37 Effect of Music Therapy on Oxygen Saturation Level: A Literature Review Ruma Chakravarty1, Neena Mehta1, Dharam Vir2 1Rayat-Bahra University, India 2Post Graduate Institute of Medical Education & Research, India Submitted: 2022-04-19. Revised: 2022-05-04. Accepted: 2022-06-11 Abstract Music therapy as a non-invasive therapeutic modality is gaining prominence worldwide both in hospital settings as an adjunct therapy as well as for community wellbeing. Music therapy offers encouraging evidence-based outcomes for stabilising vital parameters to improve symptoms as- sociated with complex illnesses such as autism spectrum disorder or major depressive disorders. The purpose of this review is to 1) identify scientific literatures that offer insights on the effect of music therapy on oxygen saturation levels of patients undergoing treatments for diverse con- ditions; 2) compare the effects of music therapy based on identified parameters 3) analyse the critical reviews of the researchers of studies included in this literature scan and 4) synthesise the review findings for the benefit of future scientific researches on the effect of music therapy on oxygen saturation levels. In this review, an analysis of relevant scientific papers published in the last 80 years from 1940 to 2020 (as available) was done by searching databases such as PubMed, Cochrane Library, Wiley Online Library, Gray Literature sources such as Google Scholar, World- cat; DOAJ, and WHO Global Index Medicus. Eighteen relevant papers describing music therapy’s effect on the patient’s oxygen saturation levels (under different conditions) were included in the review. The results and discussions respectively compare and analyse characteristics of included studies, music therapy administered, measuring device used, the effectiveness of music therapy on oxygen saturation levels, and critical reviews of authors of the scanned literature. Keywords: music therapy, oxygen saturation level, SpO2, SaO2 How to Cite: Chakravarty, R., Mehta, N., & Vir, D. (2022). Effect of Music Therapy on Oxygen Saturation Level: A Literature Review. Harmonia: Journal of Arts Research And Education, 22(1), 37-47 Harmonia: Journal of Arts Research and Education 22 (1) (2022), 37-47 Available online at http://journal.unnes.ac.id/nju/index.php/harmonia DOI: http://dx.doi.org/10.15294/harmonia.v22i1.36232 psychological, physiological, and other areas. It has become a norm to measure and maintain a normal oxygen saturati- on level, especially during the pandemic when oxygen saturation is being used as a marker of fatality for Covid-19-affected patients (Mejía F et al., 2020). A pulse oxi- meter (oximeter) has entered every home, and people are more conscious than before about their oxygen uptake and saturation; and how they breathe. At the same time, INTRODUCTION Music therapy is considered to be one of the best alternative, adjunct, and non-invasive therapeutic measures world- wide for alleviating diverse conditions/ symptoms of diseases and disorders. As a natural therapeutic and healing modali- ty, researchers and scientists are conduc- ting numerous experiments to assess the benefit of music therapy in neurological, Corresponding author: E-mail: ruma.consult@gmail.com p-ISSN 2541-1683|e-ISSN 2541-2426 Harmonia: Journal of Arts Research and Education 22 (1) (2022): 37-4738 people’s reliance on natural therapies to improve oxygen saturation level and up- take has increased significantly. Music therapy is one such therapeutic measure accepted well across the globe. The effect of music therapy on diverse conditions has been studied for the past many years. The- re is a body of evidence-based scientific re- search where music therapy has shown ef- ficacy in improving conditions, disorders, and symptoms. Music therapy has been used for acute stroke rehabilitation (Ale- xander Street et al., 2020); to bring positive changes in cognitive, psychological (anxie- ty, depression), and behaviour aspects for patients having Alzheimer’s disease (Gó- mez Gallego M et al., 2017); in lowering an- xiety and distress of cancer patients during simulation procedure for radiation thera- py (Andrew Rossetti et al., 2017); in better social skill developments, mood, langu- age, sensory perception and behaviour in individuals having autism spectrum disor- der (Zhi-Min Shi et al., 2016) and for other symptom improvements. Further research focuses on permanently damaging the Co- ronavirus shell with ultrasound vibrations at frequencies between 25 megahertz to 110 megahertz (Wierzbicki T et al., 2021). The- se frequencies for collapsing viral shells and damaging vibration of viral spikes are routinely used in medical imaging diag- nostics. As a natural and non-invasive in- tervention, the impact of music therapy on oxygen saturation levels is studied for pa- tients suffering from diverse conditions or undergoing treatments for some diseases. Oxygen saturation is a key parame- ter in determining blood oxygen content as well as oxygen delivery. Oxygen sa- turation is the measure of the proportion of oxygen attached to haemoglobin in the blood (that is, oxyhaemoglobin), estimated as a percentage. Oxygen saturations are abbreviated SpO2/ SaO2 (for arterial sa- turation) or SvO2 (for venous saturation). SpO2/ SaO2 is generally measured