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Effectiveness of a dance-physiotherapy combined intervention in Parkinson’s disease: a randomized controlled pilot trial

Abstract

Background

Physical therapies have been recommended as crucial components in Parkinson’s disease (PD) rehabilitation.

Objective

The study aims to examine the effectiveness of a new dance-physiotherapy combined intervention, called DArT method, in mild PD patients.

Methods

A prospective, randomized, single-blind, controlled pilot trial was conducted on 38 mild PD patients under dopaminergic therapy. The intervention consisted in an add-on protocol: the control group received 1 h of conventional physiotherapy followed by 1 h of conventional physiotherapy each day, 3 times a week, for 5 weeks. The experimental group received 1 h of conventional physiotherapy followed by 1 h of dance class each day, 3 times a week, for 5 weeks. The week before and after the training period, patients were assessed for motor, cognitive, emotional, and sensory components of PD, with MDS-UPDRS-III as primary outcome measure.

Results

DArT method was associated with a 2.72-point reduction in the post-treatment MDS-UPDRS-III total score compared to control group (95% CI − 5.28, − 0.16, p = 0.038, d = 0.71), and with a 2.16-point reduction in the post-treatment MDS-UPDRS-III upper body subscore (95% CI − 3.56, − 0.76, p = 0.003, d = 1.02). Conversely, conventional physiotherapy program was associated with a 2.95-point reduction in the post-treatment trait anxiety compared to the experimental group (95% CI 0.19, 5.71, p = 0.037, d = 0.70). Withdrawal and fall rates were equal to 0% in both groups.

Conclusion

DArT method showed to be safe, well accepted, and more effective than an intensive program of conventional physiotherapy in improving motor impairment in mild PD.

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Fig. 1

Data Availability

The data that support the findings of this study are available on request from the corresponding author (Frisaldi Elisa).

Code availability (software application or custom code)

Not applicable.

References

  1. 1.

    Postuma RB, Berg D, Stern M, Poewe W, Olanow CW, Oertel W, Obeso J, Marek K, Litvan I, Lang AE, Halliday G, Goetz CG, Gasser T, Dubois B, Chan P, Bloem BR, Adler CH, Deuschl G (2015) MDS clinical diagnostic criteria for Parkinson’s disease. Mov Disord 30:1591–1601. https://doi.org/10.1002/mds.26424

    Article  PubMed  Google Scholar 

  2. 2.

    Abbruzzese G, Marchese R, Avanzino L, Pelosin E (2016) Rehabilitation for Parkinson’s disease: current outlook and future challenges. Parkinsonism Relat Disord 22:S60–S64. https://doi.org/10.1016/j.parkreldis.2015.09.005

    Article  PubMed  Google Scholar 

  3. 3.

    Sacheli MA, Murray DK, Vafai N, Cherkasova MV, Dinelle K, Shahinfard E, Neilson N, McKenzie J, Schulzer M, Appel-Cresswell S, McKeown MJ, Sossi V, Stoessl JA (2018) Habitual exercisers versus sedentary subjects with Parkinson’s disease: multimodal PET and fMRI study. Mov Disord 33:1945–1950. https://doi.org/10.1002/mds.27498

    Article  PubMed  Google Scholar 

  4. 4.

    Kwok JYY, Choi KC, Chan HYL (2016) Effects of mind–body exercises on the physiological and psychosocial well-being of individuals with Parkinson’s disease: a systematic review and meta-analysis. Complementary Ther Med 29:121–131. https://doi.org/10.1016/j.ctim.2016.09.016

    Article  Google Scholar 

  5. 5.

    Kalyani HHN, Sullivan K, Moyle G, Brauer S, Jeffrey ER, Roeder L, Berndt S, Kerr G (2019) Effects of dance on gait, cognition, and dual-tasking in Parkinson’s disease: a systematic review and meta-analysis. J Parkinsons Dis 9:335–349. https://doi.org/10.3233/JPD-181516

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    dos Santos Delabary M, Komeroski IG, Monteiro EP, Costa RR, Haas AN (2018) Effects of dance practice on functional mobility, motor symptoms and quality of life in people with Parkinson’s disease: a systematic review with meta-analysis. Aging Clin Exp Res 30:727–735. https://doi.org/10.1007/s40520-017-0836-2

    Article  PubMed  Google Scholar 

  7. 7.

