The impact of music on anxiety, pain, and blood pressure in ophthalmic surgery: A systematic review and meta-analysis

Objectives: To evaluate the effectiveness of music therapy in reducing anxiety, pain, and vital sign changes in ophthalmic surgery patients. Methods: An extensive search of databases, including PubMed, Embase, Cochrane, Web of Science, and Google Scholar, identified relevant studies up to Jan 2024. Selection of studies was conducted based on the PICOS criteria. The quality of methodology was assessed using the Cochrane risk-of-bias assessment tool and Review Manager 5.4. Meta-analysis comparing the control group and the music therapy group was performed using R and Stata/SE 15.1 random or fixed effects model. Results: This meta-analysis included fifteen studies comprising 2098 participants. The analysis revealed that music therapy significantly reduced the risk of high anxiety levels as measured by Visual Analogue Scale (VAS) (I2 = 0 %, RR(95 %CI): 0.75(0.63, 0.88), p = 0.0006), indicating a substantial effect without heterogeneity. The Anxiety scores determined by State-Trait Anxiety Inventory-State (STAI-S) also showed a significant decrease (SMD(95 %CI): - 0.75(- 0.88, - 0.61), p < 0.0001), albeit with moderate heterogeneity (I2 = 36 %). Additionally, music therapy was associated with a reduction in intraoperative pain levels, with no observed heterogeneity (I2 = 0 %, SMD(95 %CI): -0.74(-0.93, -0.56), p < 0.0001). In contrast, music intervention did not significantly influence self-reported nervousness, relaxation, or satisfaction levels as determined by VAS. Regarding to physiological parameters, a marginal decrease in systolic blood pressure (SBP) was observed (SMD(95 %CI): -0.42(-0.79, -0.04), p = 0.0286), with considerable heterogeneity (I2 = 92 %). Diastolic blood pressure (DBP) experienced a slight reduction (I2 = 90 %, SMD(95 %CI): -0.45(-0.79, -0.11), p = 0.0088). However, no significant effect was observed on patients' heart rate (p = 0.0864). Conclusion: Music therapy effectively reduced anxiety and pain, and moderately improved vital signs in patients undergoing ophthalmic surgery, highlighting its role in enhancing patient well-being. Further in-depth RCTs are needed to confirm its efficacy.