- Email: [email protected]
The effect of music on the anxiety levels of patients undergoing hysterosalpingography
Radiography (2007) 13, 122e125
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / r a d i
The effect of music on the anxiety levels of patients undergoing hysterosalpingography K.K. Agwu a,*, I.J. Okoye b a
Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Nigeria b Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria Received 8 April 2005; accepted 1 December 2005 Available online 13 February 2006
KEYWORDS Hysterosalpingography; Anxiety; Music therapy
Abstract Objectives: To determine the effect of music on the anxiety levels of patients undergoing a hysterosalpingography procedure. Patients and methods: One hundred hysterosalpingography referrals were randomly assigned to either the experimental or control group. Music chosen earlier by the patients was played during the hysterosalpingography procedure for the experimental group. The control group was studied without music. Certain physiological parameters and the State-Trait Anxiety Inventory were used to assess the patients’ anxiety levels before and during the investigation. Patient’s willingness to have a repeat procedure, should it become necessary, was also assessed in both groups as a measure of acceptability of the investigation. The z-test was used to analyze the results for any statistically significant differences between the experimental and the control groups. Results: The blood pressure (BP) monitored during the procedure was reduced in 31 (62%) of the patients in the experimental group compared to their pre-investigation values. Reduction in the pulse rate (PR) in 28 (56%) of the patients was also noted in the experimental group. On the other hand, the blood pressure of 37 (74%) of the patients and the pulse rate of 32 (64%) patients in the control group were increased from their pre-investigation values. The physiological parameters in the experimental group were significantly lower than the values in the control group during the investigation (p < 0.05). A comparison of the State-Trait Anxiety Inventory scores taken before and during the procedure shows significantly lower scores for the experimental group compared to those for the control group (p < 0.05). More patients, 41 (82%) in the experimental group were also willing to have a repeat procedure compared to 16 (32%) patients in the control. Conclusion: Music reduces the physiological and cognitive responses of anxiety in patients undergoing hysterosalpingography and can be harnessed for clinical use. The use of music therapy made the procedure to be more acceptable by the patients. ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: C234 42 456165. E-mail address: [email protected] (K.K. Agwu). 1078-8174/$ - see front matter ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2005.12.002
Effect of music on anxiety levels
Introduction Hysterosalpingography is the commonest diagnostic option for the infertile woman in the African region.1,2 This diagnostic procedure is, however, associated with high levels of anxiety, pain and stress from various causes.3,4 Many patients consequently develop fear of undergoing the procedures or decline a repeat procedure.3 The tubal spasms that result from the psycho-physiological effects of anxiety have been implicated in false tubal occlusions and the need for a repeat procedure.4 This may lead to unnecessary surgery that at times results in real occlusions from postsurgery adhesions. Control and reduction of the anxiety associated with this procedure are ways of improving the accuracy of the test as well as its acceptability. Many approaches have consequently been advocated to reduce the anxiety associated with hysterosalpingography. These range from prior explanation of the procedure5,6 to the use of sedative or smooth muscle relaxants and analgesics.7 This study was therefore undertaken to investigate the effect of music on the anxiety levels of patients undergoing hysterosalpingography procedures.
123 scores indicate higher anxiety levels. The favorite music the patient chose was played to her hearing through an audio-cassette player until the end of the procedure. Each patient’s BP and PR were monitored during the procedure by an attending nurse using Digital Automatic Blood Pressure Monitor manufactured by OMRON Model6. The instruments have accuracies of G5% and G3 mmHg for PR and BP measurements, respectively. Four readings were taken during the procedure and the mean value calculated. Only changes in the BP measurements that were 5 mmHg above or below the pretest values were regarded as genuine changes. Similarly, only changes in the PR that were 80% above or below the pretest values were considered as genuine changes. At the end of the procedure, each patient completed the State-Trait Anxiety Inventory again to reflect her feelings during the procedure. In the control group, a similar process was followed as for the experimental group except that no music was played during the procedure. Each patient’s response on her willingness to have a repeat procedure should it become necessary was obtained from both groups.