    Martinez-Martin P, Chaudhuri KR (2018) Comprehensive grading of Parkinson’s disease using motor and non-motor assessments: addressing a key unmet need. Expert Rev Neurother 18:41–50. https://doi.org/10.1080/14737175.2018.1400383

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Biundo R, Weis L, Bostantjopoulou S, Stefanova E, Falup-Pecurariu C, Kramberger MG, Geurtsen GJ, Antonini A, Weintraub D, Aarsland D (2016) MMSE and MoCA in Parkinson’s disease and dementia with Lewy bodies: a multicenter 1-year follow-up study. J Neural Transm 123:431–438. https://doi.org/10.1007/s00702-016-1517-6

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Keus SHJ, Bloem BR, Hendriks EJM, Bredero-Cohen AB, Munneke M, Practice Recommendations Development Group (2007) Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research. Mov Disord 22:451–460. https://doi.org/10.1002/mds.21244

    Article  PubMed  Google Scholar 

  10. 10.

    Tomlinson CL, Herd CP, Clarke CE, Meek C, Patel S, Stowe R, Deane KHO, Shah L, Sackley CM, Wheatley K, Ives N (2014) Physiotherapy for Parkinson’s disease: a comparison of techniques. Cochrane Database Systematic Rev CD002815. https://doi.org/10.1002/14651858.CD002815.pub2

  11. 11.

    Keus S, Munneke M, Graziano M, Paltamaa J, Pelosin E, Domingos J, Brühlmann S, Ramaswamy B, Prins J, Struiksma C, Rochester L, Nieuwboer A, Bloem B (2014) European physiotherapy guideline for Parkinson’s disease. https://www.parkinsonnet.com/discipline/physiotherapy. Accessed 2 Mar 2021

  12. 12.

    Goetz CG, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stebbins GT, Stern MB, Tilley BC, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, Van Hilten JJ, LaPelle N (2007) Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan. Mov Disord 22:41–47. https://doi.org/10.1002/mds.21198

    Article  PubMed  Google Scholar 

  13. 13.

    Bouça-Machado R, Maetzler W, Ferreira JJ (2018) What is functional mobility applied to Parkinson’s disease? J Parkinsons Dis 8:121–130. https://doi.org/10.3233/JPD-171233

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Nieuwboer A, Rochester L, Herman T, Vandenberghe W, Emil GE, Thomaes T, Giladi N (2009) Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson’s disease and their carers. Gait Posture 30:459–463. https://doi.org/10.1016/j.gaitpost.2009.07.108

    Article  PubMed  Google Scholar 

  15. 15.

    Christofoletti G, Andrade LP, Beinotti F, Borges G (2014) Cognition and dual-task performance in older adults with Parkinson’s and Alzheimer’s disease. Int J Gen Med 7:383–388. https://doi.org/10.2147/IJGM.S65803

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Peto V, Jenkinson C, Fitzpatrick R, Greenhall R (1995) The development and validation of a short measure of functioning and well being for individuals with Parkinson’s disease. Qual Life Res 4:241–248. https://doi.org/10.1007/BF02260863

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Visser M, Leentjens AFG, Marinus J, Stiggelbout AM, van Hilten JJ (2006) Reliability and validity of the Beck Depression Inventory in patients with Parkinson’s disease. Mov Disord 21:668–672. https://doi.org/10.1002/mds.20792

    Article  PubMed  Google Scholar 

  18. 18.

    Mondolo F, Jahanshahi M, Granà A, Biasutti E, Cacciatori E, Di Benedetto P (2007) Evaluation of anxiety in Parkinson’s disease with some commonly used rating scales. Neurol Sci 28:270–275. https://doi.org/10.1007/s10072-007-0834-9

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Delbaere K, Close JCT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR (2010) The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing 39:210–216. https://doi.org/10.1093/ageing/afp225

    Article  PubMed  Google Scholar 

  20. 20.

    Chaudhuri KR, Rizos A, Trenkwalder C, Rascol O, Pal S, Martino D, Carroll C, Paviour D, Falup-Pecurariu C, Kessel B, Silverdale M, Todorova A, Sauerbier A, Odin P, Antonini A, Martinez-Martin P, EUROPAR and the IPMDS Non Motor PD Study Group (2015) King’s Parkinson’s disease pain scale, the first scale for pain in PD: an international validation. Mov Disord 30:1623–1631. https://doi.org/10.1002/mds.26270

    Article  PubMed  Google Scholar 

  21. 21.

