Evidence of disease severity, cognitive and physical outcomes of dance interventions for persons with Parkinson’s Disease: a systematic review and meta-analysis

Abstract

Background Patients with Parkinson’s Disease (PD) usually experience worsening of both motor and non-motor symptoms. Dancing has been postulated to help patients with Parkinson’s via several mechanisms that lead to improved physical, cognitive and social functions. Methods This systematic review was conducted following Cochrane methodology and reported following the PRISMA guideline. Four databases (up to June 2021) were searched for RCTs comparing dance to standard or other physical therapy for improvements in disease severity, quality of life, cognitive and physical outcomes as well as adverse events in patients with PD. We synthesised data using RevMan and included certainty-of-evidence rating (GRADE) for major outcomes. Results A total of 20 RCTs (N = 723) articles that evaluated Tango, Ballroom, Irish, Waltz-Foxtrot, Folk, Turo, mixed dances and a PD-tailored dance were included. Dancers (versus non-dancers) had better motor experience (MDS-UPDRS 3) (MD -6.01, 95 % CI -9.97 to -3.84; n = 148; 5 RCTs) and improved balance (MiniBest Test) (MD 4.47, 95 % CI 2.29 to 6.66; n = 95; 3 RCTs), with no consistent differences on gait, agility and cognitive outcomes. Small samples and methodological limitations resulted in low-certainty-evidence across outcomes. Conclusions Apart from a suggestion that dance intervention modestly reduced motor disease severity and improved certain aspects of balance, there is insufficient evidence on all other outcomes, such as agility and motor function, cognitive, mood and social outcomes, quality of life as well as adverse events including the risk of fall. As evidence is insufficient to inform practice, evidence of benefits on motor disease severity and balance needs to be considered in the context of user-perception of benefit versus harm and acceptability in the development of practice guideline recommendations.

Dance movement therapy for neurodegenerative diseases: A systematic review

“…Sixteen systematic analyses (Mandelbaum and Lo, 2014 ; Sharp and Hewitt, 2014 ; Lötzke et al, 2015 ; Shanahan et al, 2015 ; Aguiar et al, 2016 ; Dos Santos Delabary et al, 2018 ; Kalyani et al, 2019 ; Tang et al, 2019 ; Zhang Q. et al, 2019 ; Barnish and Barran, 2020 ; Berti et al, 2020 ; Carapellotti et al, 2020 ; Hidalgo-Agudo et al, 2020 ; Emmanouilidis et al, 2021 ; Ismail et al, 2021 ; Hasan et al, 2022 ), 18 RCTs (Hackney et al, 2007 ; Hackney and Earhart, 2009 , 2010 ; Hashimoto et al, 2015 ; Rios Romenets et al, 2015 ; Hulbert et al, 2017 ; Shanahan et al, 2017 ; Lee et al, 2018 ; Michels et al, 2018 ; Poier et al, 2019 ; Solla et al, 2019 ; Frisaldi et al, 2021 ), and 62 clinical trials investigated the effects of dance on Parkinson's symptoms ( Tables 1 – 4 , Supplementary Tables 1, 2 ). Most studies (11/13 systematic analyses and all RCTs) examined the effects of dance exercise therapy in PD patients using exercise parameters as the primary outcome measure.…”

“…MDS-UPDRS-3 evaluated motor functions, such as tremor, bradykinesia, postural instability, rigidity, and gait. Six meta-analyses (Sharp and Hewitt, 2014 ; Lötzke et al, 2015 ; Dos Santos Delabary et al, 2018 ; Kalyani et al, 2019 ; Ismail et al, 2021 ; Hasan et al, 2022 ) reported higher MDS-UPDRS-3 scores on PD patients who had DMT compared with the non-dance group. The DMT group obtained significantly better MDS-UPDRS-3 scores compared with the no treatment or other exercise groups (SMD = −10.73, 95%CI = −15.05 to −6.16, p = 0.004), and standard or other physical therapy (MD= −6.91, 95%CI = −9.97 to −3.84, p < 0.05) (Sharp and Hewitt, 2014 ; Ismail et al, 2021 ).…”

“…Six meta-analyses (Sharp and Hewitt, 2014 ; Lötzke et al, 2015 ; Dos Santos Delabary et al, 2018 ; Kalyani et al, 2019 ; Ismail et al, 2021 ; Hasan et al, 2022 ) reported higher MDS-UPDRS-3 scores on PD patients who had DMT compared with the non-dance group. The DMT group obtained significantly better MDS-UPDRS-3 scores compared with the no treatment or other exercise groups (SMD = −10.73, 95%CI = −15.05 to −6.16, p = 0.004), and standard or other physical therapy (MD= −6.91, 95%CI = −9.97 to −3.84, p < 0.05) (Sharp and Hewitt, 2014 ; Ismail et al, 2021 ). More than half of trials with MDS-UPDRS-3 as the primary outcome measure demonstrated that dance intervention improved the overall motor performance in PD patients (Duncan and Earhart, 2012 , 2014 ; Volpe et al, 2013 ; Hashimoto et al, 2015 ; Lee et al, 2018 ; Solla et al, 2019 ; Frisaldi et al, 2021 ).…”

“…Various neuroimaging studies of dance observation showed that DMT can improve the neuronal connectivity in specific brain regions of older participants' brain, promote neuroplasticity, and induce changes in gray and white matter in multiple brain regions, especially the frontotemporal region. Previous studies suggested DMT as a rehabilitation tool of disease management and clinical improvement for patients with AD (Mabire et al, 2019 ; Ruiz-Muelle and López-Rodríguez, 2019 ), MCI (Liu et al, 2021 ; Wang et al, 2021 ; Wu et al, 2021 ), and PD (Barnish and Barran, 2020 ; Berti et al, 2020 ; Carapellotti et al, 2020 ; de Almeida et al, 2020 ; Emmanouilidis et al, 2021 ; Ismail et al, 2021 ). The pooled results of the latest meta-analysis of the efficacy of DMT in PD patients showed that DMT can improve motor function and reduce the burden on caregivers (Emmanouilidis et al, 2021 ; Ismail et al, 2021 ).…”

“…Previous studies suggested DMT as a rehabilitation tool of disease management and clinical improvement for patients with AD (Mabire et al, 2019 ; Ruiz-Muelle and López-Rodríguez, 2019 ), MCI (Liu et al, 2021 ; Wang et al, 2021 ; Wu et al, 2021 ), and PD (Barnish and Barran, 2020 ; Berti et al, 2020 ; Carapellotti et al, 2020 ; de Almeida et al, 2020 ; Emmanouilidis et al, 2021 ; Ismail et al, 2021 ). The pooled results of the latest meta-analysis of the efficacy of DMT in PD patients showed that DMT can improve motor function and reduce the burden on caregivers (Emmanouilidis et al, 2021 ; Ismail et al, 2021 ). The meta-analysis findings of randomized controlled trials (RCTs) and non-RCTs reported the positive effects of DMT in improving the motor, cognitive, and psychological functions in patients with AD (Ruiz-Muelle and López-Rodríguez, 2019 ).…”