with a pulse oximeter as a clinically acceptab- le standard monitoring modality to assess oxygen sufficiency in clinical settings and also at home setups (Andrew B. Lumb et al., 2019). The normal SpO2/ SaO2 level is 95% - 100% in healthy adults. The prevalent disorders and symp- toms affecting respiratory system functio- ning, unstable oxygen saturation, oxygen uptake, lower oxygen saturation level in Covid-19 patients, etc., have accentuated increased employment of natural modali- ties. These eventually help improve SpO2/ SaO2 – whether in clinical setup, home se- tup, or in rehabilitation procedures. Con- sidering music therapy as a natural the- rapeutic modality, studies have shown increased SpO2/ SaO2 for patients under different conditions and medical care. Examples include women undergoing caesarean delivery (Handan E et al., 2018), patients undergoing open-heart surgery (Nilsson U, 2009), or babies in a neonatal intensive care unit (NICU) (Berna Alay et al., 2019). Studies have also shown no effect of music therapy in certain cases where the duration of therapy was less (Dixit UB et al., 2020) or for postoperative patients who underwent hernia repair (Nilsson U et al., 2005). Thus, in view of all the above as- pects, it becomes relevant to find out what the recent literature narrates about the im- pact of music as a therapeutic modality on the oxygen saturation levels of patients un- dergoing treatments. At the same time, the purpose of the literature scan is also to as- certain whether music therapy can be con- sidered a modality for improved oxygen saturation levels. Therefore, the literature review was carried out with the objective of addressing the questions: ‘can music therapy be administered for patients ha- ving challenges with oxygen saturation le- vel?’ and ‘can music therapy be an effecti- ve natural therapy for improving patients’ oxygen saturation level? ’ Thus, this literature review aims to identify existing research papers that nar- rate whether music therapy has any effect on vital parameter oxygen saturation le- vels of patients undergoing treatments for diverse conditions. The further objective is to compare and analyse the findings and critical reviews/ reflections of authors of Ruma Chakravarty, et al., Effect of Music Therapy on Oxygen Saturation Level: A Litera- 39 scanned literature and synthesise from those for widening the application of mu- sic therapy in future research works to as- sess its effectiveness on oxygen saturation levels. METHOD Search Strategy A literature review was thus a logical progression to explore the purpose at hand and to find answers to the questions re- counted above. Databases searched for the review of literature are PubMed (Jan 1940 – Dec 2020), Cochrane library (Jan 1947 – Dec 2020), Wiley Online Library (Jan 2004 – Dec 2020), Gray Literature sources such as Google Scholar (Jan 1940 – Dec 2020), Worldcat (Jan 2011 – Dec 2020); DOAJ (Jan 2012 – Dec 2020) and WHO Global Index Medicus (Jan 1940 – Dec 2020) with the keywords ‘music therapy’, ‘oxygen satu- ration level’, ‘SpO2’ and ‘SaO2’. Filter was applied for 1940–2020 as applicable for dif- ferent databases. All relevant and original full-text articles that matched the search criteria of the effect of music therapy on oxygen saturation levels were included. Selection Criteria The selection criteria of the studies in the literature review were based on the fol- lowing aspects: Inclusion criteria were 1) original research papers published in the last 80 years (1940-2020) in peer-reviewed jour- nals that report the effect of music therapy on the oxygen saturation level of a diverse group of patients; 2) the papers where the parameter was independently measured; 3) included full-text papers and 4) papers that were written in English. Papers exclu- ded were 1) review papers; 2) thesis, 3) on- going clinical trials, and 4) papers without any outcomes concerning oxygen saturati- on level as a result of music therapy inter- vention. No other criteria were applied for the search of the literature in this review. RESULT AND DISCUSSION Results Characteristics of the included studies In total (n=321) unfiltered/ raw pa- pers were found during the first phase of the literature search within the databa- ses PubMed (33); Cochrane (47); Google Scholar (172); Wiley Online Library (49); Worldcat (12); DOAJ (5) and WHO Glo- bal Index Medicus database (3) (Figure. 1). Taking into consideration the objective of this literature review, the emphasis was to identify which of these (n=321) papers focus precisely on reporting any effect of music therapy on oxygen saturation levels of respective participant groups. Removal of duplicate records resulted in (n=284) papers. Through preliminary screening, records remained (n=93), which offered focused reporting of the impact of music therapy on oxygen saturation levels. Furt- her screening resulted in (n=30) full-text articles. Final cleaning was applied in the analysis of the literature review scan when review papers and papers reporting no study results were removed; this resulted in (n=18) papers, which were included for review. Close scrutiny of these eighteen literature-scanned papers helped compile study details, music type used in therapy, and study conclusions. The results are pre- sented in Table 1. Eighteen studies included in the li- terature review have varied numbers of participants ranging from 26 to 202. 