• An agenda for best practice research on group singing, health, and well-being

      Dingle, Genevieve A.; Clift, Stephen; Finn, Saoirse; Gilbert, Rebekah; Groarke, Jenny M; Irons, J. Yoon; Jones-Bartoli, Alice; Lamont, Alexandra; Launay, Jacques; Martin, Eleanor S; et al. (Sage, 2019-07-10)
      Research on choirs and other forms of group singing has been conducted for several decades and there has been a recent focus on the potential health and wellbeing benefits, particularly in amateur singers. Experimental, quantitative and qualitative studies show evidence of a range of biopsychosocial and wellbeing benefits to singers; however, there are many challenges to rigour and replicability. To support the advances of research into group singing, the authors met and discussed theoretical and methodological issues to be addressed in future studies. The authors are from five countries and represent the following disciplinary perspectives: music psychology, music therapy, community music, clinical psychology, educational and developmental psychology, evolutionary psychology, health psychology, social psychology, and public health. This paper summarises our collective thoughts in relation to the priority questions for future group singing research, theoretical frameworks, potential solutions for design and ethical challenges, quantitative measures, qualitative methods, and whether there is scope for a benchmarking set of measures across singing projects. With eight key recommendations, the paper sets an agenda for best practice research on group singing.
    • Cochrane systematic review singing for people with parkinson’s: preliminary findings

      Irons, J. Yoon; coren, Esther; Young, Megan K; Gschwandtner, Manfred; Stewart, Donald E; Mellick, George D; Health and Social Care Research Centre, University of Derby (University of Derby, 2019-06-05)
      This is a Conference (5th World Parkinson's Congress) poster based on the on-going Cochrane Systematic review on the effects of singing for people with Parkinson's.
    • Group singing has multiple benefits in the context of chronic pain: an exploratory pilot study

      Irons, J. Yoon; Kuipers, Pim; Wan, Aston; Stewart, Donald E; Health and Social Care Research Centre, University of Derby (Elsevier, 2019-09-05)
      This paper reports findings of a pilot singing intervention to assist people living with chronic pain. Pain Management Clinic out-patients participated in 10 weekly group singing sessions. Benefits of the intervention and its impact on participants’ (N=4) experience of pain were explored qualitatively. Three main themes comprising over 20 separate codes indicated physical, psychological and social dimensions associated with the intervention. People with chronic pain identify multiple benefits from participating in a group singing program. Group singing in chronic pain settings has multiple benefits; and can be a beneficial adjunct to conventional pain management care and nursing, which may positively complement clinical outcomes.
    • Group singing improves quality of life for people with Parkinson’s: an international study

      Irons, J. Yoon; Hancox, Grenville; Vella-Burrows, Trish; Han, E-Y; Chong, H-J; Sheffield, David; Stewart, Donald E; University of Derby; Sing to Beat Parkinson's, Cantata Canterbury Trust; Canterbury Christ Church University, Kent; et al. (Taylor & Francis, 2020-02-05)
      Group singing has been reported to enhance quality of life (QoL) and mental health in older people. This paper explored whether there are differences in the effects of group singing intervention on people with Parkinson’s (PwPs) in Australia, UK and South Korea. The study included PwPs (N = 95; mean age = 70.26; male 45%) who participated in a standardised 6-month weekly group singing programme. Parkinson’s health-related QoL measure (PDQ39) and mental health assessment (DASS) were administered at baseline and follow-up. ANOVAs were performed with significance set as p < .05. ANOVAs revealed main effects of Time on the Stigma and Social Support subscales of PDQ39; both showed a small but significant improvement over time. However, the social support reduction was moderated by country; social support was improved only in South Korean participants. The reduction in stigma was greater than previously reported minimal clinically important differences, as was the social support reduction in South Korean participants. In terms of mental health, ANOVAs revealed that the scores of Anxiety and Stress domains of DASS significantly decreased from pre-test to post-test with small effect sizes. This first international singing study with PwPs demonstrated that group singing can reduce stigma, anxiety and stress and enhance social support in older adults living with Parkinson’s. The findings are encouraging and warrant further research using more robust designs.
    • A group singing program improves quality of life: An international study

