CLINICAL ISSUES

Adolescents’ perceptions of music therapy following spinal fusion

surgery
Charmaine Kleiber and Mary S Adamek

Aims and objectives. To explore adolescents’ memories about music therapy after spinal fusion surgery and their recommen-
dations for future patients.
Background. Spinal fusion for adolescent idiopathic scoliosis is one of the most painful surgeries performed. Music therapy is
shown to decrease postoperative pain in children after minor surgery. In preparation for developing a preoperative information
program, we interviewed adolescents who had spinal fusion and postoperative music therapy to find out what they remembered
and what they recommended for future patients.
Methods. Eight adolescents who had spinal fusion for adolescent idiopathic scoliosis were interviewed about their experiences.
For this qualitative study, the investigators independently used thematic analysis techniques to formulate interpretive themes.
Together they discussed their ideas and assigned overall meanings to the information.
Results. The eight participants were 13–17 years of age and had surgery between 2–24 months previously. The overarching
themes identified from the interviews were relaxation and pain perception, choice and control, therapist interaction and
preoperative information. Participants stated that music therapy helped with mental relaxation and distraction from pain. It was
important to be able to choose the type of music for the therapy and to use self-control to focus on the positive. Their
recommendation was that future patients should be provided with information preoperatively about music therapy and pain
management. Participants recommended a combination of auditory and visual information, especially the experiences of
previous patients who had spinal fusion and music therapy.
Conclusion. Music provided live at the bedside by a music therapist was remembered vividly and positively by most of the
participants.
Relevance to clinical practice. The presence of a music therapist providing patient-selected music at the bedside is important.
Methods to introduce adolescents to music therapy and how to use music for relaxation should be developed and tested.

Key words: adolescents, music therapy, pain, surgery

Accepted for publication: 12 May 2012

stay and decreased patient satisfaction (Puntillo & Weiss

Introduction
Spinal fusion (SF) for adolescent idiopathic scoliosis (AIS) is
one of the most painful surgeries experienced by adolescents,
with several studies reporting mean postoperative pain scores
above 5, on a 0–10 scale (Kotzer 2000, LaMontagne et al.
2003a, Kleiber et al. 2007). High postoperative pain scores
are associated with more frequent atelectasis, longer length of
1994).
Postoperative pain can be positively affected by teaching
pain-coping strategies (Logan & Rose 2005) and anxiety-
reducing strategies (Gillies et al. 1999, Caumo et al. 2000).
Introducing pain-coping strategies to adolescent surgical
patients is particularly challenging because of the natural
development of the adolescent. Adolescents are at a juncture

Authors: Charmaine Kleiber, PhD, RN, FAAN, Associate Professor,
University of Iowa College of Nursing, Iowa City, IA; Mary S
Adamek, PhD, MT-BC, Clinical Professor and Director of Music
Therapy, School of Music, The University of Iowa, Iowa City, IA,
USA
Correspondence: Charmaine Kleiber, Associate Professor, University
of Iowa College of Nursing; 364 NB, Iowa City, IA 52242, USA.
Telephone: +1 319 335 7057.
E-mail: charmaine-kleiber@uiowa.edu

