INTRODUCTION:

Pain is an unpleasant sensory and emotional experience. Pain can affect the physiological, emotional, affective and psychological dimension of an individual. Hence it is termed as a complex, Multi-dimensional experience. Pain is personal, Subjective in expression with no objective measurements. Pain is frequently the result of nociception¹

Music therapy is the use of music to improve client’s quality of life. Music therapy is an evidence-based, clinical use of music interventions.

The music therapist uses music and all of its facets–physical, emotional, mental, social, aesthetic, and spiritual–to help clients improve their health and quality of life. Music has proven to be an effective tool for music therapists through extensive research. It is beneficial for any individual, both physically and mentally, through improved heart rate, reduced anxiety, stimulation of the brain, and improved learning. Music therapists use their techniques to help their patients in many areas, ranging from stress relief before and after surgeries²

Nurses are the key person who provides holistic care to the client. So nowadays complimentary therapies are introduced in the nursing curriculum which can increase the knowledge of the Nurses. Today the most commonly used complementary therapies are acupressure, aroma therapy, music therapy and yoga. These promote the health and well-being of the client without side effect.³

A meta-analysis found that postoperative patients who received music therapy had a 50% reduction in pain intensity and needed less analgesia than patients who didn't receive music therapy. Other studies have found that music therapy may be an acceptable, safe, and inexpensive alternative or adjunct therapy to pharmacologic pain relief for postoperative patients and for those undergoing painful procedures. Patients exposed to music reported 57% to 72% less pain intensity, distress, and anxiety than the control patients⁴

Nancy Ames et al (2017) conducted a randomized controlled trial with mixed-methods analysis on music listening among postoperative patients in the intensive care unit with total of 41 surgical patients were randomized to either music listening or controlled non-music listening groups on ICU admission. Approximately 50-minute music listening interventions were offered 4 times per day (every 4-6 hours) during the 48 hours of patients’ ICU stays. Pain, distress, and anxiety scores were measured immediately before and after music listening or controlled resting periods. Total opioid intake was recorded every 24 hours and during each intervention. Results shows that there was no significant difference in pain, opioid intake, distress, or anxiety scores between the control and music listening groups during the first 4 time points of the study. However, a mixed modeling analysis examining the pre- and post-intervention scores at the first time point revealed a significant interaction in the Numeric Rating Scale (NRS) for pain between the music and the control groups (P = .037). The Numeric Rating Score decreased in the music group but remained stable in the control group. Following discharge from the ICU, the music group’s interviews were analyzed for themes. It concluded that music listening as an appropriate intervention that improved patient’s post-intervention experience, according to patientsself-reports.⁵

STATEMENT OF THE PROBLEM:

A study to evaluate the effect of music therapy on pain among post-operative patients at selected hospital.

OBJECTIVES:

· To assess pain among post-operative patients in experimental and control group before intervention

· To administer music therapy among post-operative patients at selected hospital.

· To assess pain among post-operative patients in experimental and control group after the intervention

· To evaluate effect of music therapy on pain among post-operative patients in experimental and control group.

· To find out the association between pain among post-operative patients with their selected demographic variables in experimental and control group.

OPERATIONAL DEFINITIONS:

Effect: In this study, effect refers to measurement of the extent to which the music therapy has produced the desired effect on pain among post-operative patients as observed by scores obtained by selected tools.

Music therapy: In this study, music therapy refers make the patient to listen instrumental music – flute for 30- 40 minutes with sound proof ear phone. It should be done daily twice from 2^rd day to 5^th postoperative day.

Pain: It is a unpleasant experience at abdomen caused by incision of abdominal surgery as measured by universal pain assessment scale

Post-operative patients: In this study, patients are the person who undergone abdominal surgeries such as appendisectomy and hernioraphy.

Hypotheses:

H₁:There is a significant difference in pain among post-operativepatients in experimental and control group after music therapy at 3^rd, 4^th, 5^th day and 2^nd week of surgery

H₂: There is a significant association between pain among post-operativepatients with their selected demographic variables.