Statistical analysis
Patients and methods Out of 140 patients who were referred for hysterosalpingography at the Radiology Department of Parklane General Hospital, Enugu from January 2004 to January 2005, 100 patients were enlisted into the study and formed the sample size based on the equation: nZ
z2 s2 d2
according to Lwanga and Tyre8 where, z Z confidence level, s Z standard deviation from a similar work and d Z error tolerance. For this work, a 5% level of significance representing a statistical power of 95% was adopted, an error tolerance of 0.4 was assumed as well as a standard deviation of 2 from a pilot study conducted earlier by us. Fifty subjects were assigned to the experimental group and another 50 subjects to the control. In assigning the subjects to either the experimental or control group, each subject was allowed to pick a wrapped piece of paper from a box. The pieces of papers were numbered from 1 to 100 and then scrambled. Any subject who picked an odd number when the paper was unwrapped was automatically assigned to the control group. Those who picked even numbers were assigned to the experimental group. Patients’ consent was obtained as well as clearance from the medical research ethics committee of the hospital. All other rules regarding the use of patients for research were strictly adhered to. In the experimental group, each patient was requested to volunteer her favorite music during the booking procedures. Just before the commencement of the procedure, each patient completed a demographic questionnaire, scored the 20-item Spielberger State-Trait Anxiety Inventory9 and in addition had her blood pressure (BP) and pulse rate (PR) measured. The State-Trait Anxiety Inventory has a four-response Likert type format. Higher summed-up
The summed state anxiety level score for the experimental group was compared against the score for the control using the z-test10 for any statistically significant difference. Changes noted in the blood pressure and pulse rate during the procedure from the pretest baseline values were recorded for both the experimental and the control groups. The number of patients who had changes in their physiological parameters during the procedure in the experimental group was compared with the corresponding number in the control group using the z-test for any significant differences.
Results Table 1 shows that women between 25 years and 34 years constituted the highest referral for hysterosalpingography. Thirty-one (62%) of the patients who had music intervention had a reduction in BP during the procedure whereas 37 (74%) of the patients in the control group had increased BP during the procedure as shown in Table 2a. From Table 2b, 28 (56%) of the patients in the experimental group had reduced pulse rate during the procedure, whereas 32 (64%) of the patients in the control had increased pulse rate during the procedure. The PR and BP for some patients remained unchanged during the procedure for both groups. Table 3 shows
Table 1
Age distribution of patients
Age range (years)
No. of patients
20e24 25e29 30e34 35e39 40e44
12 38 30 15 5
124
K.K. Agwu, I.J. Okoye
Table 2 Changes in patients’ (a) blood pressure and (b) pulse rate during the HSG procedure Physiological parameter (a) Patients’ blood Decrease in blood pressure (BP) Constant BP Increase in BP Total
Experimental group (no. of patients) pressure 31 (62%) 14 (28%) 5 (1%) 50 (100%)
(b) Patients’ pulse rate Decrease in 28 (56%) pulse rates (PR) Constant PR 16 (32%) Increase in PR 6 (12%)
Control group (no. of patients)
Patients’ willingness for a repeat procedure
Response
Experimental group
Control group
Willing for a repeat Not willing for a repeat
41 (82%) 9 (18%)
16 (32%) 34 (68%)
4 (0.8%) 9 (18%) 37 (74%) 50 (100%) 7 (14%) 11 (22%) 32 (64%)
the State-Trait Anxiety scores for both groups. The result of the z-test on the State-Trait Anxiety level score between the experimental group and the control group during the procedure showed a statistically significant difference (p < 0.05). The z-test on the values of BP and PR for the experimental and control groups shows a significant difference (p < 0.05). While 41 (82%) patients in the experimental group were willing to have a repeat procedure should it become necessary, only 16 (32%) of the patients in the control group were willing to do so (Table 4).
