THE USE OF PERCUSSION IN THERAPY: A REALIST SYNTHESIS

Abstract

Background: Percussion use is common in both music therapy clinical practice and in publications. However, no comprehensive review regarding the use of percussion instruments in music interventions appears to exist. The investigator examined the various literature review types available in order to address the complex and contextual nature of percussion-related interventions. The purpose of this study was to conduct a realist synthesis-type systematic review of the literature regarding the use of percussion in therapy in order to answer the following research questions. Research Questions: 1. When using published tools designed to evaluate quality of research, what was the outcome of this appraisal process when reviewing identified studies? 2. What are the context-mechanism-outcome configurations within percussion-related interventions as found through the systematic review process? Methods: Literature review types were examined in order to locate a systematic review type that best fit the research questions. The investigator used a prior database from Matney (in press), and employed inclusion/exclusion criteria to locate studies with reduced bias and increased study rigor. Eligible studies were examined using methodological evaluation tools, which were corroborated through inter-rater reliability. The investigator created evidence tables that included context-mechanism-outcome configurations (CMOC’s). These configurations were examined for larger patterns that may inform theory development. The investigator linked chains of evidence in accordance with the realist synthesis methodology, and offered CMOC propositions. Results: Results revealed that 30.91% of studies prior to eligibility screening did not report internal review board or consent procedures. Regarding experimental studies evaluated after screening, 34.79% did not report the type of randomization procedure used, and 43.48% were unclear regarding concealment of allocation. Reporting within qualitative and mixed-methods studies also lacked transparent reporting. The investigator presented CMOC’s for each individual study, and proposed evidence linkage that may promote theory development regarding percussion interventions. Conclusions: The percussion-related intervention literature that was evaluated demonstrates a lack of study rigor (internal review board and/or consent procedures, intention to treat principle), a lack of transparent and detailed reporting (randomization details, allocation concealment, treatment consistency amongst groups), as well as a lack of replication and transferability. While context-mechanism-outcome configurations can only provide tentative theory development due to the paucity of connections available, the literature suggests that particular mechanisms may promote effective outcomes in particular situations. The investigator provides implications for future research, clinical practice, and pedagogy.