Research and Evidence-Based Practice Flashcards

A music therapist wants to compare the effectiveness of two improvisation protocols on anxiety reduction in oncology patients. After randomizing 40 patients, the therapist finds a statistically significant result (p = 0.03) but a Cohen's d of 0.18. Which is the most accurate interpretation of these findings?

Answer: The result is statistically significant but the effect size indicates a small, potentially clinically negligible difference between protocols

Statistical significance (p < 0.05) only indicates that the result is unlikely due to chance, not that the difference is clinically meaningful. Cohen's d of 0.18 is a small effect size (small ≈ 0.2, medium ≈ 0.5, large ≈ 0.8), meaning the practical difference between protocols may be too small to matter clinically, even though the result reached statistical significance. Distinguishing statistical from clinical significance is essential in EBP.

In a systematic review of music therapy for dementia, four RCTs are included. One RCT has high internal validity but used a sample of 8 participants with mild dementia only. The other three RCTs used mixed-severity samples of 60+ participants each but have moderate risk of bias. When synthesizing evidence for clinical recommendations, what principle best guides how to weight these studies?

Answer: Both internal validity and external validity (generalizability) must be considered; the small high-validity RCT may not generalize, and the larger studies' moderate bias must be explicitly acknowledged

EBP synthesis requires balancing internal validity (methodological rigor) and external validity (generalizability to the target population). A single RCT with n=8 and restricted severity may not generalize to the broader dementia population, regardless of its rigor. The larger studies' moderate bias is a real limitation but their generalizability is greater. A nuanced recommendation acknowledges both dimensions rather than mechanically prioritizing one criterion.

A music therapist reads a study claiming that receptive music listening significantly reduced cortisol levels in ICU patients (p = 0.01). The study did not include a true control group — instead, it compared pre-session to post-session cortisol within the same participants. Which threat to internal validity is MOST relevant here?

Answer: History and maturation effects, because cortisol naturally fluctuates over time and patients may have been calming down regardless of the music

Without a control group, a pre-post design cannot rule out history (external events that occurred during the session) or maturation (natural physiological changes over time, such as patients settling down after an acute episode). Cortisol naturally decreases with rest, making it impossible to attribute the change specifically to music. This is the central threat when a true control condition is absent in within-subjects pre-post designs.

According to the hierarchy of evidence used in music therapy research, which of the following study designs provides the WEAKEST level of evidence for establishing a causal relationship between a music therapy intervention and a clinical outcome?

Answer: An expert consensus statement based on clinical experience without systematic data collection

Expert consensus and opinion-based statements sit at the bottom of the evidence hierarchy because they rely on subjective clinical experience rather than controlled data collection, making causal inference impossible. RCTs with blinding are near the top. Quasi-experimental designs with control groups provide moderate evidence. Single-subject experimental designs with multiple baselines allow for causal inference within an individual and are considered experimental designs, providing stronger evidence than expert opinion.

A music therapist is critically appraising a qualitative phenomenological study exploring the lived experience of music therapy among survivors of traumatic brain injury. The researcher was both the treating therapist and the interviewer. Which specific trustworthiness criterion is MOST compromised, and what reflexivity strategy would best address it?

Answer: Credibility is compromised by researcher dual-role bias; member checking and a reflexivity journal documenting the researcher's assumptions would best address this

When the researcher holds dual roles (therapist and interviewer), the primary threat is to credibility — participants may respond based on the therapeutic relationship rather than authentic experience, and the therapist's prior knowledge may bias interpretation. Member checking (returning transcripts/themes to participants for validation) directly addresses whether findings accurately represent participants' experiences, while a reflexivity journal makes the researcher's biases explicit and transparent, which is the recommended strategy for dual-role qualitative research.

A board-certified music therapist working in a pediatric palliative care unit wants to implement a new sedation-reduction protocol using live harp music during painful procedures. The unit's medical director requests evidence support. The MT finds three published case studies, one pilot RCT (n=12), and two systematic reviews on music and pain — but none specifically address pediatric palliative sedation. Using the EBP framework, what is the MOST defensible next step?

Answer: Synthesize the best available indirect evidence alongside clinical expertise and family/patient values, implement with ongoing single-subject data collection to build local evidence, and plan to reassess

The EBP model integrates three components: best available research evidence, clinical expertise, and client/family values. When direct evidence for a specific population is absent, the clinician must use the best available indirect evidence and exercise clinical judgment. Refusing to act until perfect evidence exists is not ethically sound in palliative contexts, nor is blindly relying on unrelated systematic reviews. Implementing with structured single-subject data collection builds local, population-specific evidence over time — a recognized and rigorous approach in MT practice when external evidence is limited.