SingStrong – singing for better lung health in pulmonary fibrosis: A feasibility study

Abstract

BACKGROUND & PURPOSE: Pulmonary fibrosis (PF) is a debilitating, incurable disease. Strategies to optimise health-related quality of life and minimise symptom impact are advocated. Available treatment options such as pulmonary rehabilitation have been severely disrupted due to COVID-19. This feasibility study explored the clinical efficacy and acceptability of an online singing and breathing retraining programme (SingStrong) for people with PF. METHODS: The weekly online programme conducted over 12 weeks was comprised of 45-minute classes of mindfulness, breathing retraining, vocal exercises and singing conducted by a trained vocal coach. People with PF were invited to participate and sessions were recorded for non-attenders. Demographic data were collected, and the St Georges Respiratory Questionnaire (SGRQ) and Idiopathic PF Patient Reported Outcome measure (IPF-PROM) were administered. The questionnaire also invited participants to provide feedback on the utility, enjoyability and main pros/cons of the intervention. Participation in the research element of the programme was not required to attend the weekly classes. RESULTS: Of 24 participants recruited, data from 15 (mean (Standard Deviation) age of 66 (8.7); male: n = 8) who completed both pre and post-intervention questionnaires were analysed. Statistically significant improvements were recorded in the IPF-PROM (p = 0.019) and self-reported quality of life (p = 0.028). Class attendance by study participants and the broader PF group cumulatively, increased from 14 to 25 participants between weeks 1 and 12. Qualitatively, strong satisfaction with classes and improved efficacy in self-management of lung health, in particular breathlessness, were reported. CONCLUSIONS: Singing and breathing retraining interventions may endow biopsychosocial benefits for people with PF, in the presence of modest objective clinical gains. Singing programmes are popular and may provide helpful adjuncts to existing clinical strategies such as pulmonary rehabilitation.

Singing Interventions in Pulmonary Rehabilitation: A Scoping Review

“…Most quantitative studies reported on an improvement in the participants in physical or psychosocial areas. Seven studies reported positive changes in both domains [17,18,21,23,26,40,41], and one study reported no change in either domain [16]. Among the studies that measured physical function, 16 out of the 17 reported positive changes in this area.…”

“…The most frequently conducted research method was randomized controlled trials (RCT) (n = 12) including one feasibility study [18] and two pilot studies [19,20]. Aside from RCT, there were five one-group pre-post design studies [21][22][23][24][25], three case studies [26][27][28] and descriptive studies including study protocols [29,30], and program evaluation [31,32]. Three qualitative studies were also found [33][34][35].…”

“…Only one of these 13 studies addressed the cross-cultural adaptation of the program [29] and considered the cultural relevance of the song selections and participation experience. Studies from 2020 onward were characterized by using the names of specific programs such as Singing for Lung Health [37,38,43], SingStrong [21][22][23], and Singing for Breathing [34,36]. These studies showed some variation that reflected the environmental challenges of conducting research during the COVID-19 pandemic.…”

“…Some studies have offered instruction to enhance safety and better engage participants in the intervention. In eight studies, the researchers met with their participants to discuss song repertoire, provide health-related education, or offer instruction on breathing control techniques for enhancing self-management skills during singing [21][22][23]32,35,39,40,43]. In fact, all of the studies that performed SingStrong [21][22][23] included this pre-instruction discussion session, and this seems to have been helpful in situating and motivating participants.…”

Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease

“…The benefits of structured singing programmes for lung health, which are offered outside the traditional health service model, are also emerging. 105 …”