METHODOLOGY:

Research approach: A quantitative research approach

Research design: Quasi–experimental Time series design

Representation of research design.

E	O₁	X.	O₂	X.	O₃	X.	O₄	X.	O₅
C	O₁		O₂		O₃		O₄		O₅

E – Experimental group

C - Control group

O₁- Pre–test assessment of pain at 2^nd day of surgery.

X - Administration of music therapy.

O₂, O₃, O₄–Post-test assessment of pain at at 3^rd, 4^th, 5^th day and 2^nd week of surgery

Setting of the study: Kamala Hospital, Salem

Variables under study

1. Dependent variable: Pain

2. Independent VariableP: Music therapy.

3. Extraneous Variable: Age, sex, educational qualification, monthly income, type of family, diet, type of anesthesia, previous history of surgery and source of information.

Population: Patients undergone abdominal surgeries such as appendisectomy and hernioraphy.

Sample: Patients undergone abdominal surgeries such as appendisectomy and hernioraphy and met inclusion criteria.

Sample Size: The sample size consisted of 20 patients in which 10 in experimental group and 10 in control group.

Sampling technique: Non-probability (purposive) sampling technique.

Sampling Criteria:

Inclusion Criteria: Patients who

· Have admitted in selected private hospital

· Have undergone abdominal surgeries such as appendisectomy and hernioraphy

· Are in 2^nd postoperative day

· Willing to participate in the study

· Are available during data collection period

Exclusion Criteria: Patients who have

· High risk factors such as perforated appendix

· Undergone any special treatments like yoga and any other complementary therapies

Data Collection Instruments:

Tools were used as follows.

Part I: Demographic variables to collect baseline data.

Part II: Universal pain assessment tool.

Description of the tool:

After a thorough review of literature related to the topic the tool was developed. The tool for data collection was divided into two sections.

Part-I: Demographic proforma:

This tool was designed to collect the baseline information like age, sex, educational qualification, monthly income, type of family, diet, type of anesthesia, previous history of surgery and source of information.

Part-II: Universal pain assessment scale to assess the level of pain.

This scale used to assess the pain level. In this tool pain rated from 0 to 10 which describes as follows:

Description	Scores
No pain	0
Mild pain	1-2
Moderate pain	3-6
Severe pain	7-9
Worst possible pain	10

Validity:

Validity of the tool and music therapy procedure was established in consultation with experts. This was sent to 6 experts in the field of medical and surgical nursing, statistics and language experts. The modification was done as per recommendation.

Data Collection Procedure:

Period of data collection:

Data collection for done from 1^st Nov 2020 to 15^th December 2020. During this period investigator collected both pretest, post test data and also implemented the music therapy

Pre-Test:

· Pre-test conducted by using selected tools on 2^nd postoperative day.

· The investigator observed the pain by Universal pain assessment scale

Implementation of Music therapy:

Immediately after pretest the investigator start music therapy among experimental group. Each patient listens the selected instrumental music with their mobile and ear phone. This continued daily twice till 5^th postoperative day in front of investigator.

Post- Test:

Posttest assessment done at3^rd, 4^th, 5^th day and 2^nd week of surgery

Data analysis and interpretation:

The data collected were organized and presented as following section

Section I: Description of sample characteristics

Section II:

a. Comparison of experimental and control group scores of samples before intervention

b. Comparison of experimental and control group scores of samples after intervention

c. Frequency and Percentage wise distribution of pain scores among samples in experimental and control group.

Section III: Testing Hypothesis.