 2012 Blackwell Publishing Ltd

414 Journal of Clinical Nursing, 22, 414–422, doi: 10.1111/j.1365-2702.2012.04248.x
Clinical issues
where the desire to independently accept or reject advice is in
conflict with the typically dependent roles of ‘patient’ and
‘child’ (McGrath & Pisterman 1991). Additionally, adoles-
cents have been shown to respond differently to surgical
experiences. For example, compared with adults undergoing
knee surgery, adolescent athletes having the same type of
surgery reported more pain and anxiety than their adult
counterparts (Tripp et al. 2003).
Music therapy is an intervention shown to decrease
postoperative pain intensity in adults (Good et al. 2002,
2010, Allred et al. 2010, Easter et al. 2010) and children
after minor surgery (Nilsson et al. 2009). Our clinical
experience and quality improvement data suggest that music
therapy, as an adjunct to the usual pharmacological treat-
ment, reduced pain in adolescents following surgery for AIS.
This study is the first step to systematically investigate the
effects of a music therapy intervention on acute pain in the
immediate postoperative period after surgery with adoles-
cents undergoing major orthopaedic surgery. In this qualita-
tive study, we interviewed previous SF patients about their
postoperative experience with music therapy and their
recommendations for music therapy interventions with future
SF patients to alleviate postoperative pain.
Background
Music and pain management
Music can distract the patient from unpleasant sensations but
can also modulate neurological responses in the brain (Thaut
2002a,b, Roy et al. 2007, Gfeller 2008). Healthcare profes-
sionals from a variety of professions and in a variety of
settings can easily implement music listening with patients.
Music listening to assist patients with relaxation and reduce
pain is prevalent in nursing literature, while music therapy
literature typically documents the effects of live music
interventions.
Music therapy is a deliberate, structured, systematic
intervention involving interaction between a professionally
trained, board certified music therapist (MT-BC) and a
patient (Stouffer et al. 2007). Music therapy is different from
music exposure, when a patient is provided with prerecorded
music for listening. Much of the music research in nursing
literature investigates the effects of music listening where the
patient listens to prerecorded music, usually through head-
phones. A small body of research examining the effects of
music therapy on postoperative pain exists, primarily with
adult participants.
A Cochrane review (Cepeda et al. 2006) on the effects of
music listening on acute or chronic pain found that music
 2012 Blackwell Publishing Ltd
Journal of Clinical Nursing, 22, 414–422
Adolescents’ perceptions of music therapy
listening reduced pain and reduced the amount of analgesics
used by patients. Although positive, the effects noted in this
systematic review were small and the clinical importance of
music listening was unclear. Nilsson’s (2008) systematic
review of music interventions identified 42 randomised
clinical trials that included 3936 subjects. Positive effects
were reported for decreasing pain in 59% of the studies and
for decreasing anxiety in 50% of the studies. Engwall and
Duppils (2009) found music listening to have significant
positive effects on postoperative pain in a systematic review
of music as a nursing intervention for postoperative pain in
adult patients. In addition, they found that the use of
analgesics was lower for the music-listening groups.
Another systematic review examined the effects of both
active music interventions and passive music on pain and
anxiety in children undergoing medical procedures (Klassen
et al. 2008). Active music interventions involved a music
therapist using music as a medium for interaction, and
passive music involved music listening without the services of
a music therapist. The researchers found that both passive
and active music interventions were effective in reducing pain
and anxiety in children. In particular, the active music
interventions were especially useful for distracting patients
from anxiety-producing stimuli.
Other nursing studies have found music listening reduces
pain and anxiety in patients undergoing spinal surgery (Lin
et al. 2011), and in postoperative patients on the first day of
ambulation (Allred et al. 2010). In another music-listening
study, the researchers used relaxation and music to reduce
pain in adults after abdominal surgery (Good et al. 2010).
Findings demonstrated that music listening was useful for
immediate pain management effects, although no lasting
effects were noted.
Music therapy literature typically describes music research
conducted by professional music therapists. A music therapist
will develop interventions based on preferred patient music
and deliver the music intervention live with the possibility of
patient interaction with the therapist. Research conducted by
music therapy professionals may include active music
engagement as well as passive music listening, using either
live or recorded music. Some studies have shown more
significant positive effects using live music interventions than
music listening alone (Bailey 1983, Robb et al. 2008).
Music therapy has been found to positively influence
patients’ responses to hospitalisation. Active music engage-
ment was found to increase coping behaviours in paediatric
patients with cancer (Robb et al. 2008). Patients participated
in active music engagement with the music therapist, listened
to music or listened to a story. Results indicated that patients
involved in active music engagement had more positive facial
415
C Kleiber and MS Adamek
affect, increased engagement and increased initiation of
interaction than patients in the other two conditions. In
another study with adults who underwent brain surgery,
interactive music therapy sessions were used to influence
quality of life indicators and amount of nausea and pain
medication used by patients. Results indicated that patients
who experienced the music therapy sessions had decreased
stress and anxiety and were more relaxed than the control
group. The music therapy did not significantly affect patients’
pain, perception of length of stay or amount of medication
used (Walworth et al. 2008).
Music-assisted relaxation has been found to promote
relaxation and reduce anxiety in a number of studies with
both children and adults. Results of a meta-analysis indicate
that music-assisted relaxation was found to have a strong
positive effect on individuals in stressful situations (Pelletier
2004). Music-assisted relaxation was also found to minimise
fear and pain in paediatric patients undergoing bone marrow
procedures (Pfaff et al. 1989). In a study with young patients,
paediatric burn patients engaged in music-assisted relaxation
involving deep breathing, music listening, progressive muscle
relaxation and imagery prior to reconstructive surgery (Robb
et al. 1995). Results from this study indicated that patients
who engaged in the music-assisted relaxation had signifi-
cantly lower anxiety than control group patients.
Pain-coping strategies for adolescents
LaMontagne et al. (2003a,b) reported a series of analyses
from a trial of preoperative coping instructions provided to
adolescents before SF. Analyses showed that youth who
received coping training had less pain. A limitation of these
studies is that there was no way to know whether the
participants actually used the coping training techniques that
they were taught preoperatively. LaMontagne suggests that,
under the circumstances of extreme distress following SF
surgery, it might be necessary for these young people to have
help from health professionals or parents to fully engage in
coping strategies. This is especially true for adolescents who
