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International Journal of Nursing Studies xxx (2011) xxx–xxx

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International Journal of Nursing Studies
journal homepage: www.elsevier.com/ijns

Effectiveness of different music-playing devices for reducing
preoperative anxiety: A clinical control study
Kwo-Chen Lee a, Yuh-Huey Chao b, Jia-Jean Yiin c, Pei-Yi Chiang d, Yann-Fen Chao e,*
a
School of Nursing, China Medical University, Taichung, Taiwan
b
Department of Anesthesiology, Lotung Poh-Ai Hospital, YiLan, Taiwan
c
Department of Neurological Surgery, Veteran General Hospital, Taichung, Taiwan
d
Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
e
Department of Nursing, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan

A R T I C L E I N F O A B S T R A C T

Article history: Background: While waiting for surgery, patients often exhibit fear and anxiety. Music is
Received 21 September 2010 thought to be an alternative to medication to relieve anxiety. However, due to concerns
Received in revised form 5 April 2011 about infection control, devices other than headphones may be considered for this purpose.
Accepted 8 April 2011 Objectives: The purpose of this study was to determine the anxiety-relieving effect of
broadcast versus headphone music playing for patients awaiting surgery.
Keywords: Design: A randomized controlled clinical study.
Anxiety Setting: The waiting area of an operating theater of a metropolitan teach hospital in Taiwan.
Preoperative
Participants: Alert adult with age between 20 and 65 years old waiting for surgery without
Surgery
premedications.
Music therapy
Infection control
Methods: A total of 167 patients were randomly assigned to the headphone, broadcast and
control groups. Both the headphone and the broadcast groups were provided with the
same instrumental music, while the control group did not listen to any music. The tools for
measuring anxiety were visual analogue scale (VAS) ranging from ‘‘not anxious at all’’ to
‘‘extremely anxious’’ and heart rate variability (HRV).
Results: The VAS score exhibited a significant decrease for both the headphone and
broadcast groups.
The low frequency and low-to-high frequency LF/HF ratio of the broadcast and
headphone groups were significantly lower than those of the control group. None of the heart
rate variables showed significant differences between the broadcast group and the
headphone group.
Conclusion: Both headphone and broadcast music are effective for reducing the
preoperative patient’s anxiety in the waiting room.
ß 2011 Elsevier Ltd. All rights reserved.

1. Introduction onment, loss of control, perceived or actual physical risk,
dependence on strangers, separation from family and
Pre-operative anxiety is among the most unpleasant friends (Gillen et al., 2008), the threat of death, and
experiences associated with surgery. An unfamiliar envir- possible postoperative complications are factors that may
cause patients to feel anxious in the waiting area before
surgery (Mitchell, 2003). The waiting period is also the
* Corresponding author. Tel.: +886 2 26360303x1310; fax: +886 2
time during which patients are most likely to imagine any
26361267. potential danger they may face (Cooke et al., 2005; Haun
E-mail addresses: lee_ruby_99@yahoo.com (K.-C. Lee), et al., 2001). Preoperative anxiety is characterized by
ettetw@hotmail.com (Y.-H. Chao), yiin_jackson@yahoo.com (J.-J. Yiin), subjective, consciously perceived feelings, of apprehension
or9526@mail.tmch.org.tw (P.-Y. Chiang), yfchao.tw@yahoo.com.tw,
and tension accompanied by autonomic nervous system
yfchaomk@mmc.edu.tw (Y.-F. Chao).

0020-7489/$ – see front matter ß 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ijnurstu.2011.04.001

Please cite this article in press as: Lee, K.-C., et al., Effectiveness of different music-playing devices for reducing
preoperative anxiety: A clinical control study. Int. J. Nurs. Stud. (2011), doi:10.1016/j.ijnurstu.2011.04.001

