Levels of Evidence in the Journal of Music Therapy from 2000-2009: Descriptive Analyses by Year and Clinical Population

Abstract

The purpose of this study was to systematically examine the levels of evidence from articles published in the Journal of Music Therapy (JMT) from 2000 – 2009 using the classification taxonomy established by Melnyk and Fineout-Overholt (2005). Most JMT studies were Level Vi (single descriptive or qualitative study, n = 83, 45.36%) or Level ii (randomized & controlled trial, n = 32, 17.49%). The populations most studied were other (n = 31, 16.94%), nondisabled persons (n = 24, 13.12%), medical/surgical (n = 16, 8.74%), Alzheimer’s/dementia (n = 12, 6.56%), and school-age populations (n = 12, 6.56%). As many systematic reviews only include Level ii evidence, there is a need for additional randomized controlled trials. The variety of research designs and clinical populations are a testament to the breadth of JMT and the profession. Limitations, implications, and suggestions for future research are provided. Music therapy clinical practice and research have unquestionably evolved since the inception of the Journal of Music Therapy (JMT) in 1964. The literature base is continually expanding as clinicians and researchers implement innovative music therapy interventions to address consumer needs. This research continues to build upon itself as authors utilize information, knowledge, and techniques found in the literature base to assess, design, implement, and evaluate methods and treatments. if a particular research study is deemed of high enough quality by a blind editorial board of experts in the field, results may be reported in JMT, which is considered a premiere research journal in the music therapy field (Madsen & Madsen, 1997). Music therapy researchers have also investigated the literature base itself. Resultant data may be constructive as scholars and clinicians can utilize results to gain perspectives concerning the status of the field and for setting future research agendas (Yarbourgh, 1984). Researchers have evaluated modes of inquiry in music therapy research (Jellison, 1973), music therapy journal articles in the English language (Brooks, 2003), the population served and researcher institutional affiliation of research posters (silverman, 2008), the history of published music therapy case studies (silverman, 2006), and other types of music therapy journals (Webster, 1993; Wheeler, 1988). Researchers have also specifically studied aspects of JMT. To date, researchers conducting descriptive studies concerning JMT have analyzed the history of the journal (solomon, 1993), the use of control groups (Jones, 2005), study content (Codding, 1987), the use of behavioral research designs (gregory, 2002), identified the focus and implications for future research (gilbert, 1979), identified test instruments used by authors (gregory, 2000), described the sources of authors’ affiliation, gender, and credentials (James, 1985), and provided annotated bibliographies for single case experiment research (Nicolas & Boyle, 1983). These studies are of considerable value as they detail the history of the journal, identify gaps in the literature base, and can serve to guide future scientific inquiry for both clinicians and researchers. As research is a vital component in providing the most effective care for music therapy recipients, classification systems of research are necessary so clinicians can interpret and apply results to clinical practice. Evidence-based practice (EBp) was a resultant of this movement toward clinical practice based upon systematic investigation, consumer values and preferences, and clinician expertise. With the modern amplified emphasis concerning evidence-based practice in contemporary music therapy (Abrams, 2010; Edwards, 2005; Else & Wheeler, 2010; Kern, 2010), it seems that music therapists are increasingly aware of utilizing this model. However, there is a plethora of available systems that researchers and clinicians can utilize to evaluate individual research studies, known as levels of evidence (phillips et al., 2001; Rice, 2008; stevens, 2005). These hierarchies differentiate levels of evidence based on the research paradigm and design of a single study. Readers should note that these hierarchies do not rate one type of research study as superior than another, provide quality indicators, nor provide a synthesis of results. Rather, researchers and clinicians can utilize levels of evidence to show a natural progression of research from a single descriptive or qualitative study (i.e., the most basic level) to meta-analysis consisting of only randomized control trials (i.e., the most complex level). A number of different levels of evidence hierarchies exist. silverman (2010) compared, contrasted, and applied a number of these hierarchies to the psychiatric music therapy literature base. For the purposes of the current paper, the researchers utilized Melnyk and Fineout-Overholt’s (2005) levels of evidence hierarchy from the nursing profession because the fields of nursing and music therapy similarly serve a broad spectrum of clinical and nonclinical populations. Additionally, the Melnyk and Fineout-Overholt (2005) hierarchy utilized a numbered system that facilitated communication and © the American Music Therapy Association 2014. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Andrea Yun-springer, MT-BC, is co-owner and music therapist at Toneworks Music Therapy in Minneapolis, MN. Michael J. silverman, phD, MT-BC, is the Director of Music Therapy at the University of Minnesota. All correspondence concerning this article should be addressed to Andrea Yun-springer, MT-BC, 1918 19th Ave NE, Minneapolis, MN 55418. Email: andrea.b.springer@gmail.com. phone: 651-231-3296. doi:10.1093/mtp/miu020 Advance Access publication september 16, 2014 Music Therapy Perspectives, 32(2), 2014, 185–190 at U niersity of M inesota on N ovem er 8, 2014 hp://m tp.oxfoournals.org/ D ow nladed from Music Therapy Perspectives (2014), Vol. 32 186 comparison whereas other levels of evidence did not utilize a numbered system (Deveraux & Yusuf, 2003; Levant, 2005). Moreover, Melnyk and Fineout-Overholt’s (2005) hierarchy contained seven levels, further differentiating studies compared to other systems utilizing only three levels (Harris et al., 2001; salmond, 2007). Table 1 depicts levels of evidence as described by Melnyk and Fineout-Overholt (2005). in the contemporary healthcare climate, funding is increasingly difficult to acquire. Clinicians utilizing interventions based from higher levels of evidence may have greater success in acquiring grants, funding treatment, and establishing paid positions. Additionally, if administrators solicit research concerning the effectiveness of clinical interventions, clinicians should be aware of the levels of evidence to provide the most appropriate and representative examples from the literature. Thus, levels of evidence are important not only for researchers, but also for clinicians and students. Although silverman (2010) applied Melnyk and FineoutOverholt’s (2005) hierarchy of levels of evidence to the psychiatric music therapy literature, there has not been a comprehensive and systematic review of recent music therapy literature utilizing an established level of evidence taxonomy. This represents a gap in the literature base as knowledge concerning what levels of evidence are needed for specific clinical populations may serve to contribute to the breadth and depth of the existing research. Therefore, the purpose of this study was to systematically examine the levels of evidence from articles published in the Journal of Music Therapy from 2000 – 2009 using the classification system established by Melnyk and Fineout-Overholt (2005). The researchers formulated the following specific research questions: 1. From 2000 2009, what levels of evidence have JMT authors been utilizing most frequently? 2. From 2000 2009, what levels of evidence have JMT authors utilized to study specific clinical populations?