Patients exposed to background music or calming multimedia in ophthalmology waiting rooms reported lower anxiety scores than those exposed to no media, according to a prospective quasi-experimental quality improvement study published in Clinical Ophthalmology.
The single-center study included 375 patients at a Canadian tertiary-care ophthalmology clinic between January and November 2025. Researchers assigned clinic days, rather than individual patients, to 1 of 3 waiting-room conditions: no media, instrumental background music, or multimedia consisting of calming aquatic and ocean imagery paired with the same music.
The study was conducted as a quality improvement initiative rather than a formal randomized clinical trial, meaning the findings should be interpreted as practice-based observational evidence rather than definitive proof of causality.
Anxiety, satisfaction, and perceived helpfulness were measured using 0-to-10 visual analog scales. Mean anxiety scores were 5.69 in the no-media group, 3.59 in the music-only group, and 3.74 in the multimedia group. Both active interventions were associated with statistically significant reductions in anxiety compared with no media, with moderate effect sizes for the pairwise comparisons (Cohen’s d = 0.65–0.70). Anxiety scores did not statistically differ between the music-only and multimedia groups.
Multimedia exposure was associated with higher satisfaction scores compared with both no media and music alone, although the researchers noted that the effect sizes for satisfaction outcomes were small. Patients also rated multimedia as more helpful than music alone, although perceived helpfulness was assessed only in the 2 active intervention groups.
Among emergent-care patients, multimedia exposure was associated with the lowest anxiety scores and highest satisfaction scores observed in the study, though the difference in anxiety between the 2 active interventions showed only a trend toward statistical significance. Satisfaction scores were significantly higher with multimedia in this subgroup, while perceived helpfulness ratings between the 2 active interventions did not statistically differ.
Among nonemergent patients, both music and multimedia were associated with lower anxiety scores compared with no media, while multimedia received higher helpfulness ratings than music alone. Age-stratified analyses suggested more consistent benefit among patients aged 65 years and older, who reported lower anxiety with both interventions and higher perceived helpfulness with multimedia.
The interventions were delivered using preexisting clinic speakers and wall-mounted television screens without additional financial investment, which the researchers said may support scalability in high-volume outpatient settings.
The researchers cautioned that the findings should be interpreted in light of several important limitations. The study used pseudo-randomized day-of-week allocation rather than patient-level randomization, and no statistical adjustment was made for clustering by clinic day. Patients were also aware of the waiting-room condition they received, raising the possibility of Hawthorne and response-bias effects, particularly for satisfaction and perceived helpfulness outcomes.
In addition, individual wait times and exposure duration were not recorded, making it unclear whether differences in waiting time may have contributed to anxiety scores. Outcomes were limited to self-reported measures, with no physiologic assessments such as heart rate, blood pressure, or cortisol levels collected. Visual acuity also was not formally assessed, despite the ophthalmology setting and the use of visual multimedia content.
The subgroup analyses were exploratory and were not adjusted for multiple comparisons.
“While auditory input alone appears sufficient to achieve meaningful anxiolysis, multimedia environments may provide additional value by enhancing patient satisfaction and perceived helpfulness,” wrote lead study author Abdullahi Abdiaziz Mohamed, of the Faculty of Medicine and Dentistry at the University of Alberta, and colleagues.
Disclosures: The authors reported no conflicts of interest.
Source: Clinical Ophthalmology
