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  • Alfredo Raglio *,
  • Virginia Cavallari and
  • Marina Rita Manera
  • et al.

Reviewer 1: Anonymous Reviewer 2: Anonymous Reviewer 3: Anonymous Reviewer 4: Heidi Ahonen Reviewer 5: Kadir Uludag

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript presents a systematic review of randomized controlled trials on non‑relational music listening interventions in medical and healthcare contexts, focusing on psychophysical outcomes such as anxiety, pain, sleep, and mood. It examines how these interventions are implemented, with particular attention to therapeutic aims, music selection strategies, specification of musical parameters, and the role of control conditions. The authors highlight substantial heterogeneity and methodological gaps in the existing literature and discuss future directions, including more rigorous reporting standards and the potential of algorithmic and AI‑generated music.

  1. In the current introduction (particularly on pp. 2–3), a substantial amount of space is devoted to listing different music listening approaches, so the core “problem” that motivates this review does not come across strongly. It would be helpful to reduce the descriptive catalogue of techniques and instead bring the main limitations of the existing literature to the foreground (e.g., heterogeneity of protocols, insufficient reporting of music parameters, weak linkage between therapeutic goals and music selection). This would clarify why this review is needed and sharpen the central research question.
  1. The distinction between relational and non‑relational music listening is central to the paper, but in its current form the introduction does not define or support this distinction sufficiently. Since the review focuses on non‑relational listening, it would be useful to state more clearly what the authors mean by “relational” and “non‑relational” in this context (for example, the presence or absence of a therapeutic relationship, therapist co‑presence, and shared processing of the music), and to anchor this distinction more explicitly in the music therapy literature. A brief summary of the theoretical and empirical reasons for treating non‑relational listening as a separate category would make the conceptual framework and the scope of the included interventions more transparent.
  1. The rationale for limiting the literature search to the years 2020–2025 is not clearly explained. If the intention is to focus on the most recent evidence and current reporting standards, this aim could be stated briefly. At the same time, it would be appropriate to acknowledge that this time frame may exclude earlier, potentially important RCTs or foundational work, and to reflect in one or two sentences on how this choice might limit the completeness of the evidence base.
  1. In the Results section, individual studies and a very large table are presented, but the overarching patterns are only weakly synthesized. For a systematic review, it would be important to go beyond description and to present more clearly the key findings regarding effectiveness (for example, which outcomes show consistently positive effects across clinical areas, and where results remain mixed or inconclusive). Given that this paper places particular emphasis on intervention characteristics and music parameters, the current, predominantly descriptive treatment of these features makes the work read more like a scoping review. It would be helpful for the authors to clarify whether their primary aim is an effect‑focused systematic review or a mapping of intervention characteristics, and to structure the Results accordingly.
  1. Table 1 currently extends over more than 20 pages, which makes it difficult for readers to quickly identify the most relevant information. I would recommend streamlining the table in the main text, focusing on core variables, and moving detailed statistics and secondary information to supplementary material. Grouping studies by clinical area or primary outcome, or removing variables that do not directly support the main messages, would substantially improve readability.
  1. Several important points raised in the Discussion—for example, the very limited involvement of certified music therapists, the single trial using algorithmic music, and the variability in control conditions and auditory environments (headphones, ANC, etc.)—are not clearly summarized in the Results but have to be inferred from Table 1. It would be helpful to briefly quantify and summarize these elements in the Results section. This would make it clear that the Discussion is interpreting already reported findings, rather than introducing what could be perceived as new information.
  2. The paper mainly describes and maps different music listening interventions (types of music, parameters, formats, control conditions), rather than clearly summarizing and comparing their effects. Because of this focus, a scoping review approach may be more suitable than a traditional effect‑focused systematic review. I would therefore suggest that the authors either (i) explicitly frame and label the work as a scoping review in the title, aims, and methods, or (ii) if they wish to keep the term “systematic review,” strengthen the synthesis of outcomes and effectiveness so that it better matches what is usually expected from a systematic review.

Author Response

Please see the attachment (Responses in red color)

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The study entitled “Music Listening in Medicine and Healthcare: A Systematic Review” has been reviewed, and the following comments are provided:

  1. In the PRISMA flow diagram, it should be clarified whether similar studies have previously been conducted by other researchers or whether this study represents an original work. Please refer to the PRISMA website and select the appropriate flow diagram for this type of study.
  2. In cases of disagreement between the reviewers, what method was used to resolve the disagreement?
  3. By what method was the quality of the included studies assessed, and how many reviewers conducted the quality assessment?
  4. Which databases were searched? How many articles were retrieved from each database?
  5. What keywords were used?
  6. What were the search strategies?
  7. What were the eligibility criteria for the included studies?
  8. In the Methods section, a “comprehensive overview” is mentioned, whereas the title refers to a “systematic review.” This inconsistency should be clarified.
  9. References should be provided in the Methods section to support the procedures used. The following study may be helpful for appropriate referencing: Calculate the Actual Overlap in an Overview. M. Arian, A. Valinejadi, and M. Soleimani. Nursing Practice Today, 2021, Vol. 8, Issue 2, Pages 91–95. DOI: 10.18502/npt.v8i2.5119
  1. The findings are presented only in tables; however, more detailed explanations of the results should also be provided in the text.
  2. The Discussion section is combined with the Findings; these sections should be separated. In addition, the comparative analysis with other studies in the Discussion section is weak.