      Irons, J. Yoon; Hancox, Grenville; Vella-Burrows, Trish; Han, E-Y; Chong, H-J; Sheffield, David; Stewart, Donald E; Health and Social Care Research Centre, University of Derby (University of Derby, 2019-06-05)
      People with Parkinson’s (PwPs) may experience stigma, isolation, stress and anxiety due to the chronic nature of Parkinson’s. Complementary therapies, including singing, have been reported to impact positively on quality of life (QoL) in PwPs. This paper reports on an international trial of Sing to Beat Parkinson’s®, a community group singing program, involving PwPs from Australia, the UK, and South Korea on QoL and mental well-being. PwPs (N=95; mean age=70.26; male 45%) participated in a standardized 6-month weekly group singing program, which included breathing exercises, vocal warm-ups and preferred song singing. PDQ39 and modified DASS21 were administered at baseline and follow-up to assess QoL and mental well-being, respectively. MANOVA and ANOVAs were performed with significance set as p<.05. MANOVA showed statistically significant multivariate effects of Time, Country, Time by Country and Time by Gender interactions on QoL. Follow-up univariate ANOVAs revealed main effects of Time on Stigma and Social Support domains of QoL; both improved. Further, MANOVA revealed a multivariate effect of Time on mental well-being; anxiety and stress significantly decreased from pre-test to post-test. This first international singing study with PwPs demonstrated that group singing enhanced some aspects of quality of life and mental well-being. Participating in a weekly group singing program for a 6-month period impacted positively on social support, and feeling stigmatized, as well as reductions in anxiety and stress. The findings are encouraging and warrant further research using more robust designs that include comparator groups.
    • How Many Maneuvers Should We Do for Maximal Inspiratory and Expiratory Muscle Pressure Testing in Children: A Retrospective Review in Children with Cystic Fibrosis

      Boonjindasup, Wicharn; Chang, Anne B.; Marchant, Julie M.; Irons, J. Yoon; McElrea, Margaret S.; Charles Darwin University, Darwin, NT, Australia; Queensland University of Technology, Brisbane, QLD, Australia; Chulalongkorn University, Bangkok, Thailand; Cough, Asthma & Airways Research Group, Centre for Children’s Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia; Queensland Children’s Hospital, Brisbane, QLD, Australia; et al. (Springer Science and Business Media LLC, 2021-02-15)
      Objectives Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) could be useful clinical parameters in monitoring many conditions including cystic fibrosis (CF). However, current protocols for undertaking the measurements lack standardization including the number of repeated attempts to achieve best values. We aimed to (a) determine the optimum number of attempts to achieve best MIP/MEP values, and (b) evaluate if the number of attempts is consistent across two different test days. Methods We analyzed data of a previous randomized controlled trial involving the effect of singing on respiratory muscle strength in 35 children with CF. On two different days (T1, T2) children performed MIP/MEP with at least ten attempts each to achieve < 10% repeatability. Results All children achieved repeatable MIP/MEP values within 10–11 attempts with 24 (68.6%) and 26 (74.3%) of these achieving best values of MIP and MEP, respectively, at attempts 6–11. Median values of the pressures by three, five, eight and all attempts significantly increased with more attempts (all p < 0.05). At T2, 56% required fewer attempts to achieve best values, but 32% required more attempts, indicating that the number of attempts required was inconsistent between test days. Conclusion It is likely that at least ten attempts (best two within < 10% variability) is required to achieve best and reliable MIP/MEP in children with CF. A larger sample size in children with CF and various conditions is required to consolidate these findings.
    • Music, public health, and health promotion: Can music be a social determinant of health?

      Stewart, Donald E; Irons, J. Yoon; Queensland Conservatorium Research Centre, Griffith University (Palgrave Macmillan, 2018)
      This chapter explores the potentials of music as a social determinant of health and resource for psycho-social well-being. Music is encompassed within a socio-ecological definition of health, and from public health perspectives, music promotes well-being through its social participation and community engagement. This chapter offers two case studies, where qualitative and quantitative data attest that participating in music activities can increase well-being from public health perspectives.
    • Music, public health, and health promotion: Can music be a social determinant of health?

