Video Analysis of Group Music Therapy for Dementia: Intervention Delivery and Treatment Fidelity.

In the recent multinational cluster-randomized Music Interventions for Dementia and Depression in ELderly care trial, group music therapy (GMT) was one of two music-based interventions for care home residents with dementia and depressive symptoms received for 6 months. In this study, we assessed the quality of intervention delivery and treatment fidelity of video-recorded GMT sessions. A randomly selected sample of video recordings (n = 53) from 19 music therapists across five countries were analyzed by two independent raters using a fidelity checklist. The average session duration was 40 min with four residents attending. Essential session components Introduction with welcome song (90.6%), Song singing and reminiscence (96.2%) and Closing with a farewell song (85.4%) were commonly carried out, in contrast to optional components Improvisation on instruments (69.8%) and Movement to music (37.7%). The inter-rater agreement showed an assessment of checklist items related to Song singing and reminiscence was challenging. Twelve categories of rater comments (n = 606) were identified, including: clarifying coding choices, therapist-related observations, expressing doubt in coding, and order of components. Six categories were identified for 82 significant moments described by the raters, including observations related to residents' (re)actions, interaction, music activity, music therapist, care staff, and disruption of session. Agreement between raters showed that it was feasible to provide GMT using a pre-established session structure, where music therapists could tailor session content to current needs of individual residents. Assessment of intervention delivery and treatment fidelity based on video-recorded sessions is challenging yet valuable for increasing understanding of efficacy and implementation of music-based interventions. Trial registration: ClinicalTrials.gov NCT03496675.