Abstract

Objectives: Music-based interventions have received growing attention to improve quality of life for people diagnosed with dementia. Results of randomized controlled trials and meta-analytic reviews to date, however, reveal a lack of conclusive evidence for or against the effectiveness of such interventions. Herein, we critically review the basic assumptions and methodological issues ingrained in the cultures of research and care as they relate to evaluating music-based treatments for people with dementia, and propose a shift in the methodology by which music interventions are empirically evaluated.

Method: We begin by reviewing existing barriers to achieving clarity on the effectiveness of music interventions, and we highlight methodological and sociocultural constraints that have limited our ability to reach concrete conclusions in research studies to-date. We then consider several key factors that have demonstrated relevance in matching people to specific music-based interventions. Based on these key factors, we developed a person-centered framework integrating elements from precision-medicine methodology to guide intervention studies.

Results: Our organizing framework systematically integrates the following factors to inform the design of intervention studies: 1) person-centered goals and desired outcomes; 2) differences among individuals in clinical, cognitive, and historical attributes; and 3) the context of intervention and access to resources.

Conclusion: Integration of the proposed framework into empirical investigations of music interventions for people living with dementia will inform precise and tailored interventions that will bring clarity to this growing body of research. Another aim of this framework is to foster a more humane, person-centered approach to our culture of care.

摘要

目标：以音乐为基础的干预措施越来越受到关注，以改善被诊断患有痴呆症的人的生活质量。然而，迄今为止的随机对照试验和荟萃分析评论的结果表明，缺乏支持或反对此类干预措施有效性的确凿证据。在此，我们批判性地回顾了研究和护理文化中根深蒂固的基本假设和方法论问题，因为它们与评估痴呆症患者的基于音乐的治疗有关，并提出了对音乐干预进行实证评估的方法论的转变。

方法：我们首先回顾现有障碍，以明确音乐干预的有效性，并强调方法论和社会文化限制，这些限制限制了我们迄今为止在研究中得出具体结论的能力。然后，我们考虑几个关键因素，这些因素已证明与将人们与特定的基于音乐的干预措施相匹配具有相关性。基于这些关键因素，我们开发了一个以人为本的框架，整合了精准医学方法的要素，以指导干预研究。

结果：我们的组织框架系统地整合了以下因素，为干预研究的设计提供信息：1）以人为本的目标和预期结果；2) 个体在临床、认知和历史属性上的差异；3) 干预背景和资源获取。

结论：将拟议的框架整合到针对痴呆症患者的音乐干预的实证调查中，将为精确和量身定制的干预提供信息，从而使这一不断增长的研究体系更加清晰。该框架的另一个目标是培养一种更加人性化、以人为本的护理文化。