Discussion The interaction of music and psyche constitutes a phenomenon, which is known to man since antiquity and for this reason has ever since been used for healing purposes. Music therapy has been used in various clinical settings. These include psychofonia for migraine patients,11 palliative treatment for cancer patients12 and relaxation therapy in cerebral atherosclerotic patients.13 From this study, some of the physiological indicators of anxiety, for example, blood pressure and pulse rate were reduced from the baseline values in the experimental group compared to the control. The results are similar to White14 who observed reductions in systolic pressure, respiratory rate and myocardial oxygen demand in patients with myocardial infarction who received music therapy. Chlan15 also noted reduced heart rate and respiratory rate in patients receiving ventilatory assistance who were on music therapy compared to a control. The ability of music to influence certain physiological indicators of state anxiety is based on the psycho-physiological theory according to O’Callaghan.16
Table 3
Table 4
The State-Trait Anxiety Inventory assessed the cognitive response to anxiety. The state anxiety scores were significantly reduced for the experimental group compared to those for the control (p < 0.05). This concomitant reduction of anxiety levels with the physiological indicators confirms the holistic nature of man. Heiser et al.17 made similar observations in post-operative patients whose anxiety levels were significantly reduced by music therapy compared to a control. Music can touch patients deeply and thus transfer their feeling of anxiety and stress into those of relaxation and healing. The role of emotions such as anxiety has long been known to affect pain. Increased anxiety levels have been noted to lead to increased pain perception and discomfort.18 Anxiety co-exists with pain in the clinical setting in general19 and hysterosalpingography procedure in particular.3,4 The positive effect of music therapy in reducing both the physiological and cognitive responses to anxiety can be put to use in creating an empathetic environment for HSG patients, as well as providing an alternative anxiety and pain reduction strategy that is more cost effective and without the side effects associated with the use of pharmacological agents. The reduction in anxiety thus observed from music therapy and expected reduced pain perception by the patients should improve on the false negatives that form muscular spasms associated with pain during the procedure. However, because of the complex relationship between anxiety and pain and the fact that pain threshold varies between individuals, a more rigorous design is required to establish a causal relationship with the diagnostic outcome of HSG. Although music therapy in health care settings is not new, it has always been considered from a philosophical and experimental perspective. Live music at the bedside of patients13 has been introduced as a new way of extending holistic care and improving the quality of service to the patient.20 As we strive towards the acquisition of high technology medical equipment and improve our clinical skill and higher precision in diagnosis, there is need to consider the patient more holistically. Our findings therefore recommend an extension of music therapy in hysterosalpingography procedures for the reduction of anxiety and associated pain. However, its effect on the diagnostic outcome of HSG procedure needs to be further investigated.
Results of state-trait anxiety scores
Anxiety score before HSG Anxiety score during HSG examination
Experimental group’ mean score
No. of patients
Control group’ mean score
No. of patients
43.4 G 8.0 25.6 G 10.3
50 50
41.6 G 7.4 38.9 G 11.0
50 50
Effect of music on anxiety levels
Summary Music has been identified to be effective in reducing the physiological and cognitive responses of state-trait anxiety in patients undergoing hysterosalpingography procedures and also improve the acceptability of the procedure; we recommend its clinical introduction.
References 1. Ladipo OA. An evaluation of 576 hysterosalpingograms of infertile women. Infertility 1979;2(1):63e70. 2. Walton SH, Mati JK. An evaluation of secondary infertility in Kenya. East African Medical Journal 1976;153(6):310e4. 3. Adinma JIB, Okpala OC. Hysterosalpingography in the management of infertility: bilateral tubal occlusion. West African Journal Radiology 1995;3(1):29e34. 4. Tyrell PM, Mchugo JM, Hall M. Patients perception of the hysterosalpingogram. The initial stages of an audit cycle. British Journal of Radiology 1993;66(782):103e7. 5. Agwu KK, Okoye IJ. Knowledge and attitudes of patient towards hysterosalpingography in eastern Nigeria. Journal of Medical Women of Nigeria 2003;1(2):37e40. 6. Haywood J. Information, a prescription against pain. Journal of Psychosomatic Research 1975;11:219. 7. Horwitz RC, Shaff MI, Hugo P. A radiological approach to infertility: hysterosalpingography. British Journal of Radiology 1979;52(616):255e62. 8. Lwanga SK, Tyre CY. Teaching health statistics. Twenty lessons and seminar outlines. Geneva: WHO; 1986. p. 157e8.