50% of the studies have less than 50 participants, while the rest 50% reported over 50 par- ticipants. Three studies (20% of the total) reported participants to be more than or equal to 100. Eight (44.4%) included stu- dies are randomised control trials; five (27.8%) are experimental studies; the re- maining five (27.8%) are quasi-experimen- tal, pre and post-test, and single-group randomised clinical trial studies. Adults (n=6; 33.3%) and preterm/ premature in- fants (n=6; 33.3%) constituted 66.7% of the studies, children and adolescents (n=5) held 27.8% of studies; while one study was conducted with full-term newborns (n=1; 5.5%). For assessing the efficacy of music Harmonia: Journal of Arts Research and Education 22 (1) (2022): 37-4740 therapy on oxygen saturation level, most of the adult studies (66.7%) (Handan E et al., 2018; Nilsson U, 2009; Nilsson U et al. 2005; Saritas et al. 2016) were concerned with pre- intra- and post-operative pro- cedures while other two papers addressed terminally ill patients (Antoniazza B et al., 2018) and ICU patients with head injury (Indriani, N. at al., 2018); three research papers (Dixit UB et al., 2020; Marwah N et al., 2005; Tshiswaka SK et al., 2020) concer- ning children and adolescents recounted using music therapy pre-, intra- and post- treatment for dental anxiety while two stu- dies (Calcaterra, Valeria et al., 2014; Atiye Karakul et al., 2018) used the music during the recovery period after daycare surgery. For studies with full-term/ preterm/ premature, predominantly (66.7%) (Berna Alay et al., 2019; Eskandari N et al., 2013; Cristiane Aparecida Moran et al., 2015; Jabraeili M et al., 2016; Elham Shafiei et al., 2020) the effect of music on physiological parameters including oxygen saturation level was measured; two (33.3%) studies (Diler Aydin et al., 2012; Aydın, D. et al., 2014) reported assessing the effect of mu- sic therapy on stress too along with oxygen saturation levels. Figure 1. Database record search and selec- tion from PubMed; Cochrane Library; Google Scholar, Wiley Online Library, Worldcat, DOAJ, and WHO Global Index Medicus Characteristics of music therapy administered Types and forms of music administe- red varied across studies, and few papers reported using multiple genres of music in both vocal and instrumental modes. Ten papers used only instrumental music, five used only vocal music, and three reported using both types. Western classical music, lullaby, and Turkish music dominated the music genres used as therapy. Other mu- sic used includes popular live music, soft melodies, nature’s sound, favourite/ pre- ferred songs/ music choice of participants, Indian classical music, etc. Classical music dominated the music genres chosen for music therapy as per the present literature scan that included western classical music (7), Turkish classical music (2), and Indian classical music (1) forms. In papers using western music therapy, two studies each reported using recorded classical music rendition of Bach (Saritas et al., 2016; Atiye Karakul et al., 2018) and Mozart (Berna Alay et al., 2019; Indriani, N. et al., 2018); two studies used ‘New Age’ (Nilsson U et al., 2005; Cristiane Aparecida Moran et al., 2015) while another study used classical music rendition of Bach, Mozart, Vival- di, A. Corelli and E. Grieg Holberg (Cal- caterra, Valeria et al., 2014). Four studies used lullabies as therapeutic music (Berna Alay et al., 2019; Eskandari N et al., 2013; Cristiane Aparecida Moran et al., 2015; El- ham Shafiei et al., 2020). Cristiane Apare- cida Moran et al., 2015 used music as an adjunct therapy to respiratory therapy for preterm infants. Music therapy duration for studies, except those reporting music therapy during surgery/ treatment, was between 15 minutes to 1 hour per session. Overall music intervention length of the studies varied significantly from a single session (example: during caesarean secti- on) to over a month (example: 29-32 days for premature infants). Five of eighteen studies reported playing music from 25 dB to 70 dB. Another study mentioned using ambient speakers. Characteristics of measuring device used For measuring oxygen saturation Ruma Chakravarty, et al., Effect of Music Therapy on Oxygen Saturation Level: A Litera- 41 levels, seven of eighteen studies used a pulse oximeter (oxymeter) while four stu- dies reported using different instruments - Primus Dräger (Lübeck, Germany), Vital monitoring system - DX 2010-LCD - Dixtal Biomedical, SAADAT monitoring system (SAADAT, Malaysia) and Mennen VL4000 bed-side monitor. The remaining seven studies did not mention the oxygen satu- ration level measuring device name. The outcome of music therapy on oxygen saturation level Eight out of eighteen papers (44.4%) concluded music therapy is an effective mo- dality that showed statistically significant outcomes for improving oxygen saturation levels, while other ten (55.6%) studies did not show statistically significant outcomes. Nine out of eleven (81.8%) qualified papers concerning adults, children and adoles- cents focus on assessing the effectiveness of music on oxygen saturation either pre-, intra- and/ or post-operative/ treatment