The effect of collaborative approach to implementing music-based interventions for patients with different neurological disorders

Li-Jie Du^1*Yun-Ze Li²Xing-Yuan Du³

• ¹Shanghai Normal University, Shanghai, China
• ²Nanjing Normal University of Special Education, Nanjing, China
• ³University of Chinese Academy of Social Sciences, Beijing, China

neurological disorders. The cited literature spans multiple contexts and formats, where terms like "music intervention" and "music medicine" are often used interchangeably.To ensure consistency, this article uniformly employs "music intervention" instead of retaining the terminology specific to each original context.The article advocates for a collaborative approach to the implementation of musicbased interventions, acknowledging that different cultures and approaches do exist.It culminates in the discussion of two critical observations: Firstly, "vertical collaboration" (cross-cultural or cross-group) in music interventions ensure its cultural adaptability that cultural characteristics embedded are deeply rooted in ethnic and geographical determinants; Secondly,"horizontal collaboration" lies in knowledge integration, which tackles complexity through a multidisciplinary perspective.The maximal efficacy of music intervention is contingent upon its integration with other therapeutic paradigms. Music intervention has been proven to be significantly effective for individuals with sleep disorders 4 5 , 6 depression patients 7 , stroke survivors 8 , and those with Alzheimer's disease 9 . It can also improve the psychological state of cancer patients and alleviate pain, among other benefits 10 . The application of music to enhance the physical and mental well-being of mothers and infants during pregnancy and postpartum constitutes an important component of the music intervention discipline 11 12 13 .The research findings presented below provide robust evidence for the positive effects of musicbased interventions in addressing neuropsychiatric disorders and broader mental health or wellbeing outcomes for non-disorder populations. Insomnia Disorder (ID) is a common sleep disorder in modern society and listening to music is widely used as a sleep aid. The music-based intervention is safe and easy to administer.The primary objective of randomized controlled trials and quasirandomized controlled trials is to compare the effects of listening to music with no treatment or treatment-as-usual on sleep improvement in adults with insomnia.The findings provide evidence that music may be effective for improving subjective sleep quality in adults with insomnia symptoms 14 .Insomnia is also a common sleep disorder for adults with depression. It reduced quality of life with significant negative effects on daytime cognitive functions, and is associated with impairments in physical and mental health.Based on comparisons of music intervention plus Treatment As Usual (TAU) vs. TAU alone, the findings indicate that music intervention combined with TAU is beneficial for patients with depression in the short term compared to TAU alone, while also improving anxiety and functioning 15 .Previous trials suggest that listening to music may be helpful in the treatment of sleep disturbances in healthy populations, including students and older adults. In addition, small studies with clinical populations of traumatized refugees, adults with chronic insomnia and adults with depression insomnia add to the evidence base 16 . Music that aids sleep is not necessarily the "sedative music" defined in academic literature, though certain features of sedative music are indeed linked to sleep-promoting effects. Some studies seek to identify the specific musical characteristics reported to be effective or ineffective in aiding sleep. Pinpointing these traits is critical for selecting musical pieces used in music-based intervention research 17 .Sleep is a complex rhythmic state that may be affected by the ageing process. A few studies have focused on the effects of music, a non-pharmacological method of improving the quality of sleep in older adults. It reported an investigation of the effects of soft music on sleep quality in older community-dwelling men and women in Taiwan.Music resulted in better sleep quality significantly in the experimental group, as well as sleep improved weekly, indicating a cumulative dose effect.The findings provide evidence for the use of soothing music as an empirically-based intervention for sleep in older people 18 . These study suggested that more research is required to strengthen the scientific knowledge of the effects of on sleep quality in adults with sleep disturbances 19 . The research findings advocate for the use of music in stroke rehabilitation, cancer care, and pain management. When integrated into routine stroke rehabilitation, music intervention has garnered excellent feedback from both patients and caregivers. All caregivers expressed the belief that this therapy could enhance stroke rehabilitation practices and yield tangible benefits for patients 20 .The research indicates that music intervention can enhance cognition, mood and behavior in individuals with AD. Non-pharmacological therapy has gained popularity in the intervention of Alzheimer's disease (AD) due to its apparent therapeutic effectiveness and the limitation of biological drug 21 . Research on music intervention for dementia in the United States began in the mid-1980s, and music intervention has been applied as a broader therapeutic approach for dementia since the 1990s 22 .Music-based intervention may also reduce anxiety, depression, and pain catastrophizing. The data support the use of music-based intervention to reduce postoperative