125 9. Spielberger CO. Manual for the state-trait anxiety inventory for adults. Palo Alto, CA: Mind Garden; 1983. 10. Nwabuokei PO. Fundamental of statistics. 3rd ed. Koruna Books; 2001. p. 241e97. 11. Meister M, Einsle R, Brunner J, Rhyner K. Psychofonia: a neurophysiologic music therapy in migraine. Schweizerische Rundschau fur Medizin Praxis 1999;88(21):946e9. 12. Tobia DM, Shamos EF, Harper DM, Walch SE, Curie JL. The benefits of group music of the 1996 music weekend for women with cancer. Journal of Cancer Education 1999; 14(2):115e9. 13. Tang X, Yang F, Zhuang. Musical relaxation therapy on cerebral arteriosclerosis. Human 1999;22(1):45e8. 14. White JM. Effect of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction. American Journal of Critical Care 1999;8(4):220e30. 15. Chlan L. Effectiveness of music therapy intervention on relaxation and anxiety of patients receiving ventilator assistance. Heart and Lung 1998;27(3):169e76. 16. O’Callaghan CC. Pain, music creativity and music therapy in palliative care. American Journal of Hospital Palliative Care 1996;13(2):43e9. 17. Heiser RM, Chiles K, Fudge M, Gray SE. The use of music during the immediate post-operative recovery period. AORN Journal 1997;65(4):781e5. 18. Nielsen B, Miaskowski C, Dibbie SL. Pain with mammography: fact or fiction. Oncology Nursing Forum 1993;20:639e42. 19. Hafslund B. Mammography and the experience of pain and anxiety. Radiography 2000;6:269e72. 20. Olson SL. Bedside musical care, applications in pregnancy, childbirth and neo-natal care. Journal of Obstetric, Gynaecologic, and Neonatal Nursing 1998;27(9):569e75.
a v a i l a b l e a t w w w. s c i e n c e d i r e c t . c o m
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / r a d i
The effect of music on the anxiety levels of patients undergoing hysterosalpingography K.K. Agwu a,*, I.J. Okoye b a
Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu, Nigeria b Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria Received 8 April 2005; accepted 1 December 2005 Available online 13 February 2006
KEYWORDS Hysterosalpingography; Anxiety; Music therapy
Abstract Objectives: To determine the effect of music on the anxiety levels of patients undergoing a hysterosalpingography procedure. Patients and methods: One hundred hysterosalpingography referrals were randomly assigned to either the experimental or control group. Music chosen earlier by the patients was played during the hysterosalpingography procedure for the experimental group. The control group was studied without music. Certain physiological parameters and the State-Trait Anxiety Inventory were used to assess the patients’ anxiety levels before and during the investigation. Patient’s willingness to have a repeat procedure, should it become necessary, was also assessed in both groups as a measure of acceptability of the investigation. The z-test was used to analyze the results for any statistically significant differences between the experimental and the control groups. Results: The blood pressure (BP) monitored during the procedure was reduced in 31 (62%) of the patients in the experimental group compared to their pre-investigation values. Reduction in the pulse rate (PR) in 28 (56%) of the patients was also noted in the experimental group. On the other hand, the blood pressure of 37 (74%) of the patients and the pulse rate of 32 (64%) patients in the control group were increased from their pre-investigation values. The physiological parameters in the experimental group were significantly lower than the values in the control group during the investigation (p < 0.05). A comparison of the State-Trait Anxiety Inventory scores taken before and during the procedure shows significantly lower scores for the experimental group compared to those for the control group (p < 0.05). More patients, 41 (82%) in the experimental group were also willing to have a repeat procedure compared to 16 (32%) patients in the control. Conclusion: Music reduces the physiological and cognitive responses of anxiety in patients undergoing hysterosalpingography and can be harnessed for clinical use. The use of music therapy made the procedure to be more acceptable by the patients. ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: C234 42 456165. E-mail address: [email protected] (K.K. Agwu). 1078-8174/$ - see front matter ª 2006 The College of Radiographers. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.radi.2005.12.002
Effect of music on anxiety levels
Introduction Hysterosalpingography is the commonest diagnostic option for the infertile woman in the African region.1,2 This diagnostic procedure is, however, associated with high levels of anxiety, pain and stress from various causes.3,4 Many patients consequently develop fear of undergoing the procedures or decline a repeat procedure.3 The tubal spasms that result from the psycho-physiological effects of anxiety have been implicated in false tubal occlusions and the need for a repeat procedure.4 This may lead to unnecessary surgery that at times results in real occlusions from postsurgery adhesions. Control and reduction of the anxiety associated with this procedure are ways of improving the accuracy of the test as well as its acceptability. Many approaches have consequently been advocated to reduce the anxiety associated with hysterosalpingography. These range from prior explanation of the procedure5,6 to the use of sedative or smooth muscle relaxants and analgesics.7 This study was therefore undertaken to investigate the effect of music on the anxiety levels of patients undergoing hysterosalpingography procedures.