The patients in the headphone compared with headphone in delivering music interven. Music involves the patient’s mind with ‘headphone day. nosocomial infections can come from contact with staff and the power as 0. played at a tempo of 60–80 beats per minute study is to evaluate the effectiveness of broadcasting and a volume of 50–55 db. group listened to music via an MP3 player (Ergotech.. Victoria. phones among patients raises a concern about nosocomial the effect size (f) of one-way ANOVA of VAS scores and infection control. Nurs. 2003. Patients can focus their ‘headphone day’ were assigned to the headphone group. Materials and methods music on pain (Cooke et al. and piano evaluate the effectiveness of broadcast music versus selections (Nilsson.. re-using head. Pelletier.1. we decided on an expected sample size of areas such as operating suites need separate cleaning 50 for each group.8 for our three groups. and it can Given the potential effects of anxiety.3 (small).. These theater.. fear. The headphone was put on when the Please cite this article in press as: Lee. regular rhythm.’ ‘broadcast day’ or ‘control day’. 2. 2002).G Model NS-1823. 2005). 2. However. 2008).9 m. / International Journal of Nursing Studies xxx (2011) xxx–xxx arousal. which allows patient to who were sent to the operating theater for surgery on escape into his or her own world. et al. 2005). Since the organisms causing most heart rate variability among the three groups as 0. Effectiveness of different music-playing devices for reducing preoperative anxiety: A clinical control study. visual impairment. 2008). 2001).001 . equipment. (4) stayed at least 25 min in common theory regarding the anxiety and stress-reducing the waiting area. and (5) was willing to participate in the effect of music is that music acts as a distracter. or caffeine. contaminated instruments and sample size was 111 participants (37 for each group). The arrhythmias. Katz et al. of Pages 8 2 K. (2) had not consumed any tical anxiety-relieving alternatives. 2004). flute. K. Int. The purpose of the present research is to harmonics. and considered in addition to broadcasting and headphone uncertainty (Gail. or operative premedication.-C. The study hospital is JCIA (Joint Commission cognitive abilities and cause discomfort both mentally and International Accreditation) certified. (3) had not been statistically significant effects on reducing pre-operative diagnosed with hearing impairment. Sampling and sample size provide anxiolytics or sedatives for patients. and of music intervention in our study. This. in turn. may increase assess patients’ anxiety and pain on admission and each postoperative pain. doi:10. The kinds of music study that took place in the operating theater of a chosen to play in this study were light music of folk songs metropolitan teaching hospital in Taiwan. Therefore.-C. (2011). Subjects something familiar and soothing.05. results are confirmed both by a review that explored the use of music and its effect on anxiety during short waiting periods and a Cochrane review that explored the effects of 2. it increased extra cost. most still feel anxious (Duggan et al. but would rather listen to music or inclusion criteria were that the patient: (1) was conscious read (Hyde et al. The resulting (cross-contamination). 2010). It is required to physically (Vaughn et al. prolong postoperative recovery.1016/j. No. levels when waiting for surgical and invasive procedures. non-contact alternative music delivering devices other It is recommended that therapeutic music should have than headphones need to be considered out of concern for a slow tempo. control group was respiratory rate. Research design and setting Considering the short stay of patient in the waiting area and time spent for HRV and VAS measuring. but not completely isolated. Though disposable headphones and small plastic sealable bags may help reduce nosocomial infec. needles. Stud. The aim of this or pop music. and aged 20–65 years. Among various non-pharmaceu. 2007). 2008.. Intervention tions (Short et al. 2003. White.. from the nursing station. 2008). awareness on the music to aid relaxation (Thorgaard et al.. which cause physical and psychological changes. Lee et al. The increase the potential for complications (Ozalp et al. It has been reported that even though doctors usually 2. The genre and headphone music playing to relieve preoperative anxiety the duration of the soothing music did not seem to levels of patients in the waiting area of an operating influence the effectiveness of music intervention. Most prior studies used a broadcast and control groups.6 m  3.. The lower their anxiety.3. 2000. The same rule was applied to recruit subjects into the 2005. holding area of an operation theatre. blood pressure. It is 12. Other research has Patients who were sent to the waiting area between revealed that patients do not want excessive medication to 07:00 and 14:00 were recruited for enrollment.. The temperature strategies to limit patient anxiety and improve comfort of the room was maintained between 19 and 21 8C. (Grant Devilly. and pleasing infection control. been reported to have a consistently positive and sedatives.. Australia). To contrast the effect including changes in heart rate..2011. compact-disk or cassette player with headphones to listen Sample size was determined with G power software to music (Gillen et al. J.ijnurstu. We set alpha as 0. focusing study and signed an informed consent form. Anxiety can affect an individual’s groups. or heart disease. and the environment (exogenous flora). 1998). low pitch. 2005). anxiety and post-operative pain (Nilsson. as well as feelings of pressure. and should consist of string. a 10-min The present study is a randomized controlled clinical music was prepared for intervention. there are take seat eight patients simultaneously. ET- tion to reduce pre-operative anxiety of the patient in U31P. music intervention had medications for hypertension or heart disease. three groups to determine each day of a month to be Nilsson. Taiwan).04. the patient’s attention away from negative stimuli to We applied random table to divide numbers 1–30 to something pleasant and encouraging (Mitchell. and significant event such as surgery and procedure. White. WHO Considering an attrition rate of 30% due to the short stay in (2002) suggested highly susceptible patients or protected the waiting area.2. waiting area is independent.

