Development and Reliability of a Music Therapy Assessment Tool for People with Dementia

Abstract

Advancements in medical care are helping people to live longer lives. However, this longevity brings other challenges and health issues. As baby boomers age, the needs of an increasing number of individuals are growing as a consequence. Dementia is an issue in this aging population, and is associated with cognitive and other types of losses. Persons with dementia need emotional support, and these needs increase as the dementia progresses. It is important that these individuals with dementia receive medical and therapeutic care to maintain their quality of life for as long as possible. Music therapy is one treatment option that has been shown to provide cognitive, physical, emotional, social and behavioral benefits for this population. However, music therapy-specific assessments are needed to document the clinical and research outcomes of music therapy interventions. The purpose of this study was to examine the reliability of the Music Therapy Assessment for People with Dementia (MTAPD), a researcher-developed measure designed to assess behaviors or responses of persons with dementia during singing or vocalization, instrumental improvisation and in non-musical domains. In order to develop assessment items, the researcher, using videotapes, extracted and identified essential elements of clients' behaviors and responses. Those items were categorized into three domains (i.e., behaviors or responses during singing or vocalization (n=7), behaviors/responses during instrumental improvisation (n=16), and non-musical response or behaviors (n=6). Scoring was based on a five-point scale for items. After developing the assessment tool, the researcher asked eight music therapists with expertise in dementia to review the assessment. Nordoff-Robbins (NR) music therapists (n=9) and non-NR music therapists (n=14) participated in the reliability testing of the assessment. Therapists rated the musical behaviors and responses of clients in these three domains while viewing 15 video excerpts of clients with dementia in music therapy sessions. Results showed that the MTAPD was a reliable instrument for assessing musical and non-musical behaviors of individuals with dementia. An inter-rater reliability analysis generated particularly strong findings with all intraclass correlation coefficients above r = 0.85 with the exception of the analysis of agreement among the NR trained music therapists with more than 10 years of clinical experience. With further reliability and validity testing, the MTAPD may serve a variety of purposes in music therapy clinical practice and research.