      Stewart, Donald E.; Irons, J. Yoon; Griffith University (Palgrave Macmillan, 2018-01-02)
      Although much of the research and policy development relating to the impact of the social determinants of health has centred around differences in socio-economic position, in occupation, income, housing, education and residential environment, for example, we are in the early stages of understanding the complex way that music works within the psycho-social-cultural field to influence people’s health and well-being. Rapid social change and its impact on individual and community well-being provides many fertile opportunities for innovative research in the music-health space. Music is an invisible thread that weaves between the social determinants of health and relates the individual, through culture and social affiliation, to risk and protective factors relating to health.
    • Singing

      Irons, J. Yoon; Hancox, Grenville; University of Derby; Canterbury Christ Church University (Emerald Publishing Limited, 2021-03-18)
      We are 'hard-wired' to sing - singing has defined our evolution. Through singing we express our feelings, communicate and connect with others. We are all singers: singing is part of us and defines cultures worldwide. Singing also, importantly, makes us feel better: it is, undoubtedly, good for us. This book provides an important overview of current research showing the benefits of singing on our health and wellbeing. Case studies illustrate its power - for example, how singing helps hospitalised children and a man living with Parkinson's. The book also discusses potential barriers for singing and useful strategies needed to overcome them. An example of a community singing group is also demonstrated, alongside practical advice on facilitating community singing groups for health and wellbeing. The book will be valuable to professionals working in health and social care settings, to practitioners and educators interested in engaging in singing for health promotion, and individuals looking to find out more about the benefits and practicalities of singing.
    • Singing as an adjunct therapy for children and adults with cystic fibrosis.

      Irons, J. Yoon; Petocz, Peter; Kenny, Dianna Theadora; Chang, Anne B.; Alder Hey Children's NHS Foundation Trust (Cochrane Library, 2014-06-10)
      Background: Cystic fibrosis is a genetically inherited, life-threatening condition that affects major organs. The management of cystic fibrosis involves a multi-faceted daily treatment regimen that includes airway clearance techniques, pancreatic enzymes and other medications. Previous studies have found that compliance with this intensive treatment is poor, especially among adolescents. Because of both the nature and consequences of the illness and the relentless demands of the treatment, many individuals with cystic fibrosis have a poor quality of life. Anecdotal reports suggest that singing may provide both appropriate exercise for the whole respiratory system and a means of emotional expression which may enhance quality of life. Objectives: To evaluate the effects of singing as an adjunct therapy to standard treatment on the quality of life, morbidity, respiratory muscle strength and pulmonary function of children and adults with cystic fibrosis. Search methods: We searched the Group's Cystic Fibrosis Trials Register and the Cochrane Central Register of Controlled Trials. Date of latest search: 31 March 2014. We also searched major allied complementary data bases, and clinical trial registers. Additionally, we handsearched relevant conference proceedings and journals. Date of latest search: 24 May 2012. Selection criteria: Randomised controlled trials in which singing (as an adjunct intervention) is compared with either a control intervention (for example, playing computer games or doing craft activities) or no singing in people with cystic fibrosis. Data collection and analysis: Results of searches were reviewed against pre-determined criteria for inclusion. Only one eligible trial was available for analysis. Main results: Since only one small study was included, no meta-analysis could be performed. The included study was a parallel, randomised controlled trial undertaken at two paediatric hospitals in Australia. The study evaluated the effects of a singing program on the quality of life and respiratory muscle strength of hospitalised children with cystic fibrosis (mean age 11.6 years, 35% male). While the singing group received eight individual singing sessions, the control group participated in preferred recreational activities, such as playing computer games or watching movies. This study was limited by a small sample size (51 participants) and a high drop-out rate (21%). There were no significant differences between the groups at either post-intervention or follow up; although by the end of treatment there were some within-group statistically significant increases for both singing and control groups in some of the domains of the quality of life questionnaire Cystic Fibrosis Questionnaire-Revised (e.g. emotional, social and vitality domains). For the respiratory muscle strength indices, maximal expiratory pressure at follow up (six to eight weeks post-intervention) was higher in the singing group, mean difference 25.80 (95% confidence interval 5.94 to 45.66). There was no significant difference between groups for any of the other respiratory function parameters (maximal inspiratory pressure, spirometry) at either post-intervention or follow up. Authors' conclusions: There is insufficient evidence to determine the effects of singing on quality of life or on the respiratory parameters in people with cystic fibrosis. However, there is growing interest in non-medical treatments for cystic fibrosis and researchers may wish to investigate the impact of this inexpensive therapy on respiratory function and psychosocial well-being further in the future.
    • Singing as an adjunct therapy for children and adults with cystic fibrosis.

