During the interventions, patients had to lie on the wooden sound-bed for 20 minutes with only
a woollen blanket as padding underneath. If no music was played this might have been more
consciously experienced as slightly uncomfortable which might have resulted in a stronger
perception of pain. Compared to the reference samplesof EORTC QLQ C-30, our study
population reported lower QOL values.

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Focusing on the vibroacoustic stimulation during sound-bed intervention, a research group of
the Department of Psychosomatic Medicine at the Charité in Berlin/Germany recently
examined the spontaneous EEG activity during vibroacoustic stimulation compared to the
relaxation state induced by listening to audio CD relaxation music in patients with a
psychosomatic disorder. The authors found changes in EEG activity which can be interpreted
as flow experience or release of control. Furthermore, the authors did another study on altered
states of consciousness that can occur during various relaxation states [19]. The subjective
ratings of their participants with respect to both conditions showed that vibroacoustic

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stimulation (body monochord) led to greater release of control than CD music exposure. The

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body monochord tended to be experienced as more transcendental and the CD music as
sadder [27]. Additionally, the authors found reduced skin conductance levels during both

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relaxation conditions and a slight increase in salivary cortisol after exposure to the first
treatment independent of the condition [28]. Summarizing the results, they found

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improvements in psychological and physiological parameters during relaxation conditions
supporting the hypothesis of the positive effects of music interventions. In contrast to the

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Charité research group, we focused on patients with an oncological disease rather than
psychosomatic disorders. Investigating the use of a monochord for music intervention, the
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research group of the Heidelberg School of Therapeutic Sciences compared the effects of live
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played monochord music combined with a vocal improvisation to a verbal relaxation program
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played through headphones. In two studies the authors mainly focused on EEG and heart rate
variability (HRV) changes [15, 16]. At a later time, they evaluated HRV changes, self-ratings
of relaxation, well-being and acute pain using visual analogue scales and health-related quality
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of life questionnaires [29]. The research group found an increase of well-being and relaxation
during music intervention as well as changes in physiological parameters corresponding to
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altered relaxation states.

The same research group did a feasibility study to examine the effects of a monochord singing
chair combined with a vocal improvisation for palliative-care patients. The authors included
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self-ratings of pain, relaxation and well-being before and after each session as well as
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recordings of HRV as a measure of autonomic function. Due to high artifact rates in the HRV
recordings, the criterion of feasibility was not met in this study [14].
Recently, the group published another study that compared receptive live monochord music
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with a pre-recorded verbal relaxation exercise in healthy adults. However, the differences
between groups with respect to subjective relaxation and HRV changes were only marginal
[30]. In all of their studies, the authors used a monochord. Our results confirm the increase of
subjective well-being. However, due to the fact that we applied a TAO-tuned sound-bed,
comparability remains limited. The same applies to some other studies exploring music therapy

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in palliative care focusing e.g. on quality of life in which other instruments are used such as the
guitar or the voice [31, 32].
The present study has some limitations: Only immediate effects of the sound-bed intervention
and no physiological parameters were evaluated. Consequently, no conclusions can be drawn
about possible long-term effects of sound-bed music intervention or about physiological
changes caused by the sound-bed. With respect to the special features of the TAO-tuned
sound-bed, we did not examine the differences between listening to sound-bed music alone
and the presumable additional effects of the vibroacoustic stimulation.

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Our results might be biased by social desirability – patients could assume that the investigator
expected a higher impact of the music intervention – and by the fact that neither the patients

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nor the study team were blinded and the assessed endpoints were subjective. Chemotherapy

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might in some patients have caused peripheral neuropathy which could result in an impaired
sensitivity for the vibroacoustic stimulation whose possible impact could not be quantified and

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thus might be another source of bias. Moreover, only few of the oncological in-patients were
in shape to participate in the study and of these several declined due to a subjective lack of