123 scores indicate higher anxiety levels. The favorite music the patient chose was played to her hearing through an audio-cassette player until the end of the procedure. Each patient’s BP and PR were monitored during the procedure by an attending nurse using Digital Automatic Blood Pressure Monitor manufactured by OMRON Model6. The instruments have accuracies of G5% and G3 mmHg for PR and BP measurements, respectively. Four readings were taken during the procedure and the mean value calculated. Only changes in the BP measurements that were 5 mmHg above or below the pretest values were regarded as genuine changes. Similarly, only changes in the PR that were 80% above or below the pretest values were considered as genuine changes. At the end of the procedure, each patient completed the State-Trait Anxiety Inventory again to reflect her feelings during the procedure. In the control group, a similar process was followed as for the experimental group except that no music was played during the procedure. Each patient’s response on her willingness to have a repeat procedure should it become necessary was obtained from both groups.
Statistical analysis
Patients and methods Out of 140 patients who were referred for hysterosalpingography at the Radiology Department of Parklane General Hospital, Enugu from January 2004 to January 2005, 100 patients were enlisted into the study and formed the sample size based on the equation: nZ
z2 s2 d2
according to Lwanga and Tyre8 where, z Z confidence level, s Z standard deviation from a similar work and d Z error tolerance. For this work, a 5% level of significance representing a statistical power of 95% was adopted, an error tolerance of 0.4 was assumed as well as a standard deviation of 2 from a pilot study conducted earlier by us. Fifty subjects were assigned to the experimental group and another 50 subjects to the control. In assigning the subjects to either the experimental or control group, each subject was allowed to pick a wrapped piece of paper from a box. The pieces of papers were numbered from 1 to 100 and then scrambled. Any subject who picked an odd number when the paper was unwrapped was automatically assigned to the control group. Those who picked even numbers were assigned to the experimental group. Patients’ consent was obtained as well as clearance from the medical research ethics committee of the hospital. All other rules regarding the use of patients for research were strictly adhered to. In the experimental group, each patient was requested to volunteer her favorite music during the booking procedures. Just before the commencement of the procedure, each patient completed a demographic questionnaire, scored the 20-item Spielberger State-Trait Anxiety Inventory9 and in addition had her blood pressure (BP) and pulse rate (PR) measured. The State-Trait Anxiety Inventory has a four-response Likert type format. Higher summed-up
The summed state anxiety level score for the experimental group was compared against the score for the control using the z-test10 for any statistically significant difference. Changes noted in the blood pressure and pulse rate during the procedure from the pretest baseline values were recorded for both the experimental and the control groups. The number of patients who had changes in their physiological parameters during the procedure in the experimental group was compared with the corresponding number in the control group using the z-test for any significant differences.