      Irons, J. Yoon; Petocz, Peter; Kenny, Dianna Theadora; Chang, Anne B.; Griffith University; South Bank Campus, Griffith University; Queensland Conservatorium Research Centre; 140 Grey Street Brisbane Australia QLD 4101; Macquarie University; Department of Statistics; Eastern Road Sydney NSW Australia 2109; University of Sydney; Behavioural and Social Sciences in Health, Faculty of Health Sciences; East St Lidcombe NSW Australia 1825; Menzies School of Health Research, Charles Darwin University; Child Health Division; PO Box 41096 Darwin Northern Territories Australia 0811 (Cochrane Library, 2016-09-15)
      People with cystic fibrosis are at risk of chest infections due to abnormally thick mucus in their airways. Airway clearance is therefore an important part of managing the condition. Increasing anecdotal reports suggest that singing may support lung function and enhance quality of life in people with cystic fibrosis. We searched for trials using the standard search methods of the Cochrane Cystic Fibrosis and Genetic Disorders Group, and conducted extensive searches in other relevant databases and publications. This is an update of a previously published review.Participants from both the singing and recreation groups reported some improvement in quality of life measurements. Participants in the singing group demonstrated a greater increase in maximal expiratory pressure (a substitute measure of respiratory muscle strength test), while participants in the recreation group did not show improvement. No adverse events were reported. There is currently not enough evidence to assess the effect of singing on clinical outcomes in people with cystic fibrosis. Future studies using robust methods are needed to assess the possible effects of singing for people with cystic fibrosis
    • Singing as an adjunct therapy for children and adults with cystic fibrosis.

      Irons, J. Yoon; Petocz, Peter; Kenny, Dianna T; Chang, Ann B.; University of Derby (2019-07-12)
      Cystic fibrosis is a genetically inherited, life‐threatening condition that affects major organs. The management of cystic fibrosis involves a multi‐faceted daily treatment regimen that includes airway clearance techniques, pancreatic enzymes and other medications. Previous studies have found that compliance with this intensive treatment is poor, especially among adolescents. Because of both the nature and consequences of the illness and the relentless demands of the treatment, many individuals with cystic fibrosis have a poor quality of life. Anecdotal reports suggest that singing may provide both appropriate exercise for the whole respiratory system and a means of emotional expression which may enhance quality of life. This is an update of a previously published review. To evaluate the effects of singing as an adjunct therapy to standard treatment on the quality of life, morbidity, respiratory muscle strength and pulmonary function of children and adults with cystic fibrosis. We searched the Group's Cystic Fibrosis Trials Register and the Cochrane Central Register of Controlled Trials. Date of latest search: 07 January 2019. We also searched major allied complementary data bases, and clinical trial registers. Additionally, we hand searched relevant conference proceedings and journals. Date of latest search: 28 March 2019. Randomised controlled trials in which singing (as an adjunct intervention) is compared with either a control intervention (for example, playing computer games or doing craft activities) or no singing in people with cystic fibrosis. Results of searches were reviewed against pre‐determined criteria for inclusion. Only one eligible trial was available for analysis. Since only one small study (n = 40) was included, no meta‐analysis could be performed. The included randomised controlled study was of parallel design and undertaken at two paediatric hospitals in Australia. The study evaluated the effects of a singing program on the quality of life and respiratory muscle strength of hospitalised children with cystic fibrosis (mean age 11.6 years, 35% male). While the singing group received eight individual singing sessions, the control group participated in preferred recreational activities, such as playing computer games or watching movies. This study was limited by a small sample size (51 participants) and a high drop‐out rate (21%). There were no differences between the groups at either post‐intervention or follow‐up; although by the end of treatment there were some improvements in some of the domains of the quality of life questionnaire Cystic Fibrosis Questionnaire‐Revised (e.g. emotional, social and vitality domains) for both singing and control groups. For the respiratory muscle strength indices, maximal expiratory pressure at follow‐up (six to eight weeks post‐intervention) was higher in the singing group, mean difference 25.80 (95% confidence interval 5.94 to 45.66). There was no difference between groups for any of the other respiratory function parameters (maximal inspiratory pressure, spirometry) at either post‐intervention or follow‐up. No adverse effects were observed in the singing group; adverse events for the control group were not reported in the paper. There is insufficient evidence to determine the effects of singing on quality of life or on the respiratory parameters in people with cystic fibrosis. However, there is growing interest in non‐medical treatments for cystic fibrosis and researchers may wish to investigate the impact of this inexpensive therapy on respiratory function and psychosocial well‐being further in the future.
    • Singing for people with Parkinson's disease