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energy and motivation. Thus, the patients who consented to participate might represent a
selective sample.
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However, we can now provide a set of data raised from oncology patients during their inpatient
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treatment including both sexes, different ages and various oncology diagnoses.
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Future research should investigate the data from multiple sessions for each patient to
determine if the benefit of sound-bed intervention increases over time. Particular emphasis
should be placed on the collection of physiological data. Evaluations of study populations
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differentiated by cancer type might shed light on the question if the response to music
intervention varies in different forms of cancer. Finally, the differences between a TAO-tuned
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sound-bed and a monochord for music intervention should be addressed in the future.
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5. Conclusion
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In conclusion, we found positive emotional experiences induced by the vibroacoustic TAO-
tuned sound-bed in oncology patients. The results showed greater subjective well-being
following the vibroacoustic music intervention compared to the non-music control condition.
However, to estimate the overall effects of a vibroacoustic sound-bed music intervention,
especially the role of the bodily vibrations of the instrument, more objective outcome
measures are needed such as physiological parameters that can reinforce the argument of
the therapeutic effect of the sound-bed.

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Authors’ Disclosures of Potential Conflicts of Interest

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The authors indicate no potential conflicts of interest.

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Acknowledgements

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We would like to express particular thanks to Dr Stefan Hiller and Dr Sebastian Schlott of the
department of oncology, Filderklinik, for supervision and general support, to Doris
Dorfmeister (music therapist at the Filderklinik, Filderstadt, Germany) for teaching how to

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play the sound-bed. We also thank the Filderklinik, Germany, especially the oncology team
for their support by providing their sound-bed. Thanks to Dr Katrin Vagedes, Tido von Schön-
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Angerer and Prof David Martin for help with the translation. The study was financed by the
ARCIM Institute.
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19. Sandler, H., et al., Positive Emotional Experience: Induced by Vibroacoustic Stimulation Using a Body
Monochord in Patients with Psychosomatic Disorders: Is Associated with an Increase in EEG-Theta
and a Decrease in EEG-Alpha Power. Brain Topogr, 2016. 29(4): p. 524-38.
20. Hobi, V., Basler Befindlichkeits-Skala (BBS). 1985, Beltz Verlag, Weinheim.

T
21. Riedel, M., et al., Quality of life in patients with Addison's disease: effects of different cortisol
replacement modes. Exp Clin Endocrinol, 1993. 101(2): p. 106-11.

IP
22. Wichers, M., et al., The influence of hydrocortisone substitution on the quality of life and parameters of
bone metabolism in patients with secondary hypocortisolism. Clin Endocrinol (Oxf), 1999. 50(6): p.
759-65.

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23. Baumann, F., Schüle, K., Einflüsse körperlicher Aktivitäten auf die Befindlichkeit von Patienten in der
Akutklinik bei einer Knochenmarktransplantation. Bewegungstherapie und Gesundheitssport, 2006. 22:
p. 176-180.

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24. Wellek, S. and M. Blettner, Vom richtigen Umgang mit dem Crossover-Design in klinischen Studien.
Deutsches Aerzteblatt International, 2012. 109(15).
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general German population. European Journal of Cancer, 2001. 37(11): p. 1345-1351.
26.
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EORTC. EORTC QLQ-C30 Reference Values Manual. 2015.02.02]; Available from:
http://groups.eortc.be/qol/manuals.
N
27. Sandler, H., et al., Subjective experience of relaxation – induced by vibroacoustic stimulation by a Body
Monochord or CD music – a randomised, controlled study in patients with psychosomatic disorders.
A
Nordic Journal of Music Therapy, 2017. 26(1): p. 79-98.
28. Sandler, H., et al., Relaxation – Induced by Vibroacoustic Stimulation via a Body Monochord and via
Relaxation Music – Is Associated with a Decrease in Tonic Electrodermal Activity and an Increase of
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the Salivary Cortisol Level in Patients with Psychosomatic Disorders. PLOS ONE, 2017. 12(1): p.
e0170411.
29. Warth, M., et al., Music Therapy in Palliative Care: A Randomized Controlled Trial to Evaluate Effects
on Relaxation. Deutsches Ärzteblatt International, 2015. 112(46): p. 788-794.
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30. Gabel, C., et al., [Effects of Monochord Music on Heart Rate Variability and Self-Reports of Relaxation
in Healthy Adults]. Complement Med Res, 2017. 24(2): p. 97-103.
31. Hilliard, R.E., The effects of music therapy on the quality and length of life of people diagnosed with
terminal cancer. J Music Ther, 2003. 40.
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32. Nguyen, J., The effect of music therapy on end-of-life patients’ quality of life, emotional state, and
family satisfaction as measured by self-report. Master's Thesis. 2003, Florida, USA: Florida State
University.
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Figures and Tables