opioid requirements.Patients in the music-based intervention group consumed less opioids than those in the control group 23 .A study's findings highlight the role of music in cancer care, indicating that patient characteristics-such as their outlook on life and willingness to explore emotions tied to their cancer experience-can influence treatment outcomes. Quantitative data further reveal that both music therapy (MT) and music medicine (MM) interventions are equally effective in improving psychological outcomes and reducing pain in cancer patients 24 .A meta-analysis demonstrated that music listening significantly alleviated preoperative anxiety and postoperative pain in patients undergoing gynecological surgery, compared with the control group. Consequently, operating room nurses are recommended to implement perioperatives 25 . The transition to motherhood can be a stressful journey, yet women's psychological and emotional needs often take a backseat to their physical wellbeing. Pregnancy profoundly impacts a woman's physical and mental health, and caring for a newborn post-childbirth presents unique challenges. Stress and anxiety are common during both pregnancy and the postpartum period, with detrimental effects on both mothers and infants. Existing research in this area provides evidence supporting the use of musicbased interventions to promote maternal mental health among women with healthy term infants during the postpartum phase 26 .The therapy aimed to reduce stress and anxiety levels, provide emotional support, and enhance maternal-infant bonding for women during antepartum and postpartum hospitalization at a large urban medical center.An evaluation study showed the music intervention program was implementable and well-received, with high satisfaction reported, positive effects on participants' relaxation and sense of connection with their infants, and strong endorsement from involved healthcare providers and staff 27 . Gestational hypertension is a common complication during pregnancy.A systematic review and meta-analysis suggests that adjunctive music intervention provides clinically relevant benefits for controlling systolic and diastolic blood pressure and improving psychological outcomes including anxiety, depression, and sleep quality in patients with hypertensive disorders of pregnancy(HDP) when compared with standard care alone 28 . Prenatal sleep disturbance has been associated with undesirable birthing outcomes.The effectiveness of listening to music at home in improving sleep quality was determined in a study about Taiwanese pregnant women with poor sleep quality. This study supported the theory that 2-week music listening interventions may reduce stress, anxiety, and yield better sleep quality for sleep-disturbed pregnant women 29 . The broad applicability of music intervention across diseases and populations arises from its universal regulatory role via a "biology-psychology-society" multidimensional mechanism. When applied to heterogeneous groups, its standardized implementation typically follows three sequential stages: Needs Assessment (physical/psychological indicators) → Program Customization (music type/intervention form) → Effect Feedback (quantitative + qualitative data). While this framework ensures procedural standardization, enhancing multiparty collaboration remains critical to improving intervention outcomes.Music-based intervention lies in both respecting the "root" of cultural diversity and pursuing the "integration" of therapeutic approaches, viewed from a collaborative perspective.So it usually requires two forms of collaboration: "vertical collaboration" (cross-cultural or cross-group) to ensure its cultural adaptability, and "horizontal collaboration" (cross-disciplinary or crossmethodological) to achieve systematic, precise treatment. Cultural characteristics embedded in music-based interventions are deeply rooted in ethnic and geographical determinants.Music intervention possesses distinct regional cultural traits, manifested in how musical traditions from different areas influence therapeutic approaches and outcomes.American music, characterized by its diversity and fusion with modern genres, widely employs methods like improvisation and music composition in therapy, reflecting the practice of the Nordoff-Robbins music intervention approach. Middle Eastern music,is frequently applied in meditation, religious rituals, and emotional regulation, demonstrating its local religious and cultural customs. Ancient Persian Medicine ( PM ) always took into account the patient's cultural background and region, and adjusted their prescriptions accordingly. This practice even affected the music interventions which was changed by the patient's individual differences-which can be described as a form of ethnomusic intervention 30 ,which originates from music intervention, and performed by a certified professional who considers the ethnic and cultural properties of music in the healing process 31 .The cross-cultural implementation of music intervention requires the establishment of a professional collaborative team, whose core members should include music therapists, cultural anthropologists, and local medical staff.For instance, Persian medical experts could be invited to verify the compatibility between music intervention programs and local traditional medical theories.In the music selection process, a dynamic screening mechanism should be established to accurately match the type of disease and intervention goals: Jazz standards can be used to promote social interaction for elderly depressed patients in the United States ; For patients with chronic pain in the Middle East, Oud improvisation can be adopted to