Comparison of the Effects of Audible Guided Imagery and Self-selected Instrumental Music on Comfort and the Well-Being Index in Hemodialysis Patients: A Randomized Controlled Trial

Abstract

Background: Comfort and well-being are fundamental to the psychological health and life satisfaction of patients undergoing hemodialysis. Objectives: This study aimed to compare the effects of audible guided imagery (AGI) and self-selected instrumental music (SSIM) on comfort and well-being indices among patients undergoing hemodialysis. Methods: In this randomized controlled trial, 90 hemodialysis patients were allocated to 3 groups (n = 30 each): AGI, SSIM, and control, using sex-stratified block randomization. The interventions lasted 20 minutes per session, 3 times per week for 4 weeks, while the control group received routine care. Comfort and well-being were assessed at baseline and at the ends of weeks 2 and 4 using Kolcaba's Hospice Comfort Questionnaire and the World Health Organization Five Well-Being Index (WHO-5). Data were analyzed using SPSS version 22 with chi-square, Kruskal-Wallis, and Mann-Whitney tests and generalized estimating equations regression. Results: Baseline comfort and well-being scores did not differ significantly among the groups. However, both intervention groups showed significant improvements by the second and fourth weeks (P < 0.05). In the SSIM group, comfort scores increased from a baseline of 93.77 ± 13.81 to 116.90 ± 8.31 at week 2, reaching 121.60 ± 7.53 by week 4. The AGI group showed a similar trajectory, with comfort scores rising from 93.53 ± 13.08 at baseline to 117.60 ± 10.47 (week 2) and 121.90 ± 7.33 (week 4). Regarding well-being, the control group exhibited a slight downward trend over time (from 57.33 ± 23.36 to 50.27 ± 18.66). In contrast, the SSIM group showed a significant increase in well-being (from 64.80 ± 21.49 to 86.93 ± 9.45), as did the AGI group (from 65.87 ± 18.64 to 87.73 ± 10.02). The regression analysis showed that both intervention groups achieved significantly higher comfort and well-being scores over time than those in the control group. The models included the main effects of time and group and were adjusted for age, education, and diabetes. Conclusions: No statistically significant difference was detected between the two interventions in this sample; however, both SSIM and AGI can serve as effective nonpharmacological interventions to enhance comfort and subjective well-being in hemodialysis patients after 4 weeks.