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A
Fig. 1
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Exemplary scene. The therapist plays the sound-bed with the fingers while sitting beside the
instrument ©Edwin Wall, studios dell´arte
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E PT
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IP
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SC
Fig. 2
U
N
Flow of study participants over the study period
A
M
ED
E PT
CC
A

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 ref. EORTC
general population
study

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U
N
A
Fig. 3
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EORTC QLQ-C30 functional scales of study participants compared with a general population [25] and
an oncology reference sample of the EORTC manual (means and standard deviation with ***p≤.001).
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E PT
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A

16
 ref. EORTC
general population

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study

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U
N
A
Fig. 4
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EORTC QLQ-C30 symptom scales of study participants compared with a general population [25] and
an oncology reference sample of the EORTC manual (means and standard deviation with ***p≤.001).
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E PT
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 26

24
Subscores Basler Mood Questionnaire

(***)

22

inner balance
20 (*)
vitality

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(***) social extroversion

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18 vigilance

R
16

SC
14
pre post pre post
(music) (music) (control) (control)

U
N
Fig. 5

Mean (±SE) changes in the subscale scores of the Basler Mood Questionnaire over each condition.
A
Each item scored from 1 to 7; higher numbers indicate greater values for inner balance, vitality, social
extroversion and vigilance
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ED
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18
 6.5

6.0
Scores additional questions

(***)

5.5 (*)
body warmth
(**)
warmth distribution

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(***) actual mood
5.0
overall satisfaction

R IP
4.5

SC
4.0
pre (music) post (music) pre (control) post (control)

Fig. 6
U
N
Mean (±SE) changes in the additional questions over each condition. Each item scored from 1 to 7;
higher numbers indicate greater values for body warmth, warmth distribution, actual mood and overall
A
satisfaction
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Table 1

Baseline characteristics of study participants by group.

Total Group 1 Group 2

Music-Control Control-Music

n = 44 n = 21 n = 23

Age t(42)=.94, p=.35

Mean ± SD 54.35 (7.67) 55.49 (5.84) 53.30

T
(9.03)

IP
Range (years) 29-65 41-64 29-65

R
Sex χ2(1)=.28, p=.74

SC
female 31 (70.5%) 14 (66.7%) 17 (73.9%)

male 13 (29.5%) 7 (33.3%) 6 (26.1%)

Disease stage

(at initial diagnosis) U χ2(4)=1.25, p=.87

N
unknown 9 (20.4%) 3 (14.3%) 6 (26.1%)
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I 4 (9.1%) 2 (9.5%) 2 (8.7%)
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II 4 (9.1%) 2 (9.5%) 2 (8.7%)

III 16 (36.4%) 9 (42.9%) 7 (30.4%)

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IV 11 (25.0%) 5 (23.8 %) 6 (26.1%)

Chemotherapy χ2(1)=.38, p=.54

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Yes 23 (52.3%) 12 (57.1%) 11 (47.8%)

No 21 (47.7%) 9 (42.9 %) 12 (52.2%)

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Education (n=43) χ2(2)=3.88, p=.14

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≤secondary school 19 (43.2%) 12 (57.1%) 7 (30.4%)

Abitur 7 (15.9%) 1 (4.8%) 5 (21.8%)