04 and 0.4. Then. / International Journal of Nursing Studies xxx (2011) xxx–xxx 3 subject agreed to participate. Malik et al.. Its are feeling the most anxious you could ever imagine.04. 1996). When mental stress on autonomic control of the heart rate subjects entered the waiting area. the VAS takes only 5 s for nerves. Second. J. The visual analog scale frequencies (LFs. To prepare music for variability parameters can provide reliable evidence for intervention.. the lines at 1 cm intervals to construct a scale. and it operates stably at temperatures of 50–1048F To use for measuring anxiety. The music invasive tool which can be used to study the effect of was played from 07:00 to 15:00 on the broadcast day. (mean NNI). After an eligible participant entered the Please cite this article in press as: Lee. operating theater. Subjects were used to responding to it. participants were asked (10–40 8C) and humidity of 25–95%. these indicators We employed both subjective and objective measures decrease (Malik et al.. we decide to use pre-selected standard of a music intervention. activity and its relation to anxiety (Friedman.5–0. the 40-item STAI takes minutes to fill out. It has been used in to say a number or indicate with their finger a score from 0 clinical studies of HR variability (Peng et al.ijnurstu. Japan). frequencies between 0. Heart rate variability broadcast group. we firstly chose 40 pieces of music which measuring preoperative anxiety. can cause the HR to increase. sent from open speaker which make every person in the 2011) evaluating the preoperative anxiety relieving effect same area can hear. of Pages 8 K. Lee et al.. the VAS was routinely In our study.15 and studies of anxiety. met potential participants in the waiting area of the ing anxiety. they were asked about (Acharya et al. To measure HR. Wen et al.G Model NS-1823. The measurement near the centre would show that you feel moderately heart rate range is 45–186 bpm and ST segment 3 to anxious’’. The past literature pointed out that when an individual feels anxiety or pressure. and provided parameters of heart rate (r = 0. Davey et al. et al. cies and the low-to-high ratio to increase (Kamath and while the patient might need to change his/her position to Fallen. the CheckMyHeart is CE would show that you are feeling not anxious at all at the (CONFORMITE EUROPEENNE) certified and has passed moment. we had 10 There were time-domain and frequency-domain para- preoperative patients to elect the top ten relax ones. They claimed that a one-item question with a Likert or Visual Analog Scale was adequately measured This research was approved by the Institutional Review current anxiety and VAS was useful when only very limited Board of the study setting (approved code: CRC-03-09-07). High values of concerns.6) variability. 2005) and STAI (r = 0. The participants were asked not number line to show how anxious you feel at the moment’’. Clan. Low 2. The have shown that analysis of heart rate variability is gaining control group did not listen to music. 2004). The researcher researchers placed the sensor on the radial area of the gave oral instruction (in mandarin) of ‘‘Please point at the patient’s forearm for 5 min.. K. In the time-domain the 10 pieces of music were stored in a MP3 player or CD analysis. Data collection process (r = 0. Effectiveness of different music-playing devices for reducing preoperative anxiety: A clinical control study. doi:10. (Abdul-Latif et al. the standard deviation of the NNIs (SDNN). It has been reported that the 2007). Stud. (calm) to 10 (very anxious). 1996).. which is used in most High frequencies (HFs. A mark at the extreme right would show that you electromagnetic interference and compatibility tests. for anxiety in our study.1. to move around to ensure the quality of the readings. 2006. Our heart rate data were analyzed by the CheckMy- VAS was significantly correlated with hospital anxiety Heart software. as in anxiety..001 . It is a handheld limb lead EKG (lead I) recorder The VAS is a 10-cm horizontal line marked by vertical with HR variability analytical software. meet the recommended criteria. a power and high frequencies to decrease. time was available for anxiety assessment. 2006).4.. Trait Anxiety Inventory (STAI).-C. total power represents the overall activity of the autonomic nervous system (ANS). First.5. the variables included the mean of the NNIs disk and played randomly. For the subjects in the 2.15 Hz) We used a visual analog scale (VAS) instead of State. 2009. heart rate was measured by a CheckMyHeart used in this hospital for pain and anxiety assessment. Measurements NNIs (rMSSD).2. and offered three examples: ‘‘A mark at the extreme left According to the user’s manual.2011. +3 mm. total the patient to communicate his/her anxiety level.78). handheld HRV device (DailyCare BioMedical. In contrast. These data The researcher (KJL) checked the operating schedule and provide reference for criterion validity of VAS for measur. Taiwan). HR variability parameters 10 pieces of music repeatedly. and low frequen- patient can remain lying down and still respond to the VAS. frequencies between 0.. the low-to high (LF/HF) ratio indicate a dominance of This could cause unnecessary strain for patients waiting for sympathetic activity while low values indicate a dominance surgery in the waiting area of the operating room and make of parasympathetic activity. PD-M427. fill out the STAI questionnaire. Cohen Considering that music for the broadcast group was and Benjamin. and the root mean square of successive differences in the 2. No. indicating that HR allow participants to make choice. Activation of the sympathetic them more nervous. Third. 2001. reflect mixed sympathetic and parasympathetic activities. Nurs. A mark sampling frequency is 250 samples/s. randomly played and not correlated well with VAS scores.. In the frequency-domain.1016/j. (2007) also reported that the VAS correlated with STAI well 2. Chungli.4. they listened to music through an open Heart rate variability (HRV) is a well-established non- speaker (Pioneer CD player. All meters in HR variability analysis. In our previous study (Lee et al. and were asked if they acceptance as a tool to measure cardiac parasympathetic would participate by having VAS and HR measurements. This decision was made out of three 0.-C. 1993). 2007. Int.4 Hz) reflect parasympathetic activity. Several studies participating by permitting VAS and HR measurements. (2011).28) (Ledowski et al.