Section I:

Description of sample characteristics:

Table 1.1: Frequency and percentage wise distribution of patients according to their Demographic data. (N=20)

Demographic data	Control group(n=10)		Experimental group (n=10)
Demographic data	F	%	F	%
1. Age (in years)
a) 21-25	4	40	4	40
b) 26-30	3	30	4	40
c) Above 30	3	30	2	20
2. Sex
a) Male	4	40	4	40
b) Female	6	60	6	60
3. Educational qualification
a) Illiterate	0	0	0	0
b) Primary school	0	0	0	0
c) High school	1	10	1	10
d) Higher secondary	3	30	3	30
e) Graduate	6	60	6	60
4. Monthly income (in rupees)
a) Below 5000	0	0	0	0
b) 5001-10000	0	0	3	30
c) 10001-15000	4	40	3	30
d) 15001-20000	3	30	2	20
e) Above 20000	3	30	2	20
5. Type of family
a) Nuclear family	6	60	6	60
b) Joint family	4	40	4	40
c) Extended family	0	0	0	0
6. Diet:
a) Vegetarian	2	20	1	10
b) Non-vegetarian	8	80	9	90
7. Type of anaesthesia
a) Spinal	8	80	8	80
b) General	2	20	2	20
8. Previous history of surgery
a) Yes	3	30	4	40
b) No	7	70	6	60
9. Sources of information
a) Newspaper/Magazine	0	0	0	0
b) TV	4	40	4	40
c) Internet	3	30	2	20
d) Friends/Neighbors	2	20	2	20
e) Health professionals	1	10	2	20

Table 1.1 shows the Distribution of samples according to their age depicts that the highest (40%) percentage were in the age group of 21-25 years in both experimental and control group. However only (20%) of samples from experimental group and 30% of samples from control group were belonged to age above 30 years.

Distribution of samples according to sex shows that majority (60%) in both experimental and control group were female and 40% in each group were male.

Distribution of samples according to their education depicts that majority (60%) percentage of samples were graduates in both experimental and control group however very less (10%) were had high school education and none of them illiterate and primary educated in both groups.

Distribution of samples according to their monthly family income depicts that highest percentage (40%) of samples from control group belonged to Rs. 10,001 to 15,000 income group and each (30%) of experimental group belonged to Rs.5001-10,000 and 10,001-15,000 respectively. The same each (30%) of samples from control group belonged to 15,001-20,000 and above Rs 20,000 income group.

Distribution of samples according to their type of family shows that majority (60%) of samples in both experimental and control group belonged to nuclear family. However, rest of all from both the group belonged to joint family.

Distribution of samples according to diet depicts that majority (90%) from experimental and (80%) from control group were belonged to non-vegetarian and only less percentage (20%) from control group and (10%) from experimental group were from vegetarian.

Distribution of samples according to their type of anesthesia depicts that majority (80%) of samples in both experimental and control group were had spinal anesthesia whereas remaining all (20%) were had general anesthesia.

Distribution of samples according to their previous history of surgery shows that majority of the samples (70%) from control group and (60%) from experimental group were had no previous experience of surgery whereas (30%) of control and (40%) of experimental were had history of previous surgery.

Distribution of samples according to their source of information depicts that majority (40%) of samples in both experimental and control group got information through T.V whereas less percentage (10%) from control group and (20%) from experimental group got information through health professionals.

Section II:

a. Comparison of experimental and control group samples before intervention

Table 1.2: Comparison of pain score median, IQR and range of control group and experimental group samples before intervention at 2^ndday of surgery

Pre test	Max Score	Control group 2^nd day			Experimental group 2^nd day			Difference in median
Pre test	Max Score	Median	IQR	Range	Median	IQR	Range	Difference in median
Pain (2^nd day)	10	8	8-6	8-6	9	7-4	5.5-5	1

b. Comparison of experimental and control group samples after intervention:

Table 1.3: Comparison of median, IQR and range of pain scores among control group and experimental group samples after intervention at 3^nd, 4^th, 5^th day and 2^nd week of surgery

Post Test	Max Score	Control Group			Experimental Group			Difference in Median
Post Test	Max Score	Median	IQR	Range	Median	IQR	Range	Difference in Median
3^rd Day	10	8	8-6	8-6	5	7-4	5.5-5	3
4^th Day	10	7	8-4	8-4	2.5	4.5-2	7-1	4.5
5^th Day	10	6	7-2	7-2	0	1.75-0	4-0	6
2^nd Week	10	8	8-6	8-6	4	5.25-2	7-2	4

c. Frequency and percentage distribution of pain among samples in experimental and control group.

