Assessment Task 3 – Scenario 3

Introduction Anti-depressant medications are consistently used throughout acute medical wards to treat symptoms of depression. However, there are complementary and lifestyle interventions that can be introduced as an alternative. This piece will explore the effects of musical therapy for lessening symptoms of depression through evidence-based practice. A clearly stated and answerable clinical question is a critical step when developing a research study. To assist in developing the question a PICO principle is used. This principle identifies four key elements to consider, which guide and structure the answerable clinical question. The elements are: Population, Intervention, Comparator and Outcome (Hastings & Fisher, 2014).

PICO question development When treating the elderly (aged 65 and older) with symptoms of depression (P), does engaging in a complementary intervention such as music therapy (I), in comparison to anti-depressant medications (C), have a greater effect on decreasing the symptoms of depression (O)? Identifying the population determines the target patient or process of interest. In this case, geriatrics or older adults (aged 65 and older) with depression is specific and marks it achievable to locate information that is relevant to the clinical question. The intervention is a guide to the best practice to be assessed, for example, music therapy as being an effective alternative to improve symptoms of depression. A comparator is essential to review the most effective form of practice, for instance, reviewing anti-depressant medications as the most or least effective practice. Finally an outcome is provided to clearly understand the success of the clinical question. In this case, the success is to decrease the symptoms of depression.

Searching for the evidence To ensure that the evidence is accurate and found correctly, a specific search strategy is to enter key terms, based on the PICO question, into certain research article databases. In order to find these key words, Medical Subject Headings (MeSH) is a valuable database to assist with identifying the words that will then be used within a nursing based database. According to MeSH, terms such as aged, depression, anti-depressant medications and music therapy are all vital words that will assist to efficiently select relevant evidence. CINAHL, Medline, Cochrane Library, Wiley Online Library and BMJ Best Practice are all evidence-based databases with reputable research for health care professionals. Combining the use of these databases provides access to a range of information, filtered and unfiltered. Using both BMJ Best Practice and Cochrane Library which hold only filtered information, will assure a quality of evidence, then utilising unfiltered sources to support the information. In order to address any sensitivity and specificity issues the use of Boolean operators can be an effective strategy. Terms such as, ‘and’, ‘or’ and ‘not’ are applied to search for precise key words in accord with other key words, as well as ignoring unwanted words to refine the search.

Types of evidence The developed search strategy above located a range of supportive pieces of evidence. The following pieces of evidence are placed in order of strongest to weakest according to the National Health and Medical Research Council (NHMRC) hierarchy of evidence:

Tedeschini, E., Levkovitz, Y., Iovieno, N., Ameral, V, E., Nelson, J, C., Papakostas, G, I. (2011). Efficacy of antidepressants for late-life depression: a meta-analysis and meta-regression of placebo-controlled randomized trials. The Journal of Clinical Psychiatry, 72(12), 1660-1668. doi: 1-.4088/JCP.10r06531

Verrusio, W., Andreozzi, P., Marigliano, B., Renzi, A., Gianturco, V., Pecci, M. T., & ... Gueli, N. (2014). Exercise training and music therapy in elderly with depressive syndrome: A pilot study. Complementary Therapies In Medicine, 22(4), 614-620. doi:10.1016/j.ctim.2014.05.012

Kumar, G., & Sinh, B. (2013). To access the role of music therapy in depression and their comparison with drug therapy. International Journal of Pharmaceutical Sciences and Research, 4(8), 3099-3102. doi: 10.13040/IJPSR.0975-8232.4(8). 1000-10

Chan, M, F., Wong, Z, Y., Onishi, H., Thayala, N, V. (2011). Effects of music on depression in older people: a randomised controlled trial. Journal of Clinical Nursing, 21(5-6), 776-783. doi: 10.1111/j.1365-2702.2011.03954.x

Erkkilä, J., Punkanen, M., Fachner, J., Ala-Ruona, E., Pöntiö, I., Tervaniemi, M., ... & Gold, C. (2011). Individual music therapy for depression: randomised controlled trial. The British journal of psychiatry, 199(2), 132-139. doi: 10.1192/bjp.bp.110.085431

In order to formally and critically appraise different levels of evidence, it is important to assess how relevant and reliable the evidence is according to current guidelines. A systematic review or meta-analysis is a pre-appraised source of evidence that is recommending to be consulted first. According to NHMRC, a “Systematic review of all randomised controlled trials” is categorised as level I evidence, indicating that it is the most reliable form of evidence. Tedeschini et al. (2011) is a meta-analysis derived from a systematic review. Its quality of evidence is at the highest level, and therefore the best available evidence to begin addressing the PICO question. This meta-analysis targets aspects of the PICO question by analysing the efficacy of antidepressants in late-life depression. From there, Verrusio et al. (2014), Kumar and Singh (2013), Chan et al. (2011) and Erkkilä et al. (2011) are all randomised control trials. NHMRC states that randomised control trials are categorised as level II evidence and are not pre-appraised. This evidence has been sourced from an unfiltered information database and is considered the highest level of unfiltered information. Each of these reviews cover multiple aspects of specificity towards the PICO question by making clear reference to the effects music therapy has on depression compared with antidepressant medications, indicating that they are highly relevant.

Conclusion In order to develop an answerable clinical question and acquire the best available evidence, using the PICO model as a framework is important. It provides a pathway for health care professionals to develop a specific question from a broad scenario. Then, by collecting key terms and operating them into specific databases allows for the most relevant and accurate sources of evidence to be located. Finally, being able to locate the highest level of evidence to strongly address the PICO question is a critical part of the process.

References
Hastings, C., & Fisher, C. A. (2014). Searching for proof: Creating and using an actionable PICO question. Nursing Management, 45(8), 9-12. doi:10.1097/01.NUMA.0000452006.79838.67

Tedeschini, E., Levkovitz, Y., Iovieno, N., Ameral, V, E., Nelson, J,C., Papakostas, G,I. (2011). Efficacy of antidepressants for late-life depression: a meta-analysis and meta-regression of placebo-controlled randomized trials. The Journal of Clinical Psychiatry, 72(12), 1660-1668. doi: 1-.4088/JCP.10r06531

Verrusio, W., Andreozzi, P., Marigliano, B., Renzi, A., Gianturco, V., Pecci, M. T., & ... Gueli, N. (2014). Exercise training and music therapy in elderly with depressive syndrome: A pilot study. Complementary Therapies In Medicine, 22(4), 614-620. doi:10.1016/j.ctim.2014.05.012

Kumar, G., & Kumar Sinh, B. (2013). To access the role of music therapy in depression and their comparison with drug therapy. International Journal of Pharmaceutical Sciences and Research, 4(8), 3099-3102. doi: 10.13040/IJPSR.0975-8232.4(8).1000-10
Chan, M, F., Wong, Z, Y., Onishi, H., Thayala, N, V. (2011). Effects of music on depression in older people: a randomised controlled trial. Journal of Clinical Nursing, 21(5-6), 776-783. doi: 10.1111/j.1365-2702.2011.03954.x

Erkkilä, J., Punkanen, M., Fachner, J., Ala-Ruona, E., Pöntiö, I., Tervaniemi, M., ... & Gold, C. (2011). Individual music therapy for depression: randomised controlled trial. The British journal of psychiatry, 199(2), 132-139. doi: 10.1192/bjp.bp.110.085431