Statistical analysis Between May and June 2009. Data were first examined for completeness. p < .001 . 1. three refused measurement. patients in the headphone group listened to to examine the different in VAS and HR variability a 10-min session of music with an MP3 player and parameters among the three groups. 186 patients were contacted and 180 were enrolled in the study. four were excluded 15.-C. Of them. One way ANOVA test was applied curtains. and Chi-squared test process of the study.. Subjects of applied to examine the paired difference. let the patient lie down on a gurney. Then. After a 10. Flow diagram of subject enrollment. Int. 3. No. IL). Effectiveness of different music-playing devices for reducing preoperative anxiety: A clinical control study. If a significant headphones. helped the patient fill out a consent were applied to evaluate the background differences form. / International Journal of Nursing Studies xxx (2011) xxx–xxx waiting room.6.G Model NS-1823. and closed the among the three groups. participants received VAS and 5-min HR measurement. doi:10. K. Participants in the broadcast group listened difference was identified. (2011).2011.-C. Stud. of Pages 8 4 K. Nurs. Incomplete six were unable to complete the study due to being sent to data or data with too many noise signals were deleted for the operating suite before the 10-min of music or rest was data processing. A value of the control group were told to rest and relax. Chicago. min session. the researcher explained the purpose and applied were descriptive statistics.0 (SPSS. Lee et al.04. a Scheffe test was further to music from a CD player broadcast in the air. Results 2.ijnurstu..05 was deemed statistically significant. Data analysis was performed with SPSS finished.1016/j. The major statistical procedures due to poor EKG recording (incomplete or too much noise Blocked by day randomization Broadcast group Control group Headphone group 66 contacted 61 contacted 59 contacted 3 refused 3 refused 66 enrolled 58 enrolled 56 enrolled 10 min Music 10 min rest 10 min Music 66 58 56 HRV and VAS HRV and VAS HRV and VAS Measure 66 Measure 58 Measure 56 Data incomplete or HRV data incomplete too much noise or too much noise signal-2 signal -2 3 Refused Sent to surgery Sent to surgery before end of before end of measure ment-3 measure ment-3 Complete and useful Complete and useful Complete and useful 66 53 48 Fig. Please cite this article in press as: Lee. J. et al.

