Singing may benefit the speech of people with PD, although evidence is not unequivocal. Further research is required to assess wider benefits including on functional communication, cognitive status, motor function and quality of life. Substantial methodological limitations were identified in the existing literature. Recommendations are made for advancing the state of the literature.
Background Parkinson’s disease (PD) is a common neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in the potential benefit of performing arts as a therapeutic medium in PD. While there have been previous reviews, none have considered all performing arts modalities and most have focused on dance. This systematic review examined the potential benefit of all active group-based performing arts interventions for quality of life, functional communication, speech, motor function and cognitive status. Methods Searches were conducted in February 2020 on five scholarly databases. Supplementary searches were conducted. Included studies were quantitative in design, and assessed the potential benefit of any active group-based performing arts intervention for quality of life, functional communication, speech, motor function or cognitive status in people with PD. Full text papers were eligible for inclusion, as were conference abstracts since January 2018. Screening, data extraction, narrative synthesis and quality assessment were conducted independently by two reviewers. Quality assessment used the SURE checklists. Results Fifty-six studies were eligible for inclusion in this systematic review, reported in 67 publications. Published from 1989 to 2020, these studies included a total of 1531 people with PD from 12 countries, and covered four broad performing arts modalities: dance, singing, music therapy and theatre. Dance remains the most commonly studied performing arts modality for PD (38 studies), while there were 12 studies on singing interventions, four on music therapy, and only two on theatrical interventions. There was evidence for a beneficial effect of all four performing arts modalities on at least some outcome domains. Conclusions This is the first systematic review to assess the potential benefit of all active group-based performing arts interventions in PD. The evidence suggests that performing arts may be a useful therapeutic medium in PD. However, a substantial limitation of the evidence base is that no studies compared interventions from different performing arts modalities. Moreover, not all performing arts modalities were assessed for all outcome domains. Therefore it is not currently possible to determine which performing arts modalities are most beneficial for which specific outcomes.
Background: Parkinson’s disease (PD) is a common neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in the potential benefit of performing arts as a therapeutic medium in PD. While there have been previous reviews, none have considered all performing arts modalities and most have focused on dance. This systematic review examined the potential benefit of all active group-based performing arts interventions for quality of life, functional communication, speech, motor function and cognitive status. Methods: Searches were conducted in February 2020 on five scholarly databases. Supplementary searches were conducted. Included studies were quantitative in design, and assessed the potential benefit of any active group-based performing arts intervention for quality of life, functional communication, speech, motor function or cognitive status in people with PD. Full text papers were eligible for inclusion, as were conference abstracts since January 2018. Screening, data extraction, narrative synthesis and quality assessment were conducted independently by two reviewers. Quality assessment used the SURE checklists. Results: 56 studies were eligible for inclusion in this systematic review, reported in 67 publications. Published from 1989 to 2020, these studies included a total of 1531 people with PD from 12 countries, and covered four broad performing arts modalities: dance, singing, music therapy and theatre. Dance remains the most commonly studied performing arts modality for PD (38 studies), while there were 12 studies on singing interventions, four on music therapy, and only two on theatrical interventions. There was evidence for a beneficial effect of all four performing arts modalities on at least some outcome domains. Conclusions: This is the first systematic review to assess the potential benefit of all active group-based performing arts interventions in PD. The evidence suggests that performing arts may be a useful therapeutic medium in PD. However, a substantial limitation of the evidence base is that no studies compared interventions from different performing arts modalities. Moreover, not all performing arts modalities were assessed for all outcome domains. Therefore it is not currently possible to determine which performing arts modalities are most beneficial for which specific outcomes.
behaviour (e.g. driving, active travel, public transit, walking, and cycling) from adults in the general population. Interventions were categorized into functions (how the intervention seeks to affect behaviour). Depending on whether gains or losses of functions could occur, interventions were classified as carrots (e.g. new bikeshare programs), combined carrot and stick (e.g. traffic calming), or stick interventions (e.g. congestion charging). Harvest plots were used to visually summarize the findings weighted by study quality. Where possible, outcomes were converted into standardized mean differences (SMD) and random-effects meta-analyses were conducted. Results We extracted data from 83 publications reporting 98 interventions. From these, we identified 20 intervention types and eight function categories. The majority of interventions were carrots (n=64), followed by carrot and stick (n=17) and stick (n=17). Harvest plots demonstrated that most evaluations, particularly those classified as higher quality, found changes in favour of the intervention. Results for carrot interventions, however, were more less consistent than for stick or combined interventions. This was consistent with findings from the meta-analysis, which were statistically nonsignificant but had point-estimates of greater magnitude for driving outcomes for sticks (SMD -0.21; 95%CI -0.43, 0.01) and combined carrot and stick interventions (-0.17; -0.65, 0.31) compared to carrots (-0.09; -0.21, 0.03). Likewise, for active travel outcomes, combined carrot and stick interventions had a higher SMD (0.39; -0.01, 0.78) compared to carrot interventions (0.10; -0.06, 0.25). Financial functions were found to be the most effective for driving outcomes, whereas access, convenience, safety, and space were more effective for active travel outcomes. Discussion This is the first review to compare whether positive, negative, or combined strategies and their functions differ in terms of effectiveness on travel behaviour, which can aid policymakers in designing sustainable transportation policies. Further research is needed for interventions with a stick component, which suggest greater effectiveness yet remain less well-studied, possibly because they are less conducive to experimental manipulation.
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