I was reading an article today on potential of eLearning in university environments (Conole, 2010, Journal of eLearning and Knowledge Society). This author was pointing out how very few academic environments have truly fulfilled on the promises made – for “personalisation, student-centred learning, to support new forms of communication and dialogical learning and enriched multi-model forms of representation” (p.13). But what really caught my attention was the author’s reference to NO SIGNIFICANT DIFFERENCE being evident in studies of eLearning vs. traditional learning.
It suddenly occurred to me that perhaps we music therapists have been approaching the idea of statistical significance all wrong. Instead of comparing our programs to other existing programs and being disappointed that we are not SIGNIFICANTLY MORE effective, we should be comparing ourselves to other equivalent programs of excellence and showing that we are NOT SIGNIFICANTLY WORSE!
The author had used the argument in the way that music therapists do. Under controlled conditions there was no evidence that eLearning was better. But to my reading, as an interested and detached observer of the phenomenon, that was all I needed to hear – that it was no worse. Times are moving forward and the only thing standing in the way of eLearning would be if it were detrimental to student learning.
Similarly, music therapy is an appealing and engaging form of therapy in many contexts. There is often strong support from families and participants for music therapy programs, but funding is often not forthcoming, perhaps because of the lack of evidence. The argument we should be making is that the evidence shows that music therapy is doing no harm and that it is also desirable to consumers. We should be conducting investigations to make sure that it is not detrimental, instead of constantly focusing on analysis of results to identify which dimensions we can claim statistically significant improvements on. The best outcome we should be hoping for is equivalence, since I think we would all agree that we find music therapy as effective as other means of achieving therapeutic outcomes, but not necessarily more? Or perhaps that’s just me?
Interesting thought. Certainly in the clinical area I work in, the multidisciplinary team despairs that sometimes, nothing they do seems to work - even the drug therapy! So on that measure, music therapy would be way ahead. It would be interesting if funding was apportioned according to how the clients and their families and carers felt the treatment worked - I'm sure there would be lots more money in our profession then. In contrast, I met a music therapist in Canada several years ago who was fighting tooth and nail to prove that music therapy WAS dangerous - in order to show that it was a powerful, real, worthwhile treatment modality that should be recognised, regulated, funded and treated like other allied health professions that have potential negative outcomes! I think I like your suggestions much better :)
ReplyDeleteI think the combination of showing that music therapy does no harm, and that patients prefer it is a powerful one. However, I think there is an important difference between showing that music therapy is no worse than another type of therapy and showing that music therapy does no harm. I think it's all about the outcomes that you are looking at. I think the idea of 'not significantly worse' means not significantly worse at being effective and is talking in terms of effectiveness outcomes. 'Doing no harm' means that is is safe and looking at safety outcomes. I don't think you can assume one from the other (i.e. one therapy could equally as well as another, but at the same time have a greater risk of harm to patients/participants).
ReplyDeleteI agree with your idea that equivalence in effectiveness to another great type of therapy is not a negative finding at all - that's when patient preference and no evidence of harm could really be convincing! :)
I do like the way your mind works!
ReplyDeleteI think that some types of "equivalence" research would be very interesting, and potentially add greatly to the evidence for music therapy.
However, our favourite saying "it all depends" really applies here. If we compare MT to a standard care control, we really need to show that MT is "adding" something to the person's care/life....otherwise, why do music therapy? If I was are wanting to know how people experience and value MT, then that to me would be a different argument to make.
To me the real difficulty at the moment is that "standard care" is often really good quality and grounded in evidence based practice. Can MT add something significantly to that?
Even if a study puts MT head-to-head with another intervention, it is likely that the clients are still receiving some form of "standard care" along side these therapies...making it really difficult to try to control (or even identify) the variables.
We apply a complex therapy to complex clients in complex situations... Tony Wigram's notion of "good enough" research comes to mind for me (see Tony's response to Tia DeNora's artilce in BJMT 2006).