Results Table 1 shows that women between 25 years and 34 years constituted the highest referral for hysterosalpingography. Thirty-one (62%) of the patients who had music intervention had a reduction in BP during the procedure whereas 37 (74%) of the patients in the control group had increased BP during the procedure as shown in Table 2a. From Table 2b, 28 (56%) of the patients in the experimental group had reduced pulse rate during the procedure, whereas 32 (64%) of the patients in the control had increased pulse rate during the procedure. The PR and BP for some patients remained unchanged during the procedure for both groups. Table 3 shows
Table 1
Age distribution of patients
Age range (years)
No. of patients
20e24 25e29 30e34 35e39 40e44
12 38 30 15 5
124
K.K. Agwu, I.J. Okoye
Table 2 Changes in patients’ (a) blood pressure and (b) pulse rate during the HSG procedure Physiological parameter (a) Patients’ blood Decrease in blood pressure (BP) Constant BP Increase in BP Total
Experimental group (no. of patients) pressure 31 (62%) 14 (28%) 5 (1%) 50 (100%)
(b) Patients’ pulse rate Decrease in 28 (56%) pulse rates (PR) Constant PR 16 (32%) Increase in PR 6 (12%)
Control group (no. of patients)
Patients’ willingness for a repeat procedure
Response
Experimental group
Control group
Willing for a repeat Not willing for a repeat
41 (82%) 9 (18%)
16 (32%) 34 (68%)
4 (0.8%) 9 (18%) 37 (74%) 50 (100%) 7 (14%) 11 (22%) 32 (64%)
the State-Trait Anxiety scores for both groups. The result of the z-test on the State-Trait Anxiety level score between the experimental group and the control group during the procedure showed a statistically significant difference (p < 0.05). The z-test on the values of BP and PR for the experimental and control groups shows a significant difference (p < 0.05). While 41 (82%) patients in the experimental group were willing to have a repeat procedure should it become necessary, only 16 (32%) of the patients in the control group were willing to do so (Table 4).
Discussion The interaction of music and psyche constitutes a phenomenon, which is known to man since antiquity and for this reason has ever since been used for healing purposes. Music therapy has been used in various clinical settings. These include psychofonia for migraine patients,11 palliative treatment for cancer patients12 and relaxation therapy in cerebral atherosclerotic patients.13 From this study, some of the physiological indicators of anxiety, for example, blood pressure and pulse rate were reduced from the baseline values in the experimental group compared to the control. The results are similar to White14 who observed reductions in systolic pressure, respiratory rate and myocardial oxygen demand in patients with myocardial infarction who received music therapy. Chlan15 also noted reduced heart rate and respiratory rate in patients receiving ventilatory assistance who were on music therapy compared to a control. The ability of music to influence certain physiological indicators of state anxiety is based on the psycho-physiological theory according to O’Callaghan.16
Table 3
Table 4
The State-Trait Anxiety Inventory assessed the cognitive response to anxiety. The state anxiety scores were significantly reduced for the experimental group compared to those for the control (p < 0.05). This concomitant reduction of anxiety levels with the physiological indicators confirms the holistic nature of man. Heiser et al.17 made similar observations in post-operative patients whose anxiety levels were significantly reduced by music therapy compared to a control. Music can touch patients deeply and thus transfer their feeling of anxiety and stress into those of relaxation and healing. The role of emotions such as anxiety has long been known to affect pain. Increased anxiety levels have been noted to lead to increased pain perception and discomfort.18 Anxiety co-exists with pain in the clinical setting in general19 and hysterosalpingography procedure in particular.3,4 The positive effect of music therapy in reducing both the physiological and cognitive responses to anxiety can be put to use in creating an empathetic environment for HSG patients, as well as providing an alternative anxiety and pain reduction strategy that is more cost effective and without the side effects associated with the use of pharmacological agents. The reduction in anxiety thus observed from music therapy and expected reduced pain perception by the patients should improve on the false negatives that form muscular spasms associated with pain during the procedure. However, because of the complex relationship between anxiety and pain and the fact that pain threshold varies between individuals, a more rigorous design is required to establish a causal relationship with the diagnostic outcome of HSG. Although music therapy in health care settings is not new, it has always been considered from a philosophical and experimental perspective. Live music at the bedside of patients13 has been introduced as a new way of extending holistic care and improving the quality of service to the patient.20 As we strive towards the acquisition of high technology medical equipment and improve our clinical skill and higher precision in diagnosis, there is need to consider the patient more holistically. Our findings therefore recommend an extension of music therapy in hysterosalpingography procedures for the reduction of anxiety and associated pain. However, its effect on the diagnostic outcome of HSG procedure needs to be further investigated.
