Overview of the Topic
The objective and purpose of the research investigation was to studythe effects of music, progressive muscle relaxation, and progressive muscle relaxation (PMR) together with music on the reduction of anxiety, fatigue and improvements of quality of life in family hospice caregivers.The study employed a three-way mixed design ANOVA statistical analysis to draw conclusions from the study.The target population was made up predominantly of primary caregivers, that is, hospice patient’s spouse and, or adult child. The total sample size was 32 participants where, 20 were hospice patient’s spouse, and 12 were adult children. The participants were categorizedunsystematically into fourgroups; Control (or silence), Progressive Muscle Relaxation (PMR) only,Music listening only, and Music combined Progressive Muscle Relaxation. These groups formed the units of analysis.
The study research question was: “What Is the Effect of Music, Progressive Muscle Relaxation, and Music Together With Progressive Muscle Relaxation on the Reduction of Anxiety, Fatigue and Improvements of Quality Of Life in Family Hospice Caregivers?”
A three-way (Group x Time x pre-post) mixed design ANOVA with group as between subject factor, number of sessions and pre-post test as within subject factors was utilized. Further complicating the three-way mixed design ANOVA is that, in addition to the three-way interaction and the three main effects, there were three two-way interactions to consider. For the research study, the null and alternative hypotheses are as follows:
H0: Main effect “Music Therapy” is not significant: µ0weeks (Pre-test) = µ2weeks (posttest)
H1: Main effect “Music Therapy” is significant: µ0weeks (pre-test) ≠ µ2Weeks (posttest)
For the main effect “Music Therapy”, the null hypothesis denotes that there is no significant difference in the reduction of anxiety, fatigue and improvements of quality of life in family hospice caregivers in pre and posttest scores. That is, at Zero weeks and after Two weeks.
H0: Main effect “Progressive Muscle Relaxation” is not significant:
H1: Main effect “Progressive Muscle Relaxation” is significant:
For the main effect “Progressive Muscle Relaxation”, the null hypothesis denotes that there is no significant difference in the reduction of anxiety, fatigue and improvements of quality of life in family hospice caregivers in pre and posttest scores. That is, at 0 weeks and after 2 weeks.
H0: Main effect “Music Therapy together with Progressive Muscle Relaxation” is not significant: µMale= µFemale
H1: Main effect “Music Therapy together with Progressive Muscle Relaxation” is significant: µMale≠ µFemale
For the main effect “Music Therapy together with Progressive Muscle Relaxation”, the null hypothesis denotes that there is no significant difference in the reduction of anxiety, fatigue and improvements of quality of life in family hospice caregivers in pre and posttest scores. That is, at 0 weeks and after 2 weeks.
H0: interaction effect is not present
µmusic=µPMR; µmusic=µ9PMR&Music; µ6PMR=µPMR&Music
H1: Interaction effect is present
µmusic≠µPMR; µmusic≠µ9PMR&Music; µ6PMR≠µPMR&Music
With regards to the interaction effect, the null hypothesis for all the three-way interactions supposes that the three main effects; Music Therapy, PMR, and Music Therapy together with PMR are independent. That is, there is no interaction between the three variables. The alternative hypothesis presupposes that the three main effects Music Therapy, PMR, and Music Therapy together with PMR are dependent. It hypothesizes that there are differences among the populations’ means which cannot be attributable to the main effects, thus they can only be attributable to interactions between the variables. That is, there is an interaction between the two independent variables.
Methods and Study Design
The study was a pretest-posttest design. It consisted of four sessions: two 30 minutes sessions a week for 2 weeks assessing the caregiver’s anxiety and fatigue level every session.Participants were selected from caregivers of patients who had been receiving hospice for at least 2 weeks. The purpose of the study was explained to the participants and thereafter they signed a consent form.The subjects participated in the research study at their homes or a quite place within the facility where their loved ones were residing. The specific qualifications for the testing environment were that it should be quite and free from distractions; and there should be a comfortable chair for the participant to sit in the course of the intervention.
The independent variables comprised of sessions of music, progressive muscle relaxation sessions, and music together with progressive muscle relaxation. Number of sessions of music therapy formed one of the independent variable. It is a quantitative measure since it can take numerical values and is measurable using a ratio scale. Progressive muscle relaxation is the other independent variable;it is a continuous variable measured using a ratio scale.