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University degree 17 (38.6%) 6 (28.6%) 11 (47.8%)

Employment status (n=43) χ2(1)=.003, p=.95

Yes 26 (59.1%) 12 (57.1%) 14 (60.9%)

No 17 (38.6%) 8 (38.1%) 9 (39.1%)

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Practicing relaxation techniques χ2(1)=.28, p=.60

Yes 13 (29.5%) 7 (33.3%) 6 (26.1%)

No 31 (70.5%) 14 (66.7%) 17 (73.9%)

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U
N
A
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Table 2

Baseline calculations comparing t1 music vs. t1 control

music control

t1 t1 t(42)

Total sum 71.80 (19.67) 73.52 (20.62) -.74, p=.46

Inner balance 19.70 (5.18) 20.50 (5.28) -1.1, p=.28

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Vitality 16.50 (6.31) 16.41 (6.17) .03, p=.97

IP
Vigilance 18.52 (5.39) 18.95 (.84) -.65, p=.52

Social extroversion 17.07 (5.58) 17.66 (5.55) -.75, p=.46

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Satisfaction 4.53 (1.93) 4.45 (2.12) .22, p=.83

SC
Current mood 5.02 (1.73) 5.27 (1.56) -1.03, p=.31

Pain intensity (VAS)

Body warmth
12.88

5.14
(19.59)

(1.46)
12.75

4.68 U
(18.62)

(1.60)
.18, p=.86

1.46, p=.15
N
Warmth distribution 4.80 (1.94) 4.57 (1.86) .65, p=.52
A
M

Table 3

Distribution of tumour diagnosis of participants

D

primary diagnosis number of patients %

TE

Mamma CA 12 27.3
EP

Colorectal CA 6 13.6

Bronchial CA 4 9.1
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Lymphoma 4 9.1
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Others 18 40.9

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Table 4

U
Descriptive statistics (M (SD)) of behavioural parameters at t1 and t2 for music and control condition

N
music control

t1 t2 t1 vs. t2 t1 t2 t1 vs. t2

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BMQ
Total sum 71.80 (19.67) 81.00 (16.26) t(43)=-3.98. p<.001 73.52 (20.62) 72.75 (20.63) t(43)=.35. p=.73

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Inner balance 19.70 (5.18) 23.47 (4.40) t(43)=-5.72. p<.001 20.50 (5.28) 20.84 (5.39) t(43)=-.49. p=.63

Vitality 16.50 ED (6.31) 19.75 (5.33) t(43)=-4.12. p<.001 16.41 (6.17) 16.73 (5.85) t(43)=-.54. p=.59

Vigilance 18.52 (5.39) 20.50 (4.95) t(43)=-2.60. p=.01 18.95 (.84) 18.55 (5.56) t(43)=.58. p=.57

Social extroversion 17.07 (5.58) 17.27 (4.95) t(43)=-.25. p=.81 17.66 (5.55) 16.64 (5.86) t(43)=1.74. p=.09
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Additional questions
Satisfaction 4.53 (1.93) 5.36 (1.78) t(43)=-3.83. p<.001 4.45 (2.12) 4.61 (1.94) t(43)=-.62. p=.54
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Current mood 5.02 (1.73) 5.36 (1.78) t(43)=-5.69. p<.001 5.27 (1.56) 5.18 (1.54) t(43)=.45. p=.66
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Pain intensity 12.88 (19.59) 10.00 (16.3) t(43)=1.28. p=.21 12.75 (18.62) 15.36 (21.56) t(43)=-1.86. p=.07

Body warmth 5.14 (1.46) 5.77 (1.38) t(43)=-2.50. p=.02 4.68 (1.60) 4.70 (1.79) t(43)=-.104. p=.92

Warmth distribution 4.80 (1.94) 5.75 (1.30) t(43)=-2.84. p=.007 4.57 (1.86) 4.86 (1.75) t(43)=-1.29. p=.20
A

23