Abstract

RATIONALE

People receiving haemodialysis for kidney failure experience substantial symptom burden, including anxiety, depression, and pain, which adversely affect physical function and quality of life. Music-based interventions are increasingly used as non-pharmacological strategies to address these symptoms; however, their effectiveness and the certainty of the evidence remain unclear. An updated systematic review of recent randomised controlled trials (RCTs) is therefore warranted.

OBJECTIVES

To assess the effects of music-based interventions on fatigue, blood pressure, depression, pain, anxiety, stress, quality of life, and sleep quality in people with kidney failure receiving haemodialysis.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, Scopus and two trials registers up to 16 May 2025.

ELIGIBILITY CRITERIA

We included RCTs involving participants with kidney failure undergoing haemodialysis, comparing music-based interventions with controls where music-based interventions were not provided (e.g. standard care, headphones without music intervention, or video). We excluded studies involving temporary haemodialysis for acute kidney injury or other conditions.

OUTCOMES

We examined the impact of music-based interventions on fatigue, blood pressure, depression, and pain over the short term (up to four weeks), medium term (four weeks to six months), and long term (more than six months). These outcomes were prespecified as critical outcomes for GRADE assessment and included in the summary of findings table. Other important outcomes included anxiety, sleep quality, stress and quality of life.

RISK OF BIAS

We used the Cochrane risk of bias 2 tool (RoB 2) to assess bias in the RCTs.

SYNTHESIS METHODS

We synthesised results for each outcome using meta-analysis, where possible, applying a restricted maximum-likelihood random-effects model. We measured outcomes as mean differences (MDs) with 95% CIs when all included studies used the same outcome scale, or standardised mean differences (SMDs) with 95% CIs when different outcome scales were used. We used the GRADE approach to assess the certainty of evidence for critical outcomes.

INCLUDED STUDIES

We included a total of 27 studies involving 1584 participants, of which 24 studies (1467 participants) contributed to the quantitative synthesis. Comparator interventions included usual care, no intervention, headphones without music or white noise, and video interventions. The studies took place in 13 countries and territories across Asia, Europe, North America, and South America.

SYNTHESIS OF RESULTS

Critical outcomes Fatigue Music-based interventions may reduce short-term fatigue (measured on the 10-point Piper Fatigue Scale) compared with usual care or other comparator interventions (MD -3.14, 95% CI -3.83 to -2.45; 1 study, 62 participants; low-certainty evidence). The evidence is very uncertain about the effect of music-based interventions on medium-term fatigue (SMD -1.99, 95% CI -3.92 to -0.06; I² = 91%; 2 studies, 86 participants; very low-certainty evidence). No studies evaluated fatigue in the long term. Blood pressure The evidence is very uncertain about the effect of music-based interventions on short-term blood pressure (mmHg) (MD -5.95, 95% CI -10.56 to -1.34; I² = 70%; 8 studies, 674 participants; very low-certainty evidence). The evidence is very uncertain about the effect of music-based interventions on medium-term blood pressure (MD -2.00, 95% CI -14.21 to 10.21; 1 study, 16 participants; very low-certainty evidence). No studies evaluated blood pressure in the long term. Depression The included studies evaluated depression using the Hospital Anxiety and Depression Scale, Patient Health Questionnaire-9, Beck Depression Inventory and Visual Analog Scale (VAS). Music-based interventions may reduce depressive symptoms compared with usual care or other comparator interventions over the short term (SMD -0.88, 95% CI -1.51 to -0.25; I² = 84%; 6 studies, 489 participants; low-certainty evidence) and medium term (SMD -0.81, 95% CI -1.42 to -0.19; I² = 43%; 5 studies, 203 participants; low-certainty evidence). No studies evaluated depression in the long term. Pain The included studies measured pain using the VAS, Kidney Disease Quality of Life Short Form, and McGill Pain Questionnaire. Music-based interventions may reduce short-term pain compared with usual care or other comparator interventions (SMD -0.89, 95% CI -1.63 to -0.15; I² = 92%; 8 studies, 675 participants; low-certainty evidence). No studies evaluated pain in the medium or long term.

AUTHORS' CONCLUSIONS

Music-based interventions may reduce fatigue, depressive symptoms, and pain in people undergoing haemodialysis in the short term compared with usual care or other comparator interventions. The evidence is very uncertain about the effect of music-based interventions on blood pressure in the short term. In the medium term, music-based interventions may reduce depressive symptoms, but the evidence is very uncertain about their effects on fatigue and blood pressure. No studies reported long-term outcomes for these critical outcomes. Further large, well-designed RCTs with longer follow-up are needed to clarify the effects of music-based interventions for this population.

FUNDING

This Cochrane review was funded (in part) by Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (Grant numbers: 22H03554, 19K03092, 24K06239).

REGISTRATION

Protocol (2025) available via 10.1002/14651858.CD016139.

MeSH

Depression, Patient Health Questionnaire, Bias, Quality Of Life, Blood, Pain, Sleep, Stress, Physiological, Blood Pressure, Kidney, Signs And Symptoms, Fatigue, Research