Physical therapies have been recommended as crucial components in Parkinson’s disease (PD) rehabilitation.
The study aims to examine the effectiveness of a new dance-physiotherapy combined intervention, called DArT method, in mild PD patients.
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.
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.
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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The data that support the findings of this study are available on request from the corresponding author (Frisaldi Elisa).
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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Dietrich A, McDaniel WF (2004) Endocannabinoids and exercise. Br J Sports Med 38:536–541. https://doi.org/10.1136/bjsm.2004.011718
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
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
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
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
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
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.
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.
The study was approved by the local Ethics Committee (CS2/472) and conducted in agreement with the Declaration of Helsinki Ethical Principles.
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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
- Parkinson’s disease
- Motor impairment