147 Waiting (min) [mean (SD)]a 24.3 .7) 23.4) 64.8 .05).9 .6) 22.8 .. Broadcast (B) (N = 66) Mean (SD) Headphone (H) (N = 48) Mean (SD) Control (C) (N = 53) Mean (SD) F p VAS score* 4.8. followed by orthopedic surgery.03) 24. which was significantly statistical processing. Lee et al.6) 33.6 (2058. There were phone group and control group were not significantly no significant differences between the two groups in age.8. SDNN (standard deviation of the NNI).1.5) 1208.2 (SD = 1.2 bpm.1016/j. Effectiveness of different music-playing devices for reducing preoperative anxiety: A clinical control study.2 (1. head- surgeries.2) 13.2).2 (29. Nurs.77 %LF** 54.001 .6 (2. 76.2) 0.4) 35.009 %HF*** 45. signal). Please cite this article in press as: Lee. and 74.2. No.4  1. p < .1) (Table 2). J. .556 Yes 45 (55) 39 (60) 41 (58) Anesthesiab .7) 22. Time-domain heart rate variability para- surgery (Table 1).62) 52.52 (17.9 (19..83) . Stud.001 HR 72. 48 in the headphone group and 53 in the broadcast group (4.8 (1. The mean anxiety score of the the significant difference was between the broadcast group Table 2 HRV and Anxiety Score comparison of three groups.64 (7.6 (15. and 3.611 Orthopedics 11 (17) 5 (10) 7 (13) General 11 (17) 9 (19) 9 (17) Gynecology 19 (29) 11 (23) 14 (26) Urology 5 (8) 6 (13) 5 (9) Neurosurgery 6 (9) 5 (10) 9 (17) Other 12 (18) 12 (25) 9 (16) a Examined by independent t-test.3) 4.009 LF/HF 1.6 bpm. the mean anxiety level of three groups (F = 4.33 rMSSD (ms) 29. Heart rate variability parameters eighteen percent underwent spinal anesthesia.2 (19. The major- ity of subjects received obstetric and gynecological The average heart rates of the broadcast group.941 Male 32 (48) 22 (46) 24 (45) Female 34 (52) 26 (54) 29 (55) Previous surgeryb No 30 (45) 19 (40) 22 (42) . different (72.3 (123. The participation process is presented in broadcast group was lower than that of the headphone group. but the 3.7) 6. rMSSD (root mean square of successive differences of NN intervals).8 (19.17 Mean NNI (ms) 847. The 167 subjects were 66 in the higher than that of the headphone group (5. There was significant difference in high frequency HR variability among the According to the VAS scores.8. time for the 167 participants was 23 min.1) 3. et al.3) 57.2  1.2 bpm. Broadcast (N = 66) Headphone (N = 48) Control (N = 53) p value a Age (years) [mean (SD)] 49. b Examined by chi-square test.9) 820.1 (17.4 (15.1) 34.3 (18.5.0 (37. Int.4 (115. The anxiety score of the control group.0 (2. doi:10.04.9 . VAS anxiety levels differences were not significant.89 (13.6) 5. of Pages 8 K.37 TP (ms2) 1069.1) 801. 1. *** Scheffe test: B > C. There were no significant differences between three but no statistically significant difference was found between groups in terms of demographics.2 (16.G Model NS-1823.7) 1.-C. Seventy-six percent of patients received general anesthesia. H > C. methods of anesthesia.367 Broadcast (N = 66) Headphone (N = 48) Control (N = 53) p value n (%) n (%) n (%) Genderb .9 (17. LF (low frequency). ** Scheffe test: C > B. or types of F = 1.4) 74.0 .43 (7. Fig. (2011).01). waiting time.3) 4.3) 1.03 NNI (normal-to-normal intervals). K. p < .4 (17.53) 46. TP (total power). HF (high frequency).7) and the broadcast group.16 SDNN (ms) 40.6 (10.0 (3185.4) 2. respectively. gender.31 (7.2 (10. meters in the broadcast group were all higher than those in the headphone and control groups (Table 2).8) 76.8) 885.2 (12.7 (142.1 .6 (25.4 (1. The Scheffe test showed that all participants was 5.212 General 47 (71) 36 (75) 44 (83) Spinal 14 (21) 7 (15) 9 (17) Local 5 (8) 5 (10) 0 (0) Surgery typeb .6) (p < .ijnurstu.0 <.5) 1.1  2. The average waiting the two groups (p = 0.3) 42.5 (1082.-C. / International Journal of Nursing Studies xxx (2011) xxx–xxx 5 Table 1 Demographic and clinical characteristics of participants in the three groups.64) .6) 1. * Scheffe test: B > C.0) 1. Finally. we got useful data from 167 subjects for control group was 6.2011.8 (1.17).