Table 1.4: Frequency and percentage wise distribution of level of pain among postoperative patients.

Level of Pain	Control group(n=10)								Experimental group (n=10)
	3^rd day		4^th day		5^th day		2^nd week		3^rd day		4^th day		5^th day		2^nd week
	f	%	f	%	f	%	F	%	f	%	f	%	f	%	f	%
No													7	70	-	-
Mild					3	30					7	70	1	10	4	40
Moderate	3	30	3	30	4	40	3	30	6	60	2	20	2	20	5	50
Severe	7	70	7	70	3	30	7	70	4	40	1	10	-	-	1	10
Total	10	100	10	100	10	100	10	100	10	100	10	100	10	100	10	100

Table 1.2 shows the comparison of pain score distribution of median, IOR and range of control and experimental group samples during 2^nd day of surgery. The median pain score of control group is 8(IQR – 8-6) whereas the same in experimental group is 9(IQR – 7-4). It concludes that both control and experimental group scores are more or less similar at 2^nd day of surgery.

Table 1.3 shows the comparison of median, IQR and range of pain scores among control group and experimental group samples after intervention at 3^rd, 4^th, 5^th day and 2^nd week of surgery. The median pain score of control group is 8(IQR – 8-6) whereas the same in experimental group is 5(IQR – 7-4) on 3^rd day. The median pain score of control group is 7(IQR = 8-4) whereas in experimental group it is 2.5(IQR=4.5-2) on 4^th day. The median score of pain in control group is 6(IQR = 7-2) whereas in experimental group score is 0(IQR=1.75-0) on 5^th day. The median score of pain in control group is 8(IQR = 8-6) whereas in experimental group score is 4(IQR=5.25-2) during 2^nd week. It concludes that music therapy is very much useful among experimental group sample at 3^rd, 4^th, 5^th day and 2^ndweek of postnatal period.

Table.1.4 shows frequency and percentage wise distribution of level of pain among samples revealed that the experimental group samples 7 (70%) had no pain during 2^ndweek whereas none of the control group scored no pain level also control group 3(30%) mothers had severe pain during 2^ndweek but none of the experimental samples had severe pain at same week. Also level of pain is reducing in both experimental and control group, hence it is faster in experimental group during 3^rd, 4^th, 5^thday and 2^ndweek due to music therapy.

Section III:

Testing Hypothesis:

H₁:There is a significant difference in pain among post-operative patients in experimental and control group after music therapy at 3^rd, 4^th, 5^th day and 2^nd week of surgery

Table 1.5: Comparison of pain score distribution of median, IQR and Z Value of control and experimental group regarding pain among postoperative patients

Post test	Pain
Post test	Z Value	P Value
3^rd Day	2.433	0.015*
4^th Day	3.148	0.002**
5^th Day	3.342	P<0.001***
2^nd Week	3.545	P<0.001***

*P<0.05, S-Significant; **P<0.01 and ***P<0.001 HS-Highly Significant; NS-Not Significant.

Table1.5 shows comparison of median, IQR and Z value of control and experimental group samples during 3^rd day foundthat pain (Z= 2.433) is significant at P< 0.05 level. During 4^th day depicts that pain (Z= 3.148) shows highly significant at P<0.01. During 6^th week found that pain (Z= 3.342) shows highly significant at P<0.001. During 2^nd week found that pain (Z= 3.545) shows that highly significant at P< 0.001 which revealed effectiveness of music therapy on pain at 3^rd, 4^th, 5^th day and 2^nd week of surgery

Hence H₁:accepted and conclude that the difference observed between experimental and control group are true differences. So, music therapy is effective on pain.