distract pain attention through the linear flow of melody. To ensure the cultural fidelity of the intervention, it is recommended to introduce the "Cultural Congruence Scale", where local experts evaluate the compatibility between musical elements and the target culture-for example, when using African-American spirituals, their cultural appropriateness needs to be verified through community religious context assessment tools, ultimately achieving the deep integration of intervention programs with community culture.In the field of special education, music intervention is also employed to assist children with autism. Cross-cultural comparative studies indicate that the methods and outcomes of music interventions for children vary across cultural contexts. Music intervention demonstrates regional cultural differences. Within folklore and child psychology traditions, both descriptive and empirical research confirms that lullabies and play songs serve not only as caregiving tools but also constitute vital components of regional knowledge systems 32 .Kerry Byers(2016) claims that most countries were introduced to music intervention by music therapists returning from studying abroad in the U.S. and U.K., but each country deserves independent inquiry as to the nuances of its development 33 .The study examined the effectiveness of s on depressive symptoms among care home residents with dementia in Australia, Germany, the Netherlands, Norway, Türkiye, and the UK.The interpretation of the findings indicates that effects varied between countries.Notably, Country was the strongest predictor for differences in effects, underlining the importance of cultural and systemic differences 34 . Globally, intervention guidelines and healthcare policies must be carefully tailored to the specific cultural and systemic contexts of care home populations and varying levels of care across different countries and regions. Music-based intervention merged with other method since its inception, serving together as a resource to promote human mental health and well-being.Since the 1990s, "Creative music intervention" proposed by Paul Nordoff and Clive Robbins, and Tom Kitwood's "person-centered dementia care" have shared humanistic therapeutic principles, forming a convergence of theories. This alignment has promoted the adoption of music intervention as a broader therapeutic approach for dementia in the United States 35 .The latest findings from Europe, implemented across Italy, Portugal, and Romania, show that the SOUND person-centered delivered to 41 older adults with mild-to-moderate dementia in eldercare facilities resulted in significant improvements in participants' well-being, cognition, and executive functions over time, with these benefits remaining stable in cross-national follow-up assessments 36 . patients with single-disease conditions with substantial supporting evidence, they exhibit certain limitations when applied to patients with complex conditions, where standalone s yield less pronounced effects. For instance, in the management of chronic pain in individuals with dementia, various types of music intervention have been recommended and utilized as an alternative to analgesic drugs 37 , yet relevant evidence remains notably insufficient.Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. A cluster randomized controlled trial (RCT) aims to demonstrate that an 8-week music-based care intervention (MBC) can effectively reduce pain intensity among nursing home residents with dementia and chronic pain.Unfortunately, this reliable randomized controlled study did not find that music care had an effect on the pain intensity of nursing home residents with dementia and chronic pain 38 .To enhance the above research, we should explore potential improvement factors by examining intervention dosage and implementation fidelity.This is because an insufficient sample size or sub-threshold intervention intensity may prevent the full manifestation of effects.Simultaneously, collaboration across multiple domains and disciplines should be strengthened: Firstly, it is recommended to optimize intervention protocols through multi-stakeholder collaboration involving physicians, patients, family members, and pharmacists, such as implementing combined nonpharmacological therapies; Secondly, incorporating professional recommendations from collaborative teams including neurologists and rehabilitation therapists, and introducing objective indicators such as cortisol levels and sleep quality to enhance the sensitivity of outcome assessments.The maximal efficacy is contingent upon its integration with other therapeutic paradigms. Music-based intervention works best when combined with other approaches.Given the existing evidence demonstrating that music intervention can be effectively integrated with social work, its significance in clinical treatment should not be overlooked. Research prioritizing the psychosocial benefits of music over purely musical outcomes is increasingly prevalent 42 . Future research efforts will focus on standardizing outcome measures, intervention delivery settings, implementation methods, and target populations to enhance the practical efficacy of music interventions. These endeavors aim to contextualize findings within clinical frameworks, guide evidence-based practice, and further establish music intervention as a validated therapeutic approach 43 . Additionally, there is a critical need for cross-national large-scale studies comparing the ethnographic dimensions of music, as well as integrated research combining biological molecular testing with socio-psychological assessments in music-based interventions for patients with different neurological disorders.