procedures. Amongst these nine studies, in adults, three out of four (75%) papers that concerned with open heart (Nilsson U, 2009), caesarean section (Handan E et al., 2018) and general surgery (Saritas et al., 2016) show increase of oxygen saturation levels of patients with music therapy inter- vention; while in children and adolescents, none of the papers reports improvement. Two papers concerning adult patients - one in ICU with head injury (Indriani, N. et al., 2018) and another (Antoniazza B et al., 2018) with terminally ill patients sta- ted statistically significant outcome where oxygen saturation level raised with music therapy. Out of these nine studies concer- ning surgery/ treatment, ones that did not find music therapy effective include one study with adult patients undergoing open hernia operation (intra and post-) (Nilsson U et al., 2005); three studies (Dixit UB et al., 2020; Marwah N et al., 2005; Tshiswaka SK et al., 2020) with children undergoing dental treatment (intra-) and two (Calca- terra, Valeria, et al., 2014; Atiye Karakul et al., 2018) with children and adolescents undergoing day care surgery (post-). Two (Jabraeili M et al., 2016; Elham Shafiei et al., 2020) out of six (33.3%) studies concerning preterm and premature infants had shown a positive effect of music therapy on oxy- gen saturation levels while four (66.7%) studies (Eskandari N et al., 2013; Cristiane Aparecida Moran et al., 2015; Diler Aydin et al., 2012; Aydın, D. et al., 2014) did not find music therapy effective for improve- ment of oxygen saturation level. In additi- on, the study (Berna Alay et al., 2019) with full-term newborns too showed statistical- ly significant outcomes. Discussion Reviewed studies The present literature review identi- fies eighteen papers that describe the the- rapeutic effect of different types and gen- res of music on the oxygen saturation level of 1,151 participants undergoing some diverse medical treatments. The literatu- re review does not focus on participant equivalence, disease equivalence, or mu- sic equivalence. Accordingly, the review showed a mixed outcome. Due to the he- terogeneity of the study types, participant profiles, music forms used and the mode of applying the intervention a comparison between the outcomes may not be justified; however, the conclusions from the review may help future researchers to explore and validate the conclusions. Music therapy on oxygen saturation level Music had diverse effects on patients’ oxygen saturation levels as per the drawn conclusions. The review reports patients from different age groups, from neonates to adults of 80+ years of age, and thus the effectiveness of music on oxygen satura- tion level as per the outcome too varied significantly. Adult patients were found to benefit most from music therapy interven- tion, followed by premature/preterm or newborn infants, while included studies with children participants showed no ef- fect of music on oxygen saturation levels. Papers narrating Western classical music’s usage reveal better outcomes for the revie- Harmonia: Journal of Arts Research and Education 22 (1) (2022): 37-4742 wed literature. Administration of Western classical instrumental music in different forms helped increase oxygen saturation levels in adults in surgical intensive care units as well as in newborn patients under medical care. Mum’s lullaby and Brahm’s lullaby positively affected the oxygen satu- ration levels of preterm infants. Favourite songs were chosen by women undergoing multiple caesarean section delivery. Clas- sical music for patients in the intensive care unit (ICU) and instrumental music from live musical performances for ter- minally ill patients significantly increased their oxygen saturation levels. Three pa- pers with children having dental anxiety reported no change in the oxygen satura- tion level when administered with music therapy, including Indian classical music, Instrumental music, nursery rhymes, and Portuguese children’s songs. All the stu- dies in the literature review reported using receptive (or passive) music; while a sing- le study reported that 1% of participants choose active live music therapy (instru- mental music played by trained music therapists and nurses) as well. Pre-, intra-, and post-therapy observations reveal that in one paper improved oxygen saturation levels were sustained even after 15 minu- tes of music therapy, while in another, the improved levels were observed during the intervention and until the completion of therapy administration. Although many of the reviewed papers did not mention the types of instruments used to measure oxy- gen saturation levels, the ones mentioned did not significantly differ in outcomes. Critical reviews, reflections, and gaps The authors of the studies included in the literature review have offered a few important critical reviews, reflections, and gaps in the process, which may be signifi- cant for efficiently using music in clinical setups in the future. Those are bucketed under a few themes. 