are naı̈ve to the hospital environment, never having experi-
enced surgery or significant pain before.
Summary
Research on the effects of music on the postoperative pain of
adults and young children is not necessarily generalisable to
adolescents. The efficacy of music therapy for adolescents
undergoing major orthopaedic surgery has not been thor-
oughly explored. This study is the first step in designing a
preoperative training program on coping strategies for ado-
416
lescents and their parents. To design an attractive and
successful program that would be acceptable to young people,
we asked previous patients for their recommendations.
Methods
The specific purpose of this study was to explore young
people’s memories on the effects of music therapy and their
recommendations for use with future patients. The research
questions were (1) What do adolescents who received music
therapy after SF surgery remember about the therapy and (2)
What do adolescents wish they had known about music
therapy and pain management before surgery?
Design
A qualitative design was used to explore adolescents’ mem-
ories and recommendations. We decided on structured phone
interviews rather than face-to-face focus groups because most
of the potential participants lived many miles from the tertiary
care hospital where the SF surgery had been performed.
Ethical review
This study was reviewed and approved by the University of
Iowa Institutional Review Board. The Board is responsible
for assuring that human subjects research is conducted in an
ethical manner.
Setting and sample
Part of standard postoperative care in our hospital is to offer
one interactive session with a board certified music therapist
during the patient’s first time out of bed to a chair, usually the
second postoperative day. During the 45-minute session, the
therapist sings and plays the patient’s preferred music,
encourages deep breathing and relaxation techniques, and
provides feedback to the patient on signs of relaxation and/or
tension. At the time of this study, the patients received no
preoperative information about music therapy.
Our facility cares for a relatively small number of children
who have corrective surgery for AIS. To recruit an adequate
number of participants, we invited all adolescents who had
undergone SF surgery for AIS within the past 24 months and
who had received an interactive music therapy session during
their postoperative hospital time. To stimulate interest in the
study, we offered a $15 iTunes gift card to adolescents as
compensation for completing the interview.
We identified 30 potential participants. After receiving
ethical approval from our Institutional Review Board, letters
 2012 Blackwell Publishing Ltd
Journal of Clinical Nursing, 22, 414–422
Clinical issues
of introduction were sent to the adolescents’ parents with a
return postcard to indicate either interest in or declining the
study. If the postcard was not returned within a week, the
research assistant tried calling the home phone once to
inquire about interest. Of the 30 potential participants, eight
young people were available for interview. One young man
who expressed interest was not available at the listed phone
number, two parents returned the postcard declining the
study and three letters of introduction were returned as
undeliverable. We were unable to contact the remaining 16
potential participants.
Interview questions and data analysis
An undergraduate research assistant in music therapy con-
ducted the interviews at a time designated by the participants.
The research assistant used specific interview questions and
had suggested probes to use to help expand participant
answers (Appendix 1). Prior to data collection, the research
assistant conducted three mock interviews that were recorded
and critiqued by one of the authors.
Inductive content analysis was used to identify themes in
the interviews. With inductive analysis, the process includes
open coding of the interviews, followed by the creation of
categories and finally a general description or abstraction of
the general meaning of the information (Elo & Kyngäs 2007).
After all of the interviews were transcribed, the authors
independently coded each phrase and developed themes or
categories. The steps followed in this process were to write
down key phrases from the interviews, note any personal
reflections, affix codes looking for similarities in data, unique
perspectives, opposing perspectives and relationships of ideas
within the data. The themes were the ‘take home message’ for
each phrase. Then, they discussed their codes and themes,
which resulted in expanding some themes and consolidating
others. The themes were reviewed again a week later, and the
authors were in agreement about the decisions. Finally, the
authors reviewed their notes and discussed the overall
meanings of the information.
Results
Participants
The mean age of the eight participants at the time of the
interview was 14Æ38 years (range, 13–17 years), and the mean
time since surgery was 11Æ5 months (range, 2–24 months).
There were seven girls and one boy in the sample. In
comparison, the average age of the 20 girls and two boys
who did not participate was 15Æ25 (range, 13–18 years) with
 2012 Blackwell Publishing Ltd
Journal of Clinical Nursing, 22, 414–422
Adolescents’ perceptions of music therapy
an average time since surgery of 10Æ6 months (range, 1–
22 months). Thus, the participant group was similar to the
non-participant group in age and time from surgery.
The interviews were brief, lasting just about five minutes.
The overarching themes identified from the comments were
relaxation, pain perception, choice and control, therapist
interaction and preoperative information. Quotations from
participants are followed by the child’s age at the time of the
interview and months lapsing between the surgery and the
interview (e.g. years old; months since surgery).
Themes
Relaxation and pain perception
The most frequently mentioned memory of music therapy
was that the therapy changed the state of mind to be more
relaxed. Statements described a mental calming rather than a
physical relaxation. The shifting of mental state also had an
effect on the emotional state or mood for some of the par-
ticipants:
It kind of soothes you like if you’re angry, it’s really soothing, and it
can help calm you down because you don’t really want to get up and
do stuff when your mad. (15 years; 24 months)
The statements about relaxation were often tied directly to
statements about pain. Most of the statements reflected an
improvement in pain, but one subject thought the volume of
the music made her pain worse:
The music actually helped calm me down and helped me relax. It
helped make the pain go away. (14 years; nine months)
With the music, it relaxes you with the pain, and it just, like to be
very honest, I didn’t feel it. (17 years; 20 months)
…my hearing was affected and I had a little pain after I had my
surgery, and she was really loud, and it kind of bothered me. It just
made the pain worse. (15 years; 20 months)
One reason that so many of the participants remembered
pain perception in relation to music therapy may be because
the therapist routinely asked patients to rate their pain on a
0–10 scale just before and just after the therapy. Although we
did not ask participants specifically about pain ratings as part
of the interview, one of the participants talked about rating
her pain. Perhaps providing evidence of an effect to individ-
ual patients at the time of therapy assists with remembering,
even many months after the surgery.
In addition to relaxation, distraction was identified as a
mechanism for reducing pain perception. Several of the
participants said that having something else to focus on was
very helpful:
417
C Kleiber and MS Adamek