Results of state-trait anxiety scores
Anxiety score before HSG Anxiety score during HSG examination
Experimental group’ mean score
No. of patients
Control group’ mean score
No. of patients
43.4 G 8.0 25.6 G 10.3
50 50
41.6 G 7.4 38.9 G 11.0
50 50
Effect of music on anxiety levels
Summary Music has been identified to be effective in reducing the physiological and cognitive responses of state-trait anxiety in patients undergoing hysterosalpingography procedures and also improve the acceptability of the procedure; we recommend its clinical introduction.
References 1. Ladipo OA. An evaluation of 576 hysterosalpingograms of infertile women. Infertility 1979;2(1):63e70. 2. Walton SH, Mati JK. An evaluation of secondary infertility in Kenya. East African Medical Journal 1976;153(6):310e4. 3. Adinma JIB, Okpala OC. Hysterosalpingography in the management of infertility: bilateral tubal occlusion. West African Journal Radiology 1995;3(1):29e34. 4. Tyrell PM, Mchugo JM, Hall M. Patients perception of the hysterosalpingogram. The initial stages of an audit cycle. British Journal of Radiology 1993;66(782):103e7. 5. Agwu KK, Okoye IJ. Knowledge and attitudes of patient towards hysterosalpingography in eastern Nigeria. Journal of Medical Women of Nigeria 2003;1(2):37e40. 6. Haywood J. Information, a prescription against pain. Journal of Psychosomatic Research 1975;11:219. 7. Horwitz RC, Shaff MI, Hugo P. A radiological approach to infertility: hysterosalpingography. British Journal of Radiology 1979;52(616):255e62. 8. Lwanga SK, Tyre CY. Teaching health statistics. Twenty lessons and seminar outlines. Geneva: WHO; 1986. p. 157e8.
125 9. Spielberger CO. Manual for the state-trait anxiety inventory for adults. Palo Alto, CA: Mind Garden; 1983. 10. Nwabuokei PO. Fundamental of statistics. 3rd ed. Koruna Books; 2001. p. 241e97. 11. Meister M, Einsle R, Brunner J, Rhyner K. Psychofonia: a neurophysiologic music therapy in migraine. Schweizerische Rundschau fur Medizin Praxis 1999;88(21):946e9. 12. Tobia DM, Shamos EF, Harper DM, Walch SE, Curie JL. The benefits of group music of the 1996 music weekend for women with cancer. Journal of Cancer Education 1999; 14(2):115e9. 13. Tang X, Yang F, Zhuang. Musical relaxation therapy on cerebral arteriosclerosis. Human 1999;22(1):45e8. 14. White JM. Effect of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction. American Journal of Critical Care 1999;8(4):220e30. 15. Chlan L. Effectiveness of music therapy intervention on relaxation and anxiety of patients receiving ventilator assistance. Heart and Lung 1998;27(3):169e76. 16. O’Callaghan CC. Pain, music creativity and music therapy in palliative care. American Journal of Hospital Palliative Care 1996;13(2):43e9. 17. Heiser RM, Chiles K, Fudge M, Gray SE. The use of music during the immediate post-operative recovery period. AORN Journal 1997;65(4):781e5. 18. Nielsen B, Miaskowski C, Dibbie SL. Pain with mammography: fact or fiction. Oncology Nursing Forum 1993;20:639e42. 19. Hafslund B. Mammography and the experience of pain and anxiety. Radiography 2000;6:269e72. 20. Olson SL. Bedside musical care, applications in pregnancy, childbirth and neo-natal care. Journal of Obstetric, Gynaecologic, and Neonatal Nursing 1998;27(9):569e75.