The dependent variables were level of anxiety and fatigue and quality of life. Anxiety levels were measured using the Spielberg State Trait Anxiety Inventory. It is a continuous variable measured using a ratio scale. The caregiver fatigue was measured using a Fatigue Visual Analogue Scale. The scale attached a numerical value to the level of fatigue the caregiver related to the caregiving experience.Therefore it was a quantitative variable measured using a ratio scale. The caregivers’ quality of life was measured using the Caregivers Quality Of Life Index-Cancer
With regards to sample selection, subjects were randomly divided by having the participants drawing pieces of paper with the name of the group listed from a bag. The groups included control (or silence), music listening only, progressive muscle relaxation (PMR) only, and PMR combined withmusic, with eight subjects making each group.
The study predominantly employed a three-way mixed ANOVA design to determine the three-way interaction between group, time and pre-post measures. The post-hoc testing was conducted with the help of paired t tests to compare pre and posttest differences scores for individual sessions separately. To control for type I error that is commonly associated with the use of this test, the study used the Bonferroni method.
Findings from the three-way (Group x Time x Pre-post) mixed designed ANOVA with group between subject factor, number of sessions and pre-posttest as within subject factors found no significant main effect for group, F (3, 28) = 0.406, p=0.750. No significant results were found for interactions between time and group, pre-post and group, time and pre-post, or for the three-way interaction between group, time and pre-post measures. Results showeda significant main effect of the pre and posttest anxiety scores, F (1, 28)=51.815, p<0.01, and time effect, F(3, 84) = 3.527, p<0.05. Follow-up paired t tests used for post-hoc testing were conducted to compare pre and posttest differences scores for each session separately.The study used the Bonferroni method to control for Type I error rates for multiple comparisons; each t test was tested at the 0.025 level. Results indicated that the music only group exhibited a significant difference in pre and posttest scores on days 1,2,3, and 4.
The last objective of the study was to examine the relationship between anxiety, fatigue, and quality of life. The study found a significant correlation between anxiety and fatigue, anxiety and quality of life, and fatigue and quality of life. These findings infer that decreasing anxiety and fatigue would result toan improved quality of life of a caregiver.
Based on the findings in relation to the stated hypothesis, the research study rejects all the null hypotheses while accepting the alternate hypotheses for both the main effects and interaction effects.
A key criticism of the research study stems from its choice of statistical analysis tool. Whereas a three-way mixed design ANOVA has the strength of incredible flexibility, it bears the weakness that it is very easy for a researcher to mis-specify the mixed model. This is also likely to happen in the context of the research study and may result to wrong inferences from the results.
Additionally, the small sample size in each group that the study adopted, the small statistical power, as well as brevity of intervention would most probably result to lack of significant findings among the conditions. Finally, the research study sample participants were limited in terms of demographic characteristics, the samples were not balanced and were not completely matched, this would result to wrong deductions. However, it is worth noting that the study also acknowledged this weakness. To obtain superior results, better matching samples would have to be included.
The results from the study exhibited decreased anxiety and fatigue and increased quality of life in all conditions across the four treatment sessions. The results also revealed that there was a significant difference between pre and posttest scores of anxiety, fatigue, and quality of life regardless of condition. There were no significant differences among groups: control, music only, PMR only, and music combined with PMR.However, an examination of mean scores indicated that music combined with PMR resulted in the greatest differences in pre to posttest, followed by the music group, PMR, and the control group. The differences in fatigue mean scores revealed the greatest change in the music group, followed by music combined with PMR, control, and PMR.
In conclusion, the research study established that music and relaxation can be viable coping strategies to support hospice family caregivers. The results demonstrate that music therapy intervention results to a positive change in anxiety, fatigue and quality of life of family hospice caregivers. Its findings directs towards music therapy being a vital element in promoting hospice services as it can play an imperative part in providing hospice services to palliative care and enhancing the quality of life.
Choi, Y. K. (2010). The Effect of Music and Progressive Muscle Relaxation on Anxiety, Fatigue, and Quality of Life in Family Caregivers of Hospice Patients. Journal of Music Therapy, 47(1), 53-67.
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