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19th May 2022
The ENO Breathe programme used by patients experiencing long COVID symptoms has been found to improve mental health scores and elements of breathlessness compared to usual care. This was the conclusion from the first randomised trial to evaluate interventions for patients with long COVID by a UK team of researchers from London.
A recognised consequence for some patients after an acute infection with COVID-19 is long COVID and which has been defined as new or ongoing symptoms 4 weeks or more after the start of acute COVID-19. A wide range of symptoms experienced by those with long COVID have been documented with the most frequently reported including breathing problems, fatigue, muscle weakness or joint stiffness, sleep disturbances, problems with mental abilities, and mood changes such as anxiety or depression. Furthermore, a review of studies has suggested in both acute and long COVID, the impact of infection on health-related quality of life is substantial. In a systematic review, researchers identified how music interventions were associated with clinically meaningful improvements in health-related quality of life.
The English National Opera has created the ENO Breathe programme, to help patients recovering from the effects of COVID-19 an,d for the present study, the UK researchers set out to determine whether the programme could improve both mental and physical aspects of health-related quality of life, as well as breathlessness, in patients with long COVID. They conducted a parallel-group, single-blinded, randomised trial to compare the ENO programme with usual care. Eligible patients were adults (> 18 years of age) and who were recovering from COVID-19 with ongoing breathlessness with or without anxiety for at least 4 weeks after their acute onset of symptoms. Individuals were randomised 1:1 to the ENO Breathe programme or usual care. The programme was individualised and designed to support people with breathlessness and/or anxiety by focusing on breathing, retraining through singing techniques and delivered online. It consisted of an introductory session followed by 6, once weekly sessions.
The primary outcome of interest was a change in health-related quality of life (HRQoL) from baseline to the end of the 6-week programme and which was assessed using the RAND 36-item short form survey instrument and in particular two summary measures, the mental health (MHC) and physical health components (PHC). A number of secondary outcomes were used including a visual analogue scale (VAS) for breathlessness on rest, walking, climbing stairs and running.
ENO Breathe programme and HRQoL
A total of 150 participants with a mean age of 49 (81% female) were randomised to either the ENO programme or usual care. Across the two groups, there was a mean of 320 days since the onset of their initial COVID-19 symptoms.
Compared to usual care, those allocated to the ENO Breathe programme had a greater improvement in the MHC (regression coefficient = 2.42, 95% CI 0.03 – 4.80, p = 0.047). However, there was no significant difference between groups for the PHC component (p = 0.54).
With respect to breathlessness, the only self-reported measure to significantly reduce was based on running (p = 0.0026).
The authors concluded that the ENO Breathe intervention could improve mental health wellbeing and one aspect of breathlessness and suggested that the programme might have a role in supporting patients with persisting long COVID symptoms.
Philip KEJ et al. An online breathing and wellbeing programme (ENO Breathe) for people with persistent symptoms following COVID-19: a parallel-group, single-blind, randomised controlled trial Lancet Respir Med 2022
31st March 2022
The use of music interventions appear to be associated with clinically meaningful improvements in mental and a smaller improvement in physical health-related quality of life. However, the specific type of music intervention providing the greatest benefit remains unclear. This was the conclusion from a meta-analysis of studies by researchers from the Institute of Music Physiology and Musicians’ Medicine, Hannover University of Music, Hannover, Germany.
The use of music interventions (MIs) such as listening to music, playing an instrument or singing, has been shown to positively impact on the global and social functioning of patients with mental health conditions such as schizophrenia. Furthermore, there is also reliable evidence for the positive effects of music and singing on wellbeing (related to the positive aspects of a person’s life) in adults without underlying mental health problems. Other evidence from an umbrella review of performing arts as a health resource, concluded that positive health effects were associated with as little as 30 to 60 minutes of performing arts participation.
The CDC in the US defines health-related quality of life (HRQOL) as an individual’s or a group’s perceived physical and mental health over time. HRQOL can be assessed using dedicated questionnaires, including the 36-item Health Survey Short Form (SF-36) and related, reduced 12-item Health Survey Short Form (SF-12). Moreover, both the SF-36 and 12 have been used in studies of music interventions.
Although music interventions appear to give rise to improvements in both HRQOL and well-being, what remains unclear is the associations between different types of MIs and changes in HRQOL as measured using both the SF-36 and SF-12. This was the purpose of the current study and the German team included randomised and non-randomised trials that investigated music making (singing, listening, playing music) interventions and which reported changes in SF-36 or SF-12, before and after the intervention. The researchers focused on both the mental component summary (MCS) and the physical component summary (PCS) of the SF-36 or SF-12 since higher scores in each of these domains were indicative of better mental and physical HRQOL. The threshold mean difference in MCS scores was set as a mean difference of 3 or more.
Music interventions and MCS and PCS scores
The literature search identified 26 eligible studies with 779 participants (mean age = 60 years) and which comprised listening to music, music therapy, singing with one study exploring the effect of gospel music.
Overall, a music intervention was associated with a significant decrease in both MCS (total mean difference, TMD = 2.95, p < 0.01) and PCS scores (TMD = 1.09, p = 0.02) compared to pre-intervention values.
In subgroup analysis, in which MIs were added to usual treatment, there was a significant increase in MCS scores vs usual treatment alone (TMD = 3.72, 95% CI 0.40 – 7.05) but not for PCS. However, it was not possible to identify any important differences based on the type of musical intervention.
The authors concluded that while MIs led to a significant increase in mental HRQOL, the changes in PCS were equivocal. They added that given the variation in the effect of the different interventions such as singing, listening to music etc, it was not possible to provide any firm recommendations about the optimal intervention or dosage for use in specific clinical scenarios.
McCrary JM et al. Association of Music Interventions With Health-Related Quality of Life: A Systematic Review and Meta-analysis JAMA Netw Open 2022