The Effectiveness of Music Therapy on Hand Function in Patients With Stroke: A Systematic Review of Randomized Controlled Trials

With music therapy having been proven well over a decade ago, why was this research needed?

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The Effectiveness of Music Therapy on Hand Function in Patients With Stroke: A Systematic Review of Randomized Controlled Trials

Wen-Hao Huang¹, Zu-Lin Dou^1*, Hui-Min Jin², Ying Cui³, Xin Li¹ and Qing Zeng⁴

• ¹Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
• ²Shanghai Sunshine Rehabilitation Center, Shanghai, China
• ³Shandong University of Traditional Chinese Medicine, Jinan, China
• ⁴Department of Rehabilitation Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China

Objective: This study aims to evaluate the efficacy of music-supported therapy for stroke patients' hand function.

Methods: The databases used included Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, Embase, Music Index, and Google Scholar. Studies published between January 2010 and August 2020 were included. The searching key terms included “music-supported therapy,” “music therapy,” “hand function,” “hand dysfunction,” “stroke,” “ischemic,” and “hemorrhagic.” Randomized controlled trials or controlled trials involving adults who have hand function problems caused by stroke are included in this study. The methodological quality and risk of bias of the included studies were rated by two independent assessors under the guidance of Cochrane collaboration's risk of bias tool.

Results: Twelve studies that met the inclusion criteria were included in this study. Totally, the data included 598 stroke patients (345 male, 253 female) with recruited time from 1.7 months to 3 years, and the mean age of the participants were 61.09 years old. Based on the Cochrane risk of bias tool, study quality ranged from three to seven out of seven points. Compared with the control group, outcomes including hand strength, range of joint motion, dexterity of hands, arm function, and quality of life were significantly superior with music-supported therapy. Five studies reported improved dexterity of hands, and one study reported the improvement of range of motion and strength of patients' hands, which supported the therapy has positive effects on patients' hand function and improving their quality of life after the therapy. The therapy ranged over a period of 4–8 weeks, with an average duration of 30 min/session and an average of three times per week.

Conclusion: Based on the results, music-supported therapy could be a useful treatment for improving hand function and activities of daily living in patients with stroke, especially for patients within 6 months after stroke. However, the low certainty of evidence downgrades our confidence to practice in hospital. More and more randomized controlled trials and larger sample sizes are required for a deeper review.

Introduction

Stroke is believed to affect more than two million patients annually in China and is one of the most common causes of hand function impairment in middle-aged as well as elderly people. The stroke symptoms may include numbness and weakness in the affected arms and cause a loss of coordination and dexterity (1, 2). Although most of the function can be restored with rehabilitation, ranging up to 79%, the recovery of functional problems of the hand left after stroke is not as satisfactory (3). It has been estimated that ~67% of stroke survivors are still unable to use the affected hand 4 years after the onset of stroke (4, 5). Therefore, rediscovering the potential of hand function and improving the quality of life is of great value to stroke patients.

The most commonly used conventional treatment for hand function problems include constraint-induced movement therapy (CIMT), mirror therapy, virtual reality, and music-supported therapy (MST) (6–8). MST for hand function is usually achieved by playing the instructions. The movement patients conduct during playing the piano or grasping drumsticks can facilitate the coordination of hands, strengthen the power of grasp of the impaired hand (9). The aim of the MST is to improve the function of the upper limbs and to provide appropriate stimulation through real-time auditory feedback. Studies have shown that after a 4-week MST program, the hand mobility, fluency, and speed of stroke patients can improve during the test. Besides, the sensory stimulation brought by music can induce functional recovery in damaged hemispheres.

Through the combination of music and movement, MST uses continuous movement and sensory input to enable the patient's central nervous system to re-establish new synaptic connections to the greatest extent possible, thereby creating new neuromotor pathways. Functional magnetic resonance imaging (fMRI) shows that the blood flow of the damaged area of the brain increases when receiving stimulation from MST, which can help repair the cerebral cortex caused by cerebral hemorrhage or cerebral infarction (10). Especially, when patients with high muscle tension caused by stroke, MST can relieve high muscle tension and increase the ability of fingers to move freely. Brain plasticity is associated with treatment-induced recovery, which helps the patient to repair after the brain is damaged (11). When stroke patients participate in MST, they need to process information from multiple senses at the same time, including auditory, visual, and sensorimotor information, which is transmitted from the auditory system to the premotor cortex (PMC), thereby adjusting the top-down output (12). However, a major current focus in MST is to evaluate how does MST works and how does MST helps patients with gait problems (13). Few researchers have addressed the problem of MST improving the hand function of stroke patients.

Up to now, the effect of MST on the recovery of hand function during rehabilitation has not been gone through systematically yet. Therefore, we decided to undertake a systematic review to find out evidence that can support that MST has ideal curative effect in the recovery of impaired hand in stroke patients. The review sheds new light on the therapy for helping patients more effectively and increasing the ability of motor control, especially the hands so that they can finish the daily life task by themselves. One of the main challenges is that we need to search the randomized controlled trials (RCTs) based on MST on stroke patients, which are the gold standard for effectiveness research (14). Our systematic literature review solves the PICOS question, “Does MST can help stroke patients improve their hand function and increase the quality of life?” The answers may provide new thinking for occupational therapy and determine the effectiveness of the MST.

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