Wang et al. showed statistically significant differences in anxiety reduction between the experimental group and the control group. the difference was a pretest–posttest comparison meaningless.005 . In patients Current study was to compare the anxiety-relieving effect listening to music with headphones..02 . was consistent with significant (Table 2) as well as the correlations with VAS Please cite this article in press as: Lee.01).005 . Thus correlated with low frequency and low-to-high frequency our findings indicated a decreased activity of sympathetic ratio of HR variability (r = . we had demonstrated the effect of 10 min progress in the environment by listening to the staff music on anxiety-relieving for patients awaiting surgery. r = . our findings that LF in the broadcast group was The correlation between VAS scores and heart rate significantly lower than the control group indicates there variability parameters were examined by Pearson correla. Lee et al. / International Journal of Nursing Studies xxx (2011) xxx–xxx Table 3 previous findings (Cooke et al. Kaemph and Amodei (1989) found a and the control group (p < . No.01. Effectiveness of different music-playing devices for reducing preoperative anxiety: A clinical control study. Kaemph and Amodei. J. indicating controls. 2006. Correlations between VAS score and HR variability parameters. Nurs.12 . we include a control group group. the HR variability parameters in the control There was no pretest–posttest comparison in this study. Gillen et al. One possible reason is that while listening to the for post intervention comparison.22* . groups were reduced after the music intervention.01). Our findings are similar to those by frequency of HR variability (r = .21* Buffum et al.80 . This is consistent with previous In this study. while In terms of the time domain of HR variability parameters. Maranets and Kain.. the control group did not exhibit a significant change the differences among the three groups were not (p < 0. patients in the waiting room can also monitor the (Lee et al.01). the total power of the headphone control group (p < 0. HF in the broadcast group was group was higher than that of the broadcast group or the markedly higher than that in the control group. HF in the head- parameters phone group was also higher than that in the control group.88 . Furthermore. arthroscopic procedures for the group exposed to music phone group.22.01). and the result * p < . low frequency change in part of the heart rate variability parameters. p < . 2003. note for abbreviations refer to Table 2.22..01 .-C. Moreover. LF in the headphone group was also lower assessment of anxiety.05) nerves and decreases the activity of parasympathetic but not time-domain ones. music might already be playing and this would make to that of the control group. This difference was between the broadcast group and the evidence indicates that when headphones are not available control group (p < . VAS score Similar findings have also been reported in the literature. p < . reference in considering using music broadcast system The HR values did not show a significant difference for anxiety-relieving effect. The VAS score was positively nerves.01). The finding of no difference between the sensory deprivation resulting from wearing headphones broadcast group and the headphone group provide requires further evaluation. as expected. Correlation of VAS scores and heart rate variability control group upon listening to music. resulting in increased LFs and lowered HFs..9. HR SDNN rMSSD TP %LF0 %HF LF/HF 1999.2011. Lee et al. 2011).01). Int. Chiu et al.. (2006) conducted a randomized control trial p . In contrast. p < . was less tension of the sympathetic nervous system in the tion to provide reference to the validity of VAS in broadcast group. Stud.G Model NS-1823. (2003) where HF was markedly elevated and LF and LF/HF ratio significantly decreased after music 4.04. though it was not statistically significant. Discussion therapy. nerves and an increased activity of parasympathetic nerves respectively) and was negatively correlated with high after listening to music.21.1016/j.3. which makes them feel more at ease. speakers can be an effective substitute. a greater modulation of HF by the parasympathetic nervous system in the broadcast group than that in the 3. among the three groups.. 2005.001 . The anxiety reliving effect was also indicated by a No significant differences in high frequency. When patients in the broadcast group entered the superior in both the headphone and the broadcast groups room. Such effect of awaiting surgery. et al.11 . There was also significant difference in low played on an audiocassette player a foot away. between the broadcast group and the headphone group. K. doi:10. 1989). This finding.02 . (2011). The Scheffe test showed that the significant was significantly lower than that of the control group.008 of 170 patients waiting for vascular angiography proce- Examined by Pearson correlation. Our and low-to-high frequency ratio of HR variability were frequency-domain analysis showed that LF and HF were found between the headphone group and the control statistically different among the broadcast group and the group. 2004. while there was no difference or not appropriate. The VAS scores were significantly correlated with stated that anxiety increases the activity of sympathetic frequency-domain parameters of HR variability (p < . Hayes et al. of Pages 8 6 K.01. To provide only significant between broadcast group and control reference in absence of pre-test. In our previous study on music. talking.05.. Padmanabhan et al. group showed less changes (Table 2). 2002). Our frequency HR variability among the three groups (F = 4. they were deprived of broadcast to headphone music playing for patients from any information from the environment. r . In addition.22* .. Comparing the HF This was limited by the intervention for our broadcast and LF. dures using a boom-box style music player.-C. the VAS levels of the two music listening studies (Buffum et al. while there was no significant decrease in anxiety among outpatients awaiting difference between the broadcast group and the head. However. 2008. Sheps and Sheffield (2001) 3.ijnurstu. the regulation of the sympathetic nervous system is group.76 . 2005. and the result was shown in Table than that of the control group... research also showed that anxiety in the broadcast group p < .

