Here are the responses to your questions: 1. Comeaux and Comeaux identified unrelieved postoperative pain as the clinical problem, while Li et al. identified insufficient evidence on the effects of music therapy on state anxiety of breast cancer patients following radical mastectomy. 2. Comeaux and Comeaux used a quasi-experimental nonequivalent control group design, while Li et al. used a randomized controlled design. A randomized controlled design is more powerful because it reduces selection bias. The researchers could have improved their designs by randomizing participants to increase internal validity. 3. Comeaux and Comeaux may have selected their design because randomization was not feasible due to room assignments. 4. The control groups in both studies received

1. Introduction. Unrelieved postoperative pain remains a common
problem despite advances in pain management. Complementary
music has been suggested as an adjuvant to the standard of care
treatment for postoperative pain.
Purpose. The purpose of this study was to determine if music
therapy was an effective adjunct to decrease state anxiety, and
increase pain management and environmental noise satisfaction
in the postoperative patient.
Method.A quasi-experimental nonequivalent control group
design was used in this study with participants assigned based
on room assignment rather than randomly. The control group,
which consisted of participants admitted to the A hallway,
received the standard of care. The intervention group, which
consisted of participants admitted to the B hallway, received
complementary music therapy in the form of preprogrammed
MP3 players, in addition to the standard of care. Neither
analgesia type nor route was controlled. Each participant was
enrolled for a total of 3 days or until discharge, whichever came
first. Outcome measures were collected upon enrollment (Time
One) and for the next 2 consecutive days (Time Two and Time
Three). Participants in the intervention group were encouraged
to listen to a selection of nonlyrical low decibel (less than 60
db) preprogrammed music, for at least 30 minutes via an MP3
player after their prescribed analgesia was administered. State
trait anxiety, as well as pain and environmental noise
satisfaction, were assessed using the State-Trait Anxiety
Inventory and two standardized questions from the Press Ganey
survey.
Findings.Before the intervention was implemented, both groups
were the same related to their average level of state and trait
anxiety, pain, and noise perception. The patient's state anxiety,
pain perception, and noise perception were measured 1 day after
the intervention was in place. A significant difference was
found from Time One to Time Two in pain management (t =

2. 3.938, p < .001 ) and environmental noise satisfaction (t =
3.457, p = .001), while there was no change in state anxiety (t =
0.373, p = .711 ). The intervention group experienced improved
pain management (t = 7.385, p < .01) and environmental noise
satisfaction over time (t = 4.371; p < .001); however, there was
no improvement in state anxiety (t = l .47; p = .159). The
findings suggest music therapy decreases pain and
environmental noise perception, although there was no effect on
state anxiety.
Conclusions.Use of music therapy improves patients'
postoperative experience by increasing their pain management
and white noise satisfaction. This intervention was inexpensive
and easy to implement in the clinical setting, and therefore
recommended to improve postoperative outcomes in other
facilities.
Comeaux, T., & Comeaux, T. (2013). The effect of
complementary music therapy on the patient's postoperative
state anxiety, pain control, and environmental noise
satisfaction. Medsurg Nursing: Official Journal Of The
Academy Of Medical-Surgical Nurses, 22(5), 313-318.
Background.There is insufficient evidence on the effects of
music therapy on state anxiety of breast cancer patients
following radical mastectomy.
Methods. A Hall’s Core, Care, and Cure Model-based clinical
trial was conducted in 120 female breast cancer patients from
March to November 2009. A randomized controlled design was
used. The patients who were randomly allocated to the
experimental group (n = 60) received music therapy in addition
to routine nursing care, and the control group (n = 60) only
received routine nursing care. A standardized questionnaire and
the State Anxiety Inventory were applied. The primary endpoint
was the state anxiety score measured at pretest (on the day
before radical mastectomy) and at three posttests (on the day
before patients were discharged from hospital, and the second
and third time of admission to hospital for chemotherapy,
respectively).

3. Results.The pretest score revealed that the majority of the
patients had a moderate level (77%) and 15% had severe level
of state anxiety. The repeated-measure ANCOVA model
analysis indicated that the mean state anxiety score was
significantly lower in the experimental group than those in the
control group at each of the three posttest measurements. The
mean difference between the experimental and control group
were -4.57, -8.91, and-9.69 at the first posttest, 2nd posttest,
and 3rd posttest, respectively.
Conclusion.Music therapy is found to have positive effects on
decreasing the state anxiety score.
Li, X., Zhou, K., Yan, H., Wang, D., & Zhang, Y. (2012).
Effects of music therapy on anxiety of patients with breast
cancer after radical mastectomy: a randomized clinical
trial. Journal Of Advanced Nursing, 68(5), 1145-1155.
doi:10.1111/j.1365-2648.2011.05824.
Question 1
Compare and contrast the clinical problem identified by each
researcher.
Question 2
Identify the research design used in each study. Who used the
more powerful strategy? How could the researchers have
improved their designs?
Question 3
Why might Comeaux and Comeaux have selected their design?
Question 4
Who comprised the control groups?
Question 5
Compare the dependent variables.
Question 6
Compare the independent variables, describing variations in the
study protocols.

4. Question 7
If you worked on a surgical unit, would you be willing to
change your unit’s pain management protocols based on the
results of these studies?