Group-Based Telehealth Music Therapy Intervention for Patients with Dementia: A Pilot Study

Background: The behavioral and psychological symptoms in dementia (BPSD) make caregiving particularly challenging. In-person music therapy sessions with a professional have been shown to be helpful for BPSD and reducing caregiver burden. There are few music therapists practicing in rural settings, specifically for this population, so telehealth offers an alternative way to access their care. However, there have been limited studies demonstrating the efficacy of telehealth music therapy, and the authors are not aware of studies investigating group-based telehealth music therapy in dementia. This investigation seeks to explore the feasibility of group-based music therapy via telehealth for people living at home with dementia. Methods: Our participants were community-based outpatients recruited from a memory clinic with mild to moderate dementia and had a willing caregiver to participate. We ran a single blinded block-randomized control pilot study. The patients were randomized one-to-one to receive either 6 weekly telehealth music therapy group sessions with a board-certified music therapist or a personalized music playlist on a platform of their choice. There were 12 participants total in each group, for a total of 24 participants, along with their caregivers. The participants were divided into 3 cohorts that took part in the study sequentially, with 8 participants per cohort and 4 participants per group (Music Therapy vs Music Playlist). Each cohort’s session lasted for 6 weeks. Our initial outcome measures were to compare scores at baseline and at 6 weeks on measures of the patient’s cognition (Mini Mental State Examination, or MMSE) and mood (Geriatric Depression Scale, or GDS); caregiver report of BPSD (Neuropsychiatric Inventory-Questionnaire: Severity/Distress scales, or NPI-Q/S/D); caregiver strain (Modified Caregiver Strain Index, or MCSI); and caregiver depression (Patient Health Questionnaire-9, or PHQ-9). As the investigation progressed, we measured study attrition and qualified reasons for dropout. Results: Throughout the investigation, there was a 67% dropout rate, equal between groups. Some of the most common reasons for dropout included unavailability of the participant due to a busy schedule with other appointments, loss to follow-up with nonresponse to calls, and deteriorating health/increasing hospitalizations that impacted participant’s ability to actively participate in sessions. There was no appreciable trend from the pre-scores to the post-scores in both the interventional and control groups. Conclusions: Despite both interventions being relatively non-burdensome, dropout rate was high among both groups, which limits the ability to draw meaningful conclusions about potential benefits of group telehealth music therapy intervention vs music playlist. Our results may help researchers to design and implement a larger group-based telehealth music therapy study with lessons we are learning from this investigation, which will hopefully better guide treatment and management of dementia in the primary care setting.