It helped a lot to like distract me from having to stay up in the Four said no. Some young people take their music very
wheelchair that long because that was kind of hard…so it was good seriously and plan ahead to make sure they have what they
distraction to have. (13 years; two months) want to listen to. Other seems to just listen out of boredom.
We do not know whether the young people in this study were
I think that it just is really a distraction and that it kind of helps put
listening for therapeutic effect, to enhance relaxation or
your mind on something else, something you enjoy. (14 years;
reduce physical discomfort or to just pass the time:
three months)
Yeah, I actually got an iPod right before I went into surgery so I spent
Choice and control a lot of time finding music and putting it on my iPod and just listening
Not surprising for this adolescent group, choice and control to my iPod. (14 years; three months)
were recurring themes among the participants. Most of the
I kind of listened when I had nothing else to do. (13 years;
participants talked about appreciating being able to select
two months)
their own music for the therapy sessions. The importance of
having up-to-date music selections from the music therapist
Preoperative information
was noted, and several participants suggested that having
A strong theme was the importance of giving information to
their own music available on iPods was helpful or would have
young people preoperatively about music therapy and pain
been helpful. The participant who complained about the
management. More than one young person expressed some
loudness of the music therapy said:
regret at not being prepared:
I think if I had my iPod with me that might have helped a little
…it would be a lot easier to know like before you had the surgery
because I could have controlled the sound a little more. (15 years;
that when you’re in a lot of pain that the music would help you.
20 months)
(14 years; four months)
Some participants in this study indicated that choosing to
If they were informed that they would be offered Music Therapy. I
have a positive, open attitude going into surgery was
know if I had, like if it was told that I would be offered it, I definitely
important. These remarks indicate a willingness to be a full
would look into it. (14 years; three months)
participant in recovery, not just a passive recipient of
therapy: Participants also had recommendations for how to deliver
preoperative information to future patients. Three partici-
…think about the positive and knowing all you want is the pain to go
pants suggested that just telling young people about music
away so try whatever. (14 years; four months)
therapy and pain management would not be effective. They
…if you focus on the pain, it just makes it worse. Don’t hold back. recommended some sort of visual introduction as well.
Get right back in. (14 years, nine months) Having a peer who had been through the surgery talk about
music therapy was also suggested:
Therapist interaction
If you showed it to them and not just recommended it to them.
The personal presence and attention from the music therapist
(15 years; 24 months)
seemed to influence the effects of the music. Not only did the
therapist perform live music with the patients, she also en- It was before my surgery, so they were like ‘Oh, it will help you’, and
gaged the children verbally, asking them how they felt, how they were right. (17 years; 20 months)
much pain they were having and what songs they wanted to
hear. This interaction, perhaps appropriately described as
Discussion and conclusion
‘caring’, may have been a key component in the effectiveness
of the therapy:
Discussion
I remember when she came in she would ask me questions on how it
made me feel and how it made me relax and stuff. (14 years; Our first important finding is that young people are able to
four months) recall their experience with music therapy quite clearly. We
were concerned that time between the actual surgery and the
She would play her guitar and sing for me when I was unhappy.
interview might inhibit memory. However, two participants
(13 years; 10 months)
who had their surgery 20 months previously clearly remem-
When participants were asked whether they used music at bered opposite effects. One was quite irritated by the
other times during the hospital stay, comments were mixed. experience saying that it ‘Just made my pain worse’, and

