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

Sophia Rasheeqa Ismail, Shaun Wen Huey Lee, Dafna Merom, Puteri Sofia Nadira Megat Kamaruddin, Min San Chong, Terence Ong, Nai Ming Lai, Sophia Rasheeqa Ismail, Shaun Wen Huey Lee, Dafna Merom, Puteri Sofia Nadira Megat Kamaruddin, Min San Chong, Terence Ong, Nai Ming Lai

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.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
The PRISMA flow diagram of the study identification process from screening to analysis
Fig. 2
Fig. 2
The risk-of-bias graph: proportions of studies with low, high, and unclear risks of bias in each domain
Fig. 3
Fig. 3
The risk-of-bias summary: the risk-of-bias judgement of each included study in each domain
Fig. 4
Fig. 4
The Forest plot for one of the major outcomes: MDS-UPDRS 3 subscale (motor examination, 1-108, higher score indicates a more severe disease)

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