Background Parkinson’s disease (PD) is a common age-related neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in performing arts interventions for PD, due to the limitations of pharmacological therapies. As no prior systematic review had addressed a wide range of artistic modalities, we systematically evaluated the potential benefit of all active group-based performing arts interventions in PD.
Methods In order to systematically evaluate the benefit of performing arts interventions in PD, searches on PsycINFO, AMED, CINAHL, EMBASE, and MEDLINE were performed in February 2020. Supplementary web searches and citation chasing were conducted. Included studies used any quantitative design to assess the benefit of any active group-based performing arts intervention on quality of life, functional communication, speech, motor function or cognitive status for people with diagnosed PD. Following standardised duplicate screening and data extraction, data synthesis was conducted using thematic narrative synthesis and random effects meta-analyses using Review Manager 5.3. Risk of bias was evaluated using SURE checklists (Cardiff University).
Results Searches identified 2669 records, of which 260 proceeded to initial full-text review following de-duplication, 129 to detailed full-text review and 67 to inclusion in the systematic review, representing 56 separate studies. Data from 10 separate studies were included in meta-analyses. Risk of bias assessment revealed limitations across many studies. Dance was the most studied artistic modality (39 studies), followed by singing (12 studies), music therapy (4 studies) and theatre (2 studies). Narrative synthesis showed evidence for a benefit of dance, music therapy and singing on quality of life; singing on speech; dance and music therapy on cognition; and dance, music therapy, singing and theatre on motor function. There was no evidence of benefit on functional communication. In meta-analyses, tango-based dance predicted superior UPDRS motor than usual care (Z=2.87, p=0.004) and superior timed-up-and-go than exercise (Z=3.77, p=0.0002), while PD-specific dance predicted superior PDQ-39 quality of life than usual care (Z=3.77, p=0.0002).
Conclusion Performing arts interventions may offer benefit in PD. However, it is difficult to assess which performing arts modalities may be most beneficial for which outcomes, due to a lack of studies directly comparing different performing arts interventions. Key limitations included small sample sizes, differences in comparator interventions, differences in intervention frequency and duration, as well as differing disciplinary backgrounds of session leaders. Further research is needed with greater methodological rigour before firm conclusions can be drawn.
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