 2012 Blackwell Publishing Ltd

418 Journal of Clinical Nursing, 22, 414–422
Clinical issues
the other said it helped her pain ‘100% because you didn’t
even think about it’. The participant with the longest lag
between surgery and interview (24 months) told us ‘Hon-
estly, I can’t really remember’. He wanted to participate in
the therapy but said ‘I remember being a little frustrated
because I was way too doped up’. We do not know if his
inability to remember was because of time since surgery or if
the pain medication he was given at the time of the music
therapy affected his level of awareness.
Adolescents are at a particularly vulnerable time of life as
they strive for self-reliance, shedding their dependence upon
adults. The typical role of hospital ‘patient’ is one of
dependence because others are in control of actions from
personal care to pain management. One way for young people
to achieve some semblance of independence in the hospital is
to have preoperative training on coping strategies that enable
them to take more control of their responses. As noted by
others (LaMontagne et al. 2003b), adolescents may need
assistance from professionals to engage in coping. Our
findings support this suggestion. Although respondents
reported relaxation from music presented by a music thera-
pist, some did not use music for relaxation on their own. Some
of the participants who did listen to music seemed to do so out
of boredom rather than as a consciously applied coping
strategy. Adolescents may need specific preoperative training
to achieve the full benefit of music as a coping strategy.
The adolescents in this study seemed to agree that it
would be helpful to have information about music therapy
for pain management prior to surgery. Several participants
recommended that future patients should know that music
can help with their pain and that a music therapist will
come in to work with them to help them feel more
comfortable. Some suggested that this information be
presented to young people in a format other than in
writing, possibly a CD recording or through a conversation
with a previous SF patient.
Implications for future research
The mix of females and males in this study happened to be
proportional to the usual ratio of girls to boys affected by
idiopathic scoliosis, which is 7:1. There is an inconclusive
evidence on gender differences related to postoperative pain.
In a systematic review of 48 studies with over 23,000
patients, gender differences were not found to be a consistent
predictor of postoperative pain (Ip et al. 2009). Type of
surgery, psychological distress and age were found to be
predictors for postoperative pain. When looking at postop-
erative pain in adolescents, other researchers did find gender
differences in pain experiences (Logan & Rose 2004). Girls
 2012 Blackwell Publishing Ltd
Journal of Clinical Nursing, 22, 414–422
Adolescents’ perceptions of music therapy
reported more pain than boys. Thus, we might expect girls to
benefit more from postoperative music therapy than boys, but
this has not been tested.
The benefit of a music intervention delivered by a trained
music therapist is that the therapist continually adapts the
intervention to the responses of the patient. For example, if the
child is breathing too quickly or too shallowly because of
discomfort, the therapist will vary the tempo or the music and
coach the child to breath in and out in time to appropriately
paced music. Realistically, trained music therapists are not
available in all settings, and frequently their schedules do not
allow for more than one therapy session per patient. Research is
needed on how young people can be taught to use the basic music
therapy strategies on their own throughout their hospital stay.
Findings from this study have helped inform the develop-
ment of a preoperative preparation program for young people
undergoing significant orthopaedic surgeries. In this web-
based training program that is now being tested for feasibil-
ity, we have created a series of training videos to educate the
adolescents about the use of music therapy to help them be
more comfortable after surgery. We guide them through some
basic breathing exercises with the music therapist playing
music and cueing them to practice the breathing technique.
The hope is that the adolescents will be better prepared to
engage in music therapy techniques to reduce pain perception
after their surgery.
Limitations
Our participation rate was low, but that was expected. First,
letters of invitation were sent during the month of May, an
especially busy time for young people in middle school or
high school. School, sports and social activities are all tightly
scheduled. Second, the letters were sent to the young person’s
parent, not directly to the potential participant. We have no
way of knowing whether the parent asked the child about
interest or just discarded the request for participation. Third,
the letter of invitation was written in the standard manner
required by our Institutional Review Board and contains very
stiff and legalistic language. It can be very overwhelming for
lay people who are not used to reading research materials.
Of course we do not know why most of the potential
participants did not respond to our initial request. We find that
recruiting adolescents into research studies is quite a challenge.
One recommendation would be to have some sort of attractive
brochure to give patients who are being discharged from the
hospital, letting them know that there may be ongoing studies
that might be interesting to them. The method of conducting
individual interviews over the phone is a limitation. It was
difficult to elicit much elaboration on the questions asked. One
419
C Kleiber and MS Adamek