. 2008.. D. European Journal of Anaesthe- from speakers can be a substitute for headphones when siology 22 (4). studies. Both headphone and broadcast music are Critical Reviews in Biomedical Engineering 21 (3). Looney.N..04. it is possible that the indicators in this short- whereas YFC..001 .2.ijnurstu. The effect of music on anxiety: a research indicated by a decrease in VAS scores.. E. K. Putland. M. Benzodiazepine premedication may attenuate the stress waiting room in our study did not have individual response in daycase anaesthesia: a pilot study. W. St. Sasso. Though our data confirmed that listening to music has an immediate effect of anxiety reduction. Researchers have This study was supported by Taipei Medical University pointed out that temporal-domain analysis is optimal for Hospital. A objective measurements such as HR variability used in this music intervention to reduce anxiety before vascular angiography study. E. 2005. were not allowed to choose their favorite music. peratively and immediately postoperatively becomes Chiu. K.S. Pseudocholinesterase activity increases and heart rate variability From an infection control perspective. The effect of music on preoperative anxiety in day surgery.. 932–935.2011. 2002. 2004.. M..J.. Journal of Advanced Nur- sing 48 (5). Termey.. F. future studies need to deter. Sasso. 2003). KCL contributed for the study design Therefore. Louis. Limitations receiving mechanical ventilatory support.P. mine if lowering the levels of anxiety in the preoperative Acharya.. 2001. Medical and Biological Engineering and intraoperative and postoperative stages.. Amodei. Meadows. effective for reducing the preoperative patient’s anxiety in Katz.S.. 1998. music arrangement without personal choice. Lanier. L... comparison. M.M. Primarily without a pre-test it is impossible to 52 (1). P.1.. 2005. and also found time-domain parameters.. 2001.. 2003. 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