Author Response

Please see the attachment (Responses in red color)

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript provides a timely and sophisticated critique of the current state of music medicine. By focusing on interventions that don't involve relationships, the study clearly reveals a major weakness in research methods, particularly the lack of consistent musical standards and the minimal participation of certified music therapy professionals. The forward-looking discussion on Artificial Intelligence (AI) and algorithmic music is a particular strength, offering a viable path toward reproducible clinical protocols, especially in how these technologies can enhance personalized music interventions and improve patient outcomes.

Specific Suggestions for Revision

  1. Methodological Rigor and Scope
    1. Database Selection: The systematic search was limited exclusively to PubMed. To align with standard systematic review protocols (such as PRISMA), please justify why other relevant databases (e.g., CINAHL, PsycINFO, or the Cochrane Library) were not included, or acknowledge their absence as a limitation.
    2. Timeline Consistency: There is a discrepancy regarding the search period. The abstract mentions trials published through November 2025, while the Materials and Methods section extends to December 31, 2025. Please ensure these dates are consistent throughout the text.
  2. Conceptual Strengths to Emphasize
    1. Control Group Environments: Your critique of Active Noise Cancellation (ANC) headphones as a non-neutral sensory condition is an insightful contribution. The conclusions should emphasize this crucial point for future trial designs.
    2. Professional Oversight: The finding that only 4 out of 63 studies involved a qualified music therapist is a powerful data point. Emphasizing the need for interdisciplinary collaboration during the design phase (playlist construction) would further strengthen your recommendations.
  3. Minor Technical Corrections
    1. Reference Citations: In Table 1, ensure all study numbers (e.g., [13] through [75]) correspond accurately with the final reference list to prevent reader confusion.
    2. Abbreviations: Ensure all acronyms, such as TML (Therapeutic Music Listening) and NMT (Neurologic Music Therapy), are consistently defined upon first use in both the abstract and the main body.

Author Response

Please see the attachment (Responses in red color)

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

This review explores receptive, non-relational music listening interventions in clinical settings. It focuses on listening to pre-recorded music without a therapist present. The introduction offers a well-organized theoretical background that clearly differentiates active music therapy, receptive music therapy (including GIM), and non-relational music listening ("music medicine").

The review draws exclusively on single databaseL PubMed for its bibliographic sources. This may increase the selection bias.

Systematic reviews typically follow PRISMA guidelines, which recommend searching multiple major databases (MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Cochrane CENTRAL). The manuscript does not clearly indicate if the PRISMA 2020 guidelines were followed. Also, the manuscript does not mention if  the review  was pre-registered with PROSPERO. Both of these are standard expectations for systematic reviews.

Is this a systematic review or a scoping/narrative review?

The included studies lack a bias assessment, which is important in any systematic review. The authors should apply a validated tool (i.e. Cochrane RoB 2.0/the PEDro scale) or provide a clear rationale and reasons for not utilizing this this step.

The first author, Raglio, is frequently cited throughout the manuscript. The authors' own study is the only example of algorithmically generated music included, and it receives particular attention in the Discussion. This may be seen as  a promotial bias. 

The manuscript addresses a relevant clinical issue, and its conceptual framework is well constructed. However, three concerns must be addressed in the revision: reliance on a single database without explanation; the absence of a risk-of-bias assessment; and excessive self-citation.

Author Response

Please see the attachment (Responses in red color)

Author Response File: Author Response.pdf

Reviewer 5 Report

Comments and Suggestions for Authors

1-)if possible, please make the abstract more concise focusing on novelty of your work.

2-)if possible, make it more precise:

 Substantial heterogeneity was ob- 28
served in music listening experiences, potentially confounding outcome interpretation.

3-)be sure the keywords are precise.

4-)if possible add reference for the first sentence.

5-)be sure its correct:

Music therapy is conventionally classi- 48
fied into two main modalities: active and listening-based (receptive) techniques

6-)be sure your methods identify studies in the literature correctly.

7-）if the methods cannot be sufficient enough to be considered systematic, you may consider converting it into narrative review.

8-)be sure the table explains the non-abbreviated words.

9-)you may add AI Statement to write the following:

In this section, you can acknowledge any support given which is not covered 266
by the author contribution or funding sections. This may include administrative and technical sup- 267
port, or donations in kind (e.g., materials used for experiments). Where GenAI has been used for 268
purposes such as generating text, data, or graphics, or for study design, data collection, analysis, or 269
interpretation of data, please add “During the preparation of this manuscript/study, the author(s) 270
used [tool name, version information] for the purposes of [description of use]. The authors have 271
reviewed and edited the output and take full responsibility for the content of this publication.

10-)make it specific: 

This review highlights substantial gaps in methodological rigor and conceptual clar- 241
ity within the literature on music-based listening interventions.

11-)be sure references are precise.

12-)be sure the manuscript lacks of accidental plagiarism.

13-)conclusion section can be more concise.

Author Response

Please see the attachment (Responses in red color)

Author Response File: Author Response.pdf

Round 2

Reviewer 5 Report

Comments and Suggestions for Authors

accept