step we might suggest for future researchers is to call the
participants twice, once for the initial interview and again to
clarify the researcher’s perceptions of what was said. A
preferred method for collecting these data would be through
focus groups. We think that having young people get together
and share their stories with each other would have improved on
the amount of information collected. However, we are in a
rural setting and it is not practical to ask adolescents to travel
many miles to participate in a study.
Conclusion
To our knowledge, this is the first qualitative exploration of
young people’s thoughts about the effects of postoperative
music therapy. Most of the participants in this study were
able to clearly remember what it was like to have the
therapist visit, and most described the effects as relaxing and
reducing pain. Participants thought that adolescents should
be informed about the possibilities of music therapy before
surgery, and that the preoperative teaching should include
information from young people who had actually been
through the experience. These findings can help to guide
the formation of preoperative preparation programs for
young people undergoing significant orthopaedic surgeries.
their hospital experience. Clinicians should consider that
everything we do with young people in the postoperative
period may be remembered and make a significant impact on
feelings about future health care.
The young people participating in this study strongly
recommended preoperative instruction on coping with pain
and specifically on how to use music to relax and take their
attention away from pain. The best time to present coping
information to adolescents is about one week before
surgery (LeRoy et al. 2003). However, in some institutions,
the preoperative visit for SF can be from the day before
surgery up to several weeks before the actual surgery.
Clinicians should keep this in mind and assure that the
specific coping strategies, such as music therapy, be
introduced when the young person is most receptive.
Because coping with pain is so important to recovery,
providing information and time for practice should be built
into standard preoperative care.
Acknowledgement
This study was supported with a University of Iowa Ober-
mann Center for Advanced Studies Interdisciplinary Research
Grant.

Relevance to clinical practice Contributions

In this study, most participants were able to clearly articulate Study design: CK, MSA; data analysis: CK, MSA and
specific memories about music therapy and how it affected manuscript preparation: CK, MSA.

