Refining a hybrid music therapy intervention for chronic obstructive pulmonary disease and heart failure: a single arm pilot study.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) pose significant challenges to patients and the health systems that care for them. Music therapy has the potential to address these challenges, but its impact on readmission rates and quality of life remains largely underexplored. This study evaluated the feasibility, fidelity, and acceptability of a hybrid music therapy intervention as a precursor to a randomized controlled trial (RCT).

Methods: Using a single-arm, mixed-methods approach, inpatients aged 30 - 89 with COPD or HF and access to home videoconferencing technology, a mobile device with a data plan, and a reliable support person were recruited during their hospitalizations. Patients with significant hearing/visual impairments, severe psychological comorbidities, terminal medical conditions, stage IV HF, or end-stage COPD were excluded. The intervention included 2 inpatient in-person sessions and 2 virtual sessions following discharge. Feasibility was assessed by rates of recruitment, retention, session attendance, and measure completion. Fidelity was evaluated by adherence to the session protocol, while acceptability was assessed through semi-structured interviews with randomly selected participants.

Results: Of 113 patients approached, 20 (17.7%) were enrolled, and 85% were retained. Median participant age was 61.5 years, with 80% having HF and participants having high rates of anxiety (50%) and depression (35%). Overall session attendance was 57.5%, with higher rates for in-person (75%) compared to virtual sessions (40%). Adherence to the intervention protocol was > 80% across all monitored sessions. Challenges with the trial included difficulty reaching participants following discharge, frequent virtual session rescheduling, and participants' challenges using technology. Semi-structured interviews supported the acceptability of the intervention with three emerging themes (1) the therapeutic relationship facilitated a positive intervention experience, (2) need for strategies to improve post-discharge engagement in the intervention, and (3) impacts on mental health.

Conclusions: Findings support the feasibility of hybrid music therapy among patients with COPD or HF. However, challenges in post-discharge communication and virtual session attendance were noted. These issues will be addressed in a subsequent feasibility RCT through implementing secure text-based communication in addition to phone communication to reach participants post-discharge, refined eligibility criteria (e.g., excluding patients on dialysis), and in-person technology instruction.

Trial registration: ClinicalTrials.gov NCT06214325. Registered on January 9, 2024.