      Irons, J. Yoon; coren, Esther; Young, Megan K; Stewart, Donald E; Gschwandtner, Manfred; Mellick, George D; Health and Social Care Research Centre, University of Derby; Queensland Conservatorium Research Centre, Griffith University, Australia (Cochrane, 2019-02-26)
      To compare the efficacy and effectiveness of singing interventions with non‐singing intervention or usual care on QoL, wellbeing, and speech and communication among people with PD. We will assess the QoL and the physical, psychological, and social health and wellbeing of people with PD who receive a singing intervention, compared to non‐singing intervention or usual care.
    • Songs for health education and promotion: a systematic review with recommendations

      Sheffield, David; Irons, J. Yoon; University of Derby (Elsevier, 2021-09-06)
      We aimed to assess evidence of the effectiveness of song-based public health programmes and to examine the analyses of song lyrics to learn what their key qualities for public health promotion are. A systematic search was employed to identify empirical studies that examined song interventions for public health education and promotion. We searched the following databases: MEDLINE, PubMed, CINAHL, PsycINFO and AMED. We also backwards searched references of all relevant studies. Of the 137 studies identified, ten studies were included: four were quantitative and six were qualitative. The qualities of the included studies were assessed to be fair or good. The studies were from developing/low-income countries, South Africa and the United States, involving children and adults. Through a narrative data synthesis, three themes were identified; song-based programmes increased public health knowledge and changed behaviours. Additionally, developing songs for public health promotion involved consultations with local people utilising culturally and socially relevant genres or songs. Although the current evidence is limited by the small number of available studies and their heterogeneity, there is evidence that songs may be an effective method to deliver public health messages that result in improved education and changes in behaviour. Several advantages of using songs as public health strategies were identified that included their social and cultural relevance, ubiquity, low cost and enjoyment. Given these advantages, further research with the robust methodology is required to assess the benefits of songs using quantifiable outcomes along with evaluation of processes. We recommend that public health professionals, stakeholders and communities utilise songs as public health strategies.
    • A systematic review on the effects of group singing on persistent pain in people with long‐term health conditions

      Irons, J. Yoon; Sheffield, David; Ballington, Freddie; Stewart, Donald E; Health and Social Care Research Centre, University of Derby (Wiley, 2019-09-23)
      Singing can have a range of health benefits; this paper reviews the evidence of the effects of group singing for chronic pain in people with long‐term health conditions. We searched for published peer‐reviewed singing studies reporting pain measures (intensity, interference and depression) using major electronic databases (last search date 31 July 2018). After screening 123 full texts, 13 studies met the inclusion criteria: five randomized controlled trials (RCTs), seven non‐RCTs and one qualitative study. Included studies were appraised using Downs and Black and the Critical Appraisals Skills Programme quality assessments. Included studies reported differences in the type of singing intervention, long‐term condition and pain measures. Due to the high heterogeneity, we conducted a narrative review. Singing interventions were found to reduce pain intensity in most studies, but there was more equivocal support for reducing pain interference and depression. Additionally, qualitative data synthesis identified three key linked and complementary themes: physical, psychological and social benefits. Group singing appears to have the potential to reduce pain intensity, pain interference and depression; however, we conclude that there is only partial support for singing on some pain outcomes based on the limited available evidence of varied quality. Given the positive findings of qualitative studies, this review recommends that practitioners are encouraged to continue this work. More studies of better quality are needed. Future studies should adopt more robust methodology and report their singing intervention in details. Group singing may be an effective and safe approach for reducing persistent pain and depression in people with long‐term health conditions.
    • ‘Withness’: Creative spectating for residents living with advanced dementia in care homes

      Astell-Burt, Caroline; McNally, Theresa; Collard-Stokes, Gemma; Irons, J. Yoon; London School of Puppetry; University of Derby (Intellect, 2020-07-01)
      Aiming to illustrate the potential for puppetry as a useful resource in dementia care, the authors argue unusually that play with puppets derives not particularly from drama or theatre, but fundamentally from the performative relationship people have with objects. The puppeteers of the study achieved remarkable emotional connection with care-home residents through an experience of puppetry, which dissolved the unitary autonomy of the puppet, recontextualizing it relationally as the puppeteer-with-puppet-with-spectator. It is this ‘withness’ that ignited the creative spark of presence of the residents. For a moment of trust and child-like joy kinaesthetic memories stirred in them, appearing to break down emotional barriers between the person and the world around them and indicating comparatively longer-term therapeutic benefits.