1) Continuity in using music in clinical setups: even though using music did not show the expected effect in a few studies, patients responded positi- vely to the music and voted in favour of listening to that in their subsequent visits (Marwah N et al., 2005). Continuity in applying music the- rapy to patients may offer a better out- come. For example, in a couple of studies (Eskandari N et al., 2013; Cristiane Apa- recida Moran et al., 2015) with premature infants, although there were no significant improvements in oxygen saturation levels, however, there was a decrease in respira- tory rates after the end of music therapy intervention. 2) In-service music therapy training: in-service music therapy training for nurses in ICUs, their continued use, and extended application for patient-care services need to be encouraged (Saritas et al., 2016; Atiye Karakul et al., 2018). 3) Rhythm variation and silence: positive ef- fect of music was seen through variation in rhythms and silence in between the mu- sic interventions in a study with Western classical music (Calcaterra, Valeria, et al., 2014). 4) Stabilisation of oxygen saturation levels: multiple studies (Diler Aydin et al., 2012; Aydın, D. et al., 2014; Indriani, N. et al., 2018; Atiye Karakul et al., 2018) showed music therapy helped stabilise oxygen sa- turation level irrespective of whether the- re was an improvement or not. 5) Music therapy expertise: four studies (Calcaterra, Valeria, et al., 2014; Saritas et al., 2016; An- toniazza B et al., 2018; Atiye Karakul et al., 2018) out of eighteen mention music design or selection by music therapist or trained/ expert musicians; two mentions trained re- search assistant (Jabraeili M et al., 2016) or nurse (Nilsson U, 2009) while rest twelve papers did not mention using expert mu- sicians or music therapists for designing/ selection of music for intervention. 6) The mechanism in which music therapy works: studies that mention the improvement of oxygen saturation levels with music thera- py do not clearly explain why it happens. A couple of studies (Nilsson U, 2009; El- ham Shafiei et al., 2020) suggest positive outcomes with deep breathing caused by soothing music. A few studies (Eskandari N et al., 2013; Cristiane Aparecida Moran et al., 2015; Handan E et al., 2018 ;) do not report improvements in oxygen saturation Ruma Chakravarty, et al., Effect of Music Therapy on Oxygen Saturation Level: A Litera- 43 levels with music therapy; however, they report better respiratory rates and quali- ties than control groups. Other papers (Di- ler Aydin et al., 2012; Aydın, D. et al., 2014; Atiye Karakul et al., 2018) report retention of oxygen saturation within normal levels. CONCLUSIONS As is identified from the results and discussions of included studies in the re- view, it becomes evident that homogeneo- us research is required to comprehend how music therapy works on a similar patient base. Even with heterogeneity in included papers in the present literature review, eit- her positive outcomes of music on oxygen saturation level improvement or no effect was reported; no negative outcomes were reported. The mixed result may be attri- buted to the diversity and heterogeneity. Thus, an exact comparison of the re- sults may not be justified because of the di- verse nature of the studies. Secondly, how music therapy affects oxygen saturation levels is yet to be understood completely. For example, whether it depends on the type of patient groups; nature of the mu- sic such as classical music, lullaby or other music forms; live or recorded music; any soothing music that may positively affect respiratory activities resulting in deeper breaths; therapy duration; targeted music therapy procedural design; trained facili- tators in clinical setups or apposite execu- tion, needs to be researched extensively. To realise the sustained experience of music therapy, a continuity in the the- rapy process with trained professionals is mandatory per the patient’s status. This is the norm and is also being reported by the authors of the included papers. The selection and designing of music therapy by the experts is an area that needs more focused details in research papers because experience in designing and app- lying music therapy might influence the efficacy of the therapy procedure as well as the overall experience of participants or patients. Further, the basis of choosing a piece of particular music for a specific pa- tient condition is also not available, which again is very important to narrate; becau- se designing relevant music intervention for therapy is important for a successful outcome that may not be homogeneous but may be targeted to the need and to be developed by experts in the domain. Re- searchers may utilise the findings (both positive outcomes, reflections, and critical reviews) of the present literature scan as base level understandings to design fu- ture research work on the effect of music therapy on oxygen saturation levels in pa- tients undergoing treatment for different conditions. More and more clinical rese- arch studies with relevant music therapy design need to be conducted with different patient profiles to understand the efficacy of music therapy and for standardisation of outcomes in this domain. Music therapy is a well-accepted, non-invasive, inexpensive, and easy-to- use modality that is used to address and improve patient conditions. Also, along with identified disease areas, surgical settings, day care treatments, preterm in- fants, and others, there is an emergent need to conduct research to