    Nilsson MH, Bladh S, Hagell P (2013) Fatigue in Parkinson’s disease: measurement properties of a generic and a condition-specific rating scale. J Pain Symptom Manag 46:737–746. https://doi.org/10.1016/j.jpainsymman.2012.11.004

    Article  Google Scholar 

  22. 22.

    Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE (2010) Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 25:2649–2653. https://doi.org/10.1002/mds.23429

    Article  PubMed  Google Scholar 

  23. 23.

    Horváth K, Aschermann Z, Ács P, Deli G, Janszky J, Komoly S, Balázs E, Takács K, Karádi K, Kovács N (2015) Minimal clinically important difference on the motor examination part of MDS-UPDRS. Parkinsonism Relat Disord 21:1421–1426. https://doi.org/10.1016/j.parkreldis.2015.10.006

    Article  PubMed  Google Scholar 

  24. 24.

    Steffen T, Seney M (2008) Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in people with parkinsonism. Phys Ther 88:733–746. https://doi.org/10.2522/ptj.20070214

    Article  PubMed  Google Scholar 

  25. 25.

    Hulzinga F, Nieuwboer A, Dijkstra BW, Mancini M, Strouwen C, Bloem BR, Ginis P (2020) The New Freezing of Gait Questionnaire: unsuitable as an outcome in clinical trials? Mov Disord Clin Pract 7:199–205. https://doi.org/10.1002/mdc3.12893

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Godi M, Franchignoni F, Caligari M, Giordano A, Turcato AM, Nardone A (2013) Comparison of reliability, validity, and responsiveness of the Mini-BESTest and Berg Balance Scale in patients with balance disorders. Phys Ther 93:158–167. https://doi.org/10.2522/ptj.20120171

    Article  PubMed  Google Scholar 

  27. 27.

    Huang SL, Hsieh CL, Wu RM, Tai CH, Lin CH, Lu WS (2011) Minimal detectable change of the Timed “Up & Go” Test and the Dynamic Gait Index in people with Parkinson disease. Phys Ther 91:114–121. https://doi.org/10.2522/ptj.20090126

    Article  PubMed  Google Scholar 

  28. 28.

    Huang LS, Hsieh CL, Wu RM, Lu WS (2017) Test-retest reliability and minimal detectable change of the Beck Depression Inventory and the Taiwan Geriatric Depression Scale in patients with Parkinson’s disease. PLoS One 12:e0184823. https://doi.org/10.1371/journal.pone.0184823

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Jonasson SB, Nilsson MH, Lexell J (2014) Psychometric properties of four fear of falling rating scales in people with Parkinson’s disease. BMC Geriatr 14:66. https://doi.org/10.1186/1471-2318-14-66

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Horváth K, Aschermann Z, Kovács M, Makkos A, Harmat M, Janszky J, Komoly S, Karádi K, Kovács N (2017) Changes in quality of life in Parkinson’s disease: how large must they be to be relevant? Neuroepidemiology 48:1–8. https://doi.org/10.1159/000455863

    Article  PubMed  Google Scholar 

  31. 31.

    Siciliano M, Chiorri C, De Micco R, Russo A, Tedeschi G, Trojano L, Tessitore A (2019) Fatigue in Parkinson’s disease: Italian validation of the Parkinson Fatigue T Scale and the Fatigue Severity Scale using a Rasch analysis approach. Parkinsonism Relat Disord 65:105–110. https://doi.org/10.1016/j.parkreldis.2019.05.028

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Berardelli A, Rothwell JC, Thompson PD, Hallett M (2001) Pathophysiology of bradykinesia in Parkinson’s disease. Brain 124:2131–2146. https://doi.org/10.1093/brain/124.11.2131

    CAS  Article  PubMed  Google Scholar 

  33. 33.

    Benedetti F, Carlino E, Frisaldi E, Piedimonte A, Zibetti M, Lanotte M, Lopiano L (2020) Placebo and nocebo responses in Parkinson’s disease. In: Martin CR, Preedy VR (eds) The neuroscience of Parkinson’s disease. Elsevier, San Diego ISBN-13: 9780128159583

    Google Scholar 

  34. 34.