References
Allred K, Byers J & Sole M (2010) The ef-
fect of music on postoperative pain and
anxiety. Pain Management Nursing 11,
15–25.
Bailey LM (1983) The effects of live music
versus tape-recorded music on hospi-
talized cancer patients. Music Therapy
3, 17–28.
Caumo W, Broenstrub JC, Flalho L, Petry
SM, Brathwait O, Bandeira D, Logu-
ercio A & Ferreira MB (2000) Risk
factors for postoperative anxiety in
children. Acta Anaesthesiologica Scan-
dinavica 44, 782–789.
Cepeda MS, Carr DB, Lau J & Alvarez H
(2006) Music for pain relief. The
Cochrane Database of Systematic Re-
views, Issue 2, Art. No.: CD004843.
Easter B, DeBoer L, Settlemyre G, Starnes C,
Marlowe V & Tart R (2010) The im-
pact of music on the PACU patient’s
perception of discomfort. Journal of
PeriAnesthesia Nursing 25, 79–87.
Elo S & Kyngäs H (2007) The qualitative
content analysis process. Journal of
Advanced Nursing 62, 107–115.
Engwall M & Duppils G (2009) Music as a
nursing intervention for postoperative
pain: a systematic review. Journal of
PeriAnesthesia Nursing 24, 370–383.
Gfeller K (2008) Music: a human phenome-
non and therapeutic tool. In An Intro-
duction to Music Therapy: Theory and
Practice (Davis W, Gfeller K & Thaut M
eds). American Music Therapy Associa-
tion, Silver Spring, MD, pp. 41–76.
Gillies M, Smith L & Parry-Jones W (1999)
Postoperative pain assessment and
management in adolescents. Pain 79,
207–215.
Good M, Anderson G, Stanton-Hicks M,
Grass J & Makil M (2002) Relaxation
and music reduce pain after gynecologic
surgery. Pain Management Nursing 3,
61–70.
Good M, Albert J, Anderson G, Wotman S,
Cong X, Lane D & Ahn S (2010) Sup-
plementing relaxation and music for
pain after surgery. Nursing Research
59, 259–269.
Ip HYV, Abrishami A, Peng PWH, Wong J
& Chung F (2009) Predictors of post-
operative pain and analgesic consump-
tion: a qualitative systematic review.
Anesthesiology 111, 657–677.
Klassen JA, Liang Y, Tjosvold L, Klassen TP
& Hartling L (2008) Music for pain
and anxiety in children undergoing
medical procedures: a systematic review
of randomized controlled trials.
Ambulatory Pediatrics 8, 117–128.
Kleiber C, Suwanraj M, Dolan L, Berg M &
Kleese A (2007) Pain sensitive

 2012 Blackwell Publishing Ltd

420 Journal of Clinical Nursing, 22, 414–422
Clinical issues Adolescents’ perceptions of music therapy

temperament and postoperative pain.
Journal for Specialists in Pediatric
Nursing 12, 149–158.
Kotzer A (2000) Factors predicting postop-
erative pain in children and adolescents
following spine fusion. Issues in Com-
prehensive Pediatric Nursing 23,
83–102.
LaMontagne L, Hepworth J, Cohen F &
Salisbury M (2003a) Cognitive-behav-
ioral intervention effects on adoles-
cents’ anxiety and pain following spinal
fusion surgery. Nursing Research 52,
183–190.
LaMontagne L, Hepworth J, Salisbury M &
Cohen F (2003b) Effects of coping
instruction in reducing young adoles-
cents pain after major spinal surgery.
Orthopaedic Nursing 22, 398–403.
LeRoy S, Elixson E, O’Brien P, Tong E,
Turpin S & Uzark K (2003) Recom-
mendations for preparing children and
adolescents for invasive cardiac proce-
dures: a statement from the American
Heart Association Pediatric Nursing
Subcommittee of the Council on Car-
diovascular Nursing in collaboration
with the Council on Cardiovascular
Diseases of the Young. Circulation 108,
2550–2564.
Lin PC, Lin ML, Huang LC, Hsu HC & Lin
CC (2011) Music therapy for patients
receiving spine surgery. Journal of
Clinical Nursing 20, 960–968.
Logan D & Rose J (2004) Gender differ-
ences in post-operative pain and patient
controlled analgesia use among adoles-
cent surgical patients. Pain 109, 481–
487.
Logan D & Rose J (2005) Is postoperative
pain a self-fulfilling prophecy? Expec-
tancy effects on postoperative pain and
patient-controlled analgesia use among
adolescent surgical patients. Journal of
Pediatric Psychology 30, 187–196.
McGrath J & Pisterman S (1991) Develop-
mental issues: adolescent pain. In Chil-
dren in Pain (Bush J & Harkins S eds).
Springer-Verlag, New York, NY,
pp. 231–250.
Nilsson U (2008) The anxiety and pain
reducing effects of music interventions:
a systematic review. AORN Journal 87,
780–807.
Nilsson S, Kokinsky E, Nilsson U, Sidenvall
B & Enskar K (2009) School-aged
children’s experiences of postoperative
music medicine on pain, distress, and
anxiety. Pediatric Anesthesia 19, 1184–
1190.
Pelletier C (2004) The effect of music on
decreasing arousal due to stress: a meta-
analysis. Journal of Music Therapy 41,
192–214.
Pfaff V, Smith K & Gowan D (1989) The
effects of music-assisted relaxation on
the distress of pediatric cancer patients
undergoing bone marrow aspirations.
Children’s Health Care 18, 232–236.
Puntillo K & Weiss SJ (1994) Pain: its
mediators and associated morbidity in
critically ill cardiovascular surgical
patients. Nursing Research 43, 31–36.
Robb S, Nichols R, Rutan R, Bishop B &
Parker J (1995) The effects of music
assisted relaxation on preoperative
anxiety. Journal of Music Therapy 32,
2–21.
Robb SL, Clair A, Watanabe M, Monahan
P, Azzouz F, Stouffer J, Ebberts A,
Darsie E, Whitmer C, Walker J, Nelson
K, Hanson-Abromeit D, Lane D &
Hannan A (2008) Nonrandomized
controlled trial of the active music
engagement (AME) intervention on
children with cancer. Psycho-Oncology
17, 699–708.
Roy M, Peretz I & Rainville P (2007)
Emotional valence contributes to
music-induced analgesia. Pain 134,
140–147.
Stouffer J, Shirk BJ & Polomano RC (2007)
Practice guidelines for music interven-
tions with hospitalized pediatric pa-
tients. Journal of Pediatric Nursing 22,
448–456.
Thaut M (2002a) Neurophyschological
processes in music perception and their
relevance in music therapy. In Music
Therapy in the Treatment of Adults
with Mental Disorders (Unkefer R &
Thaut M eds). MMB Music, St. Louis,
MO, pp. 2–32.
Thaut M (2002b) Physiological and motor
responses to music stimuli. In Music
Therapy in the Treatment of Adults
with Mental Disorders (Unkefer R &
Thaut M eds). MMB Music, St. Louis,
MO, pp. 33–41.
Tripp D, Stanish W, Reardon G, Coady C &
Sullivan M (2003) Comparing postop-
erative pain experiences of the adoles-
cent and adult athlete after anterior
cruciate ligament surgery. Journal of
Athletic Training 38, 154–157.
Walworth D, Rumana C, Nguyen J & Jar-
red J (2008) Effects of live music ther-
apy sessions on quality of life
indicators, medications administered
and hospital length of stay for patients
undergoing elective surgical procedures
for brain. Journal of Music Therapy 45,
349–359.