assess music therapy’s role on oxygen saturation levels of Covid-19 patients and survivors. There is a dearth of literature on this domain of scientific work. Overall, the review’s fin- dings and critical analysis emphasise how music therapy as a therapeutic modality can be helpful for promoting natural the- rapy and further benefit humankind holis- tically. REFERENCES Alexander Street, Jufen Zhang, Susan Pethers, Lydia Wiffen, Katie Bond & Helen Palmer (2020. Neurologic music therapy in multidisciplinary acute stroke rehabilitation: Could it be feasible and helpful? Topics in Stroke Rehabilitation, 27(7), 541-552. Andrew Rossetti, Manjeet Chadha, Jae K. Lee, Joanne V. Loewy, Louis B. Har- rison (2017). The Impact of Music Therapy on Anxiety in Cancer Pa- Harmonia: Journal of Arts Research and Education 22 (1) (2022): 37-4744 tients Undergoing Simulation for Radiation Therapy. Int J Radiation Oncol Biol Phys, 99(1), 103-110. Atiye Karakul, Zehra Bahire Bolışık2 (2018). The Effect of Music Listened to During the Recovery Period After Day Surgery on the Anxiety State and Vital Signs of Children and Ado- lescents. J Pediatr Res, 5(2), 82-7. Aydın, D., & Yıldız, S (2014). Effect of Turk- ish music that premature infants are made to listen during care on stress, oxygen saturation level and length of hospital stay. Journal of Human Sci- ences, 11(1), 1343–1359. Barbara Antoniazza, Monica Patricio Pinto, Matteo Ferraraccio, Massimo Damini, Damini, Alfonso Sollami, Giuseppe Marletta (2018). Effects of Music Therapy on Vital Signs and Anxiety: A Study with Terminally Ill Patients. J Hosp Palliat Med Care, 1, 002. Berna Alay, Figen Isik Esenay (2019). The clinical effect of classical music and lullaby on term babies in neonatal in- tensive care unit: A randomised con- trolled trial. J Pak Med Assoc, 69(4), 459-463. Calcaterra, V., Ostuni, S., Bonomelli, I., Mencherini, S., Brunero, M., Zam- baiti, E., Mannarino, S., Larizza, D., Albertini, R., Tinelli, C., & Pelizzo, G. (2014). Music benefits on post- operative distress and pain in pedi- atric day care surgery. Pediatric re- ports, 6(3), 5534. Cristiane Aparecida Moran; Roberta de Oliveira Cacho; Enio Walker Aze- vedo Cacho; Klayton Galante Sousa; Jane Carla de Souza; Gentil Gomes da Fonseca Filho; Silvana Alves Pereira (2015). Use of music during physical therapy intervention in a neonatal intensive care unit: a ran- domized controlled trial. Rev. bras. crescimento desenvolv. Hum, 25(2). Diler Aydin, Suzan Yildiz (2012). Effect of classical music on stress among pre- term infants in a neonatal intensive care unit. Journal of Society for develop- ment in new net environment in B&H, HealthMED, 6, 3176-82. Dixit UB, Jasani RR (2020). Comparison of the effectiveness of Bach flower therapy and music therapy on dental anxiety in pediatric patients: A ran- domized controlled study. J Indian Soc Pedod Prev Dent, 38(1), 71-8. Elham Shafiei, Zahra Daneshvar Ameri, Hojjat Sheikhbardsiri, Mahdi Yaseri, Hamideh Baniasadi (2020). The Ef- fect of Mother’s Lullaby on Preterm Infants’ Physiological Parameters. J Pediatr Res, 7(1), 46-51. Eskandari N, Alipour Z, Ahmari Teh- ran H, Eshagh Hossaini K, Sangi S (2013). Effect of vocal stimulation on responses of premature infants: A randomized controlled trial. Health Spiritual Med Ethics, 1(1), 9-16. Gómez Gallego M, Gómez García J (2017). Music therapy and Alzheimer’s dis- ease: Cognitive, psychological, and behavioural effects. Neurologi, 32(5), 300-308. Handan E, Sahiner NC, Bal MD, Dissiz M (2018). Effects of Music during Multiple Cesarean Section Delivery. J Coll Physicians Surg Pak, 28(3),247- 249. Indriani, N., Santoso, B., Arwani, A., & Mardiyono, M (2018). Comparison of effectiveness of a progressive mo- bilization and Mozart music therapy on non-invasive hemodynamic sta- tus changes in patients with head injury in the intensive care unit. Be- litung Nursing Journal, 4(2), 135-144. Jabraeili M, Sabet T, MustafaGharebaghi M, Asghari Jafarabadi M, Arshadi M (2016). The effect of recorded mum’s lullaby and brahm’s lullaby on oxy- gen saturation in preterm infants: a randomized double-blind clinical trial. J Caring Sci, 5(1), 85-94. Marwah N, Prabhakar A R, Raju O S (2005). Music distraction - its efficacy in management of anxious pediatric dental patients. J Indian Soc Pedod Prev Dent, 23(4), 168-70. Mejía, F., Medina, C., Cornejo, E., Morello, Ruma Chakravarty, et al., Effect of Music Therapy on Oxygen Saturation Level: A Litera- 45 E., Vásquez, S., Alave, J., ... & Mála- ga, G. (2020). Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru. PloS one, 15(12), e0244171. Nilsson U (2009). Soothing music can in- crease oxytocin levels during bed rest after open-heart surgery: a ran- domised control trial. J Clin Nurs, 18(15), 2153-61. Nilsson U, Unosson M, Rawal N (2005). Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized con- trolled trial. Eur J Anaesthesiol, 22(2), 96-102. Pulmonary Physiology (2019). Andrew B. Lumb, Elizabeth Horncastle. In Phar- macology and Physiology for Anesthe- sia (Second Edition), edited by Hugh C. Hemmings, Talmage D. Egan, pp 586-612, ISBN 9780323481106. [Online URL: https://www.scien- cedirect.com/science/article/pii/ B9780323481106000296]. Saritas, Seyhan Citlik and Bilsev Araç (2016). The Effect of Music Therapy on the Vital Signs of Patients in a Surgical Intensive Care Unit. Int J Med Invest, 5(2), 54-59 Tshiswaka SK, Pinheiro SL (2020). Effect of music on reducing anxiety in chil- dren during dental treatment. RGO, Rev Gaúch Odontol, 68, e20200033. Wierzbicki T, Li W, Liu Y, Zhu J (2021). Effect of receptors on the resonant and transient harmonic vibrations of Coronavirus. J Mech Phys Solids, 150, 104369. Zhi-Min Shi, Gui-Hong Lin, Qing Xie (2016). Effects of music therapy on mood, language, behavior, and so- cial skills in children with autism: A meta-analysis. Chinese Nursing Re- search, 3(3), 137-141. https://intjmi.com/browse.php?mag_id=17&slc_lang=en&sid=1 https://intjmi.com/browse.php?mag_id=17&slc_lang=en&sid=1 Harmonia: Journal of Arts Research and Education 22 (1) (2022): 37-4746 Appendix Table 1. Characteristics of included papers regarding effect of music therapy on oxygen satura- tion level 1st author (year) Age Range # Sub- jects Diagno- sis Study Type Music Form – Therapy Duration Conclusions Nilsson U (2005) Mean age = 55 - 57 yrs. 75 Patients under- going open hernia repair RCT Recorded classical music New-Age synthesizer; seven melodies that are soft and relaxing were :43 minutes to 1 hour :intra- and post- operatively :instrumental :pulse oximeter There were no significant differences between the three groups (intra- music, pos- toperative music and silence/ control groups) with regards to SpO2, however postoperative group reported less anxiety with music therapy. Marwah N (2005) 4-8 yrs. 40 Anxious pediatric dental patients Experimen- tal study Recorded instrumental music and nursery rhymes music as per pa- tients’ choice :throughout treatment procedure :instrumental and vocal :pulse oximeter The values of oxygen saturation showed minimal variations during all the visits with instrumental music and rhymes groups. The results were not statistically significant. Even though pain relief was less, the patients responsed positively to the music therapy and wished for listening to the same during their subsequent visits. Nilsson U (2009) Mean age = 65.5 yrs. 40 Open Heart Surgery RCT Recorded soft and relaxing music MusiCure (Musi Cure) with differ- ent melodies of 60 to 80 beats per minute (bpm) :30 minutes; 50–60 dB :post-surgery :instrumental The results found a trend towards higher SaO2 in the music group compared with the control group although there were no statistically significant result obtained. The author mentions that patients might have taken deeper breaths during music listening, which might have helped subside pain perceptions. Diler Aydin (2012) Preterm infants 26 Stress Experimen- tal study Recorded Turkish classical music :1 hour; 45–60 dB :during a scheduled time of the day : instrumental and vocal No significant change in oxygen saturation levels was observed before and after music therapy inter- vention however the levels were maintained within normal limits between the trial and control groups. D Aydın (2014) Pre- mature Infants 60 Stress Experimen- tal study Turkish music CD of Dede Efendi :musical instruments used in the CD - reed flute, rebab, lute and dombra :30 minutes :during a scheduled time of the day :instrumental Oxygen saturation values increased marginally at the onset attributed to the stimulating and relaxing effect of music therapy; however remained at the normal levels during hospital stay of 29-32 days. Overall, there was no statistically significant differ- ence in oxygen saturation between the experimental and control groups. Valeria Calcaterra (2014) 3 to 14 yrs. 42 Day surgical proce- dures (includ- ing orchi- dopexy, inguinal hernia repair, circum- cision) RCT Six tracks of slow (70-80 beats/min) and fast (140-150 beats/min) classical music (recorded) were used - Andante Molto A. Vivaldi; Suite J. S. Bach; Suite E. Grieg Holberg’s Rigaudon; Andante W.A. Mozart; Suite J. S. Bach; Allegro A. Corelli :20 minutes :postoperative (while awakening) :instrumental :Primus Dräger (Lübeck, Germany) While awakening at the recovery room SpO2 decreased significantly with respect to admission and end of surgical procedure times. There were no dif- ferences between the music and non-music groups. Narges Eskandari (2014) Pre- mature infants 120 Pre- mature infants RCT Recorded lullaby (goodnight kid, produced by the national radio of Iran) :20 minutes; 50-60 dB :during a scheduled time of the day :vocal :pulse oximeter No statistically significant changes were seen in short term responses for oxygen saturation of premature infants following lullaby music intervention. How- ever, infants listening to lullaby experienced decrease in respiratory rate at the end of the therapy session. Cristiane Aparecida Moran (2015) Pre- mature infants 26 pre- mature infants RCT Recorded classical music New – Age :21 minutes ; 25 dB :during respiratory (physical) therapy :instrumental :Vital monitoring system - DX 2010- LCD - Dixtal Boimedical Between the control and experimental groups, there was no statistically significant difference in oxygen saturation level, however lower variation in respiratory rates were shown with music inclusion in experimental group. S Çıtlık Sarıtaş (2016) 18+ yrs. 202 Patients in surgical intensive care unit Quasi-ex- perimental research Recorded classical music Bach’s, violin concertos :30 