    Frisaldi E, Carlino E, Zibetti M, Barbiani D, Dematteis F, Lanotte M, Lopiano L, Benedetti F (2017) The placebo effect on bradykinesia in Parkinson’s disease with and without prior drug conditioning. Mov Disord 32:1474–1478. https://doi.org/10.1002/mds.27142

    Article  PubMed  Google Scholar 

  35. 35.

    Dietrich A, McDaniel WF (2004) Endocannabinoids and exercise. Br J Sports Med 38:536–541. https://doi.org/10.1136/bjsm.2004.011718

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Nombela C, Hughes LE, Owen AM, Grahn JA (2013) Into the groove: can rhythm influence Parkinson’s disease? Neurosci Biobehav Rev 37:2564–2570. https://doi.org/10.1016/j.neubiorev.2013.08.003

    Article  PubMed  Google Scholar 

  37. 37.

    De Bartolo D, Morone G, Giordani G, Antonucci G, Russo V, Fusco A, Marinozzi F, Bini F, Spitoni GF, Paolucci S, Iosa M (2020) Effect of different music genres on gait patterns in Parkinson’s disease. Neurol Sci 41:575–582. https://doi.org/10.1007/s10072-019-04127-4

    Article  PubMed  Google Scholar 

  38. 38.

    Heiberger L, Maurer C, Amtage F, Mendez-Balbuena I, Schulte-Mönting J, Hepp-Reymond MC, Kristeva R (2011) Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson’s disease. Front Aging Neurosci 3:14. https://doi.org/10.3389/fnagi.2011.00014

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Carlino E, Piedimonte A, Frisaldi E (2014) The effects of placebos and nocebos on physical performance. Handb Exp Pharmacol 225:149–157. https://doi.org/10.1007/978-3-662-44519-8_9

    Article  PubMed  Google Scholar 

  40. 40.

    Galili DF (2015) Gaga: moving beyond technique with Ohad Naharin in the twenty-first century. Dance Chron 38:360–392. https://doi.org/10.1080/01472526.2015.1085759

    Article  Google Scholar 

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Acknowledgements

We would like to acknowledge the Direction, health workers, and staff of the San Camillo Hospital (Turin, Italy) for the expertise, administrative and technical supports, gyms, and equipment made available for the whole study period; all patients for their time, enthusiasm, and commitment to this research; Jan Vollert, from the Imperial College of London, for his assistance in statistical analysis; and Vanessa Maher, Honorary Professor in Cultural Anthropology at the University of Verona and native-English speaker, for valuable editing the description of DArT method.

Funding

This study was supported by grants from Innovative Clinical Trainings, Trials & Healthcare Worldwide Initiative (Italy/Switzerland, grant number KCL-001) to Fabrizio Benedetti; the Ministry of Education, University and Research (MIUR) under the program “Dipartimenti di Eccellenza ex L. 232/2016” to the Department of Surgical Sciences of the University of Turin; and the Opera San Camillo Foundation, Milan, Italy.

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Authors

Contributions

Design: Benedetti, Frisaldi, Lopiano, Zibetti, Massazza, Milano, Bottino, Trucco. Execution and data collection: Frisaldi (dance classes), Bottino (recruitments, reading and signing of the informed consent, reference doctor for the enrolled patients), De Ceglia (second hours of physiotherapy classes), Esposito (first hours of physiotherapy classes), Fabbri (recruitment and first assessor), Zibetti (recruitment and second assessor), Barbiani (first assessor), Camerone (first assessor), Costa (first assessor), Destefanis (recruitment). Statistical analysis: Frisaldi. Manuscript: Frisaldi (first draft); Frisaldi, Trucco, De Ceglia (supplementary material); all co-authors (review and critique).

Corresponding author

Correspondence to Elisa Frisaldi.

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Ethics approval

The study was approved by the local Ethics Committee (CS2/472) and conducted in agreement with the Declaration of Helsinki Ethical Principles.

Consent to participate

All subjects provided written informed consent.

Consent for publication

Not applicable.

Conflict of interest

The authors declare that they have no conflict of interest.

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Frisaldi, E., Bottino, P., Fabbri, M. et al. Effectiveness of a dance-physiotherapy combined intervention in Parkinson’s disease: a randomized controlled pilot trial. Neurol Sci (2021). https://doi.org/10.1007/s10072-021-05171-9

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Keywords

  • Parkinson’s disease
  • Rehabilitation
  • Physiotherapy
  • Dance
  • Motor impairment
  • Mind-body