Appendix 1: Interview questions asked by the

research assistant

1 Could you please tell me what you remember about having
the music therapist with you playing music?
2 How did having the music therapist play music affect the
amount of pain you were feeling?
3 Did you use music at other times during your hospital
stay to help with pain? If yes, please tell me what you
did.
4 Are there other ways that music could be used to help kids
going through spinal fusion?
5 We are thinking about developing other ways to offer
music to kids after scoliosis surgery, like on an IPod or
IPad or over a web site. Do you think that any of those
would be useful or not?
6 Do you think kids would watch something about music
therapy on YouTube or on the web before having surgery?
7 Is there anything that you would like other kids to know
about pain management and music before they have sco-
liosis surgery?

 2012 Blackwell Publishing Ltd

Journal of Clinical Nursing, 22, 414–422 421
C Kleiber and MS Adamek

The Journal of Clinical Nursing (JCN) is an international, peer reviewed journal that aims to promote a high standard of
clinically related scholarship which supports the practice and discipline of nursing.

For further information and full author guidelines, please visit JCN on the Wiley Online Library website: http://
wileyonlinelibrary.com/journal/jocn

Reasons to submit your paper to JCN:

High-impact forum: one of the world’s most cited nursing journals, with an impact factor of 1Æ118 – ranked 30/95 (Nursing
(Social Science)) and 34/97 Nursing (Science) in the 2011 Journal Citation Reports (Thomson Reuters, 2011)
One of the most read nursing journals in the world: over 1Æ9 million full text accesses in 2011 and accessible in over 8000
libraries worldwide (including over 3500 in developing countries with free or low cost access).
Early View: fully citable online publication ahead of inclusion in an issue.
Fast and easy online submission: online submission at http://mc.manuscriptcentral.com/jcnur.
Positive publishing experience: rapid double-blind peer review with constructive feedback.
Online Open: the option to make your article freely and openly accessible to non-subscribers upon publication in Wiley
Online Library, as well as the option to deposit the article in your preferred archive.

 2012 Blackwell Publishing Ltd

422 Journal of Clinical Nursing, 22, 414–422