Response to letter regarding “A pilot trial exploring the use of music in the emergency department and its association with delirium and other clinical outcomes”

Résumé fourni par la source

We thank Dr. Daungsupawong and Professor Wiwanitkit for their interest in our work, namely our recently published article describing a pilot trial exploring the use of music therapy in the ED. We are glad to note that these authors agree with several of the limitations which we detailed in our paper, including aspects such as the revised and pragmatic recruitment approach,1 where we converted from a randomised controlled trial to a self-selection design. We completely acknowledge, here again as we did in our original paper, that in not pursuing randomisation we lose the ability to correct for potential confounders, and that there is a need for randomised trials in this space. As a pilot trial, this was primarily an exploratory study, and despite the inherent flaws, we believe it adds to the limited literature regarding both music listening and music therapy in the ED and their potential efficacy. As we reported, and as Dr. Daungsupawong and Professor Wiwanitkit also write, we were under-powered to detect or out-rule any differences between intervention and control. However, perhaps more importantly for a pilot trial, we determined that the collection of planned outcome measures, such as incidence and resolution of delirium, as well as pain scores or agitation/sedation scores, was feasible, even in the busy ED setting. Similarly to these two authors, we advocate for more controlled music listening and music therapy trials in to-date typically neglected acute settings.2, 3 In addition to investigations of other types of music therapy, we acknowledge that the optimum duration of therapy, if any, is yet to be established. We note too that in the Australian setting, rapid transfer from the ED to the in-patient wards is encouraged (with the so-named ‘4-hour rule’), potentially limiting the investigation of substantially longer treatment periods in this setting, although in real life these transfer targets are not always achieved.4 We look forward to future research which can expand on the findings of our pilot trial and better inform our provision of patient-centred care to those at risk of or experiencing delirium, among other patient cohorts. We welcome collaboration on future projects and further stimulating debates around methodology and design. Disposable headphone covers for the referenced original pilot study were kindly provided by an unrestricted donation from Haines Medical Australia. The authors have no other conflicts of interest to declare.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.