H₂: There is a significant association between pain among post-operative patients with their selected demographic variables

Table 1.6: Association between level of pain among postnatal mothers in control and experimental group with their selected demographic data.

Demographic Variables	Control group		Experimental group
Demographic Variables	Pain
	χ²(df)	p-value	χ²(df)	p-value
1. Age (In Years)
a) 21-25	0	1	1.667	0.435
b) 26-30		NS	(df=2)	NS
c) Above 30
2. Sex
a) Male	0	1	0.741	0.389
b) Female		NS	(df=3)	NS
3. Educatioal Qualification
a) Illiterate	0	1	0.741	0.69
b) Primary School		NS	(df=2)	NS
c) High School
d) Higher secondary
e) Graduate
4. Monthly Income (in rupees)
a) Below 5000	0	1	4.44	0.217
b) 5001-10000		NS	(df=2)	NS
c) 10001-15000
d) 15001-20000
e) Above 20000
5. Type of Family
a) Nuclear Family	0	1	0.741	0.389
b) Joint Family		NS	(df=1)	NS
c) Extended Family
6. Diet
a) Vegetarian	0	1	0.123	0.725
b) Non- Vegetarian		NS	(df=2)	NS
7. Type of Anaesthesia
a) Spinal	0	1	0.278	0.598
b) General		NS	(df=1)	NS
8. Previous history of Surgery
a) Yes	0	1	0	1
b) No		NS		NS
9. Sources of Information
a) Newspaper/ Magazine	0	1	4.44	0.217
b) TV		NS	(df=3)	NS
c) Internet
d) Friends/Neighbors
e) Health professionals

*-P<0.05, significantand **-P<0.01 and***-P<0.001, highly significant.

Table 1.6: shows that there was no significant association at P<0.05 level between level of pain score of patients and with selected demographic variables such as age, sex, education, monthly income, type of family, diet, type of anesthesia, previous surgery and source of information in both the experimental and control group.

Hence H₂ is rejected and concludes that there is no significant association between level of pain and selected demographic variables of post-operative patients.

CONCLUSION:

The following conclusions were drawn on the basis of the findings of the study:

· Music therapy is an effective e intervention in reducing pain score in experimental group as Z value was highly significant at P< 0.001 which revealed effectiveness of music therapy on pain at 3^rd, 4^th, 5^th day and 2^nd week of surgery.

· There was no significant association (P<0.05) between level of pain score of patients and with selected demographic variables such as age, sex, education, monthly income, type of family, diet, type of anesthesia, previous surgery and source of information in both the experimental and control group.

REFERENCES:

1. Jenny S. Music therapy, A. Complementary Therapy in Pain management. Nightingale Nursing Times: April-2014; 10(1): 15-16.

2. McCaffrey T, Edwards J, Fannon D. "Is there a role for music therapy in the recovery approach in mental health?". The Arts in Psychotherapy. (2011). 38(3): 185-89. doi:10.1016/ j.aip.2011.04.006. hdl:10344/3362

3. Arzta Sophia. Effect of reflexology on lactation in promoting breastfeeding among immediate postnatal mothers. Nightingale Nursing Times, December 2018; xiv (9): 35.

4. Ebneshahidi A, Mohseni M. The effect of patient-selected music on early postoperative pain, anxiety, and hemodynamic profile in cesarean section surgery. J Altern Complement Med. 2008; 14(7): 827-831.

5. Nancy Ames et al. Music Listening Among Postoperative Patients in the Intensive Care Unit: A Randomized Controlled Trial with Mixed-Methods Analysis, Integrative Medicine Insights. 2017; 12: 1178633717716455. Published online 2017 Jul 20. doi: 10.1177/1178633717716455

Received on 22.02.2021 Modified on 12.03.2021

Int. J. of Advances in Nur. Management. 2021; 9(3):309-314.

DOI: 10.52711/2454-2652.2021.00069