minutes; 60 dB :pre-surgery :instrumental Oxygen saturation increased with music therapy and the difference was considered statistically significant (p<.001). Authors feedback were to offer in-service training of music therapy as nursing activity and maintain continuity. Mahnaz Jabraeili (2016) Preterm infants 66 Preterm Infants RCT Recorded folkloric (Turkish or Persian lullaby) in mother’s voice (65-70 dB) and Brahms’ lullaby (65 dB) :15 minutes each :during a scheduled time of the day :vocal :SAADAT monitoring system (SAA- DAT, Malaysia) There were statistically significant difference in oxygen saturation of infants between Brahm’s lullaby and mum’s lullaby when compared with controls during 15 minutes after music. The conclusion was that music therapy may be administered for short- term vital benefits of the preterms. Ruma Chakravarty, et al., Effect of Music Therapy on Oxygen Saturation Level: A Litera- 47 1st author (year) Age Range # Sub- jects Diagno- sis Study Type Music Form – Therapy Duration Conclusions Novi Indri- ani (2018) Mean age = 36 yrs. 34 Head injury in ICU Quasi-ex- perimental study with pre-, post- design Recorded Mozart’s music with a 60-80 beat size :90 minutes per day which was divided into 3 intervention times :morning, noon and afternoon :instrumental Mozart’s music therapy had a significant effect on changes in oxygen saturation (p=0.008). The authors concluded that Mo- zart’s music therapy may help shorten the ICU stay of patients with head injury. Handan Eren (2018) Mean age = 31 yrs. 60 Cae- sarean Section delivery Experimen- tal study Favourite songs chosen by patients (re- corded) :throughout treatment procedure :vocal A significant increase (p=0.017) in the oxygen saturation levels of women in the experi- mental group undergoing caesarean section procedure was observed. Authors mention better repiratory qualities in response to music therapy during caesarean procedures. Barbara Antoniazza (2018) Up to 80+ yrs. 50 Termi- nally Ill Patients Pre and post-test study Live instrumental music by music therapist and trained nurse :instruments used - guitar, long and/or wooden flute, maracas, drums, piano :30-40 minutes :during a scheduled time of the day :instrumental :pulse oximeter The study witnessed positive effects and improvement of blood oxygen saturation with statistically significant result between pre- and post- tests (p<0.01) with live music therapy intervention. Authors conclude that their study offers a strong scientific evidence in favour of the efficacy of music therapy for terminally ill patients and should be used for all health settings. Atiye Kara- kul (2018) 9-17 yrs. 65 Day sur- gery of children and ado- lescents Pre- post- test control group study Recorded The Art of The Fugue by Bach :20 minutes :post-operative recovery period/ awakening period :instrumental The study did not find significant effect on the oxygen saturation value of children and adolescents who listened to music while awakening post-operation. However in the experimental group, music therapy helped retain the oxygen saturation level within normal limits. Berna Alay (2019) Full-term new- borns 45 Physi- ological mea- sure- ments and Stress symp- toms RCT Mozart for Babies music CD11 (Valley En- tertainment Inc, USA) and mother’s lullaby (both recorded) :30 minutes; 65 dB :during a scheduled time of the day :instrumental and vocal :Mennen VL4000 bed-side monitor Oxygen saturation levels of full-term babies in the classical music group increased from the 10th minute and remained stable until the completion of intervention (p<0.05). Lul- labies did not affect oxygen saturation level. The authors as a reason conclude that may be recorded lullaby was not as effective as the live vocal singing of the mother. Uma B Dixit (2020) 4-6 yrs. 120 Dental anxiety in pae- diatric patients RCT Recorded Indian classical instrumental music (Raag Sohni, Pt. Shiv Kumar Sharma, santoor) :pre-, intra- and post- treatment procedure :instrumental :pulse oximeter Music therapy had no appreciably clinically significant effects on oxygen saturation in this study. The authors report using music therapy for just 5 minutes during the dental treatment procedure and that may be too short a time to have an effect on the vitals. Serge Kalongo (2020) 5 to 11 yrs. 40 Dental anxiety in chil- dren Experimen- tal study Thirty-seven children’s songs in Portuguese were selected by the children. Four songs were played live with 6 stringed guitar (pre- ). Same recorded songs were played during treatment from among the 37 songs :pre and intra- dental procedure :vocal :pulse oximeter There was no significant difference in oxygen saturation in children who listened to music during dental care compared to the non- music group. Elham Shafiei (2020) Preterm infants 40 Preterm infants Single group random- ized clinical trial Recorded mother’s Lullaby :20 minutes; 50 DB :during a scheduled time of the day :vocal :pulse oximeter Statistical analyses showed a significant dif- ference in oxygen saturation levels (p=0.039) of preterm infants between two stages of ex- periment – lullaby and non-lullaby. Authors conclude that the soothing effect might have caused decrease in sympathetic activities that eventually helped deep breathing and thus improved oxygen saturation level.