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Table 1 Studies on the effects of tango dancing in patients with Parkinson’s disease

From: Argentine tango in Parkinson disease – a systematic review and meta-analysis

Authors [Study-ID]

Year

N

Study design

Intervention

Control Intervention

Time intervals

Tested Outcome Variables

Described effects

Romenets et al. [31]

2015

40 (33)

RCT

24 partnered tango classes (n = 18); 1 h twice a week for 12 weeks

Wait-list group: self-directed exercise (n = 15)

0, 12 weeks

Primary: MDS Unified

Primary:

• No significant difference in UPDRS-3 between groups (1.6 vs.1.2-point reduction, p = 0.85).

Secondary:

• No significant difference in Patient-rated clinical global impression of change (p = 0.33),

• Significant improvement in examiner rating in favour of tango (p = 0.02)

• Significant improvement on the Mini-BESTest in the tango group in comparisonto controls (0.7+/−2.2 vs. -2.7+/−5.9, p =0.032).

• Tango improved gait speed, in both simple (−1.3 ± 1.6 s vs. 0.1 ± 2.3, p = 0.042) and dual task score (0.4 ± 0.9 vs. -0.2 ± 0.4, p = 0.012), with borderline improvement in pivot turns (0.2 ± 0.5 vs. -0.1 ± 0.5, p = 0.066).

• Cognitive functioning (MoCA 0.4+/−1.6 vs. -0.6+/−1.5, p = 0.080) and fatigue severity scores (−3.6+/−10.5 vs. 2.5+/−6.2, p = 0.057) showed a trend towards improvement in AT.

• No significant differences for depression, apathy and disease-related quality of life (PDQ-39)

• Tango participants found the activity more enjoyable (p < 0.001) compared to controls and felt more “overall” treatment satisfaction (p < 0.001).

Parkinson’s Disease Rating Scale (UPDRS-3).

Secondary: Off fluctuations and dyskinesia (from the MDS-UPDRS), Mini–Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go (TUG) and Dual-task Timed up and Go, Falls questionnaire (Canadian Longitudinal Study of Aging), Freezing of gait (FOG) Questionnaire, Purdue Pegboard for assessment of upper extremity function; Montreal Cognitive Assessment (MoCA), Beck Depression Inventory (BDI), Apathy Scale (AS), Krupp Fatigue severity scale; Parkinson’s Disease Questionnaire (PDQ −39), Clinical Global Impression of Change (CGI-C), exit questionnaire (level of enjoyment and satisfaction with program)

Duncan & Earhart [32]

2012

62 (52); 26 in each group

RCT

Community-based AT dance class (1 h twice weekly for 12 months)

No intervention

0, 3, 6 and 12 months

Primary:

Primary:

Movement Disorders Society–Unified Parkinson Disease Rating Scale 3 (MDS-UPDRS-3)

• MDS-UPDRS-3: no significant change in the Control group within 12 months; AT group had a reduction of 28.7 % (12.8 points).

significant group by time interactions for balance, FOG, 6MWT, forward and dual task walking velocities and in upper extremity function in favour of the dance group.

Secondary:

MDS-UPDRS-1, MDS-UPDRS-2, MiniBESTest; FOG Questionaire; 6MWT; GAITRite: gait velocity for comfortable forward, fast as possible forward, dual task, and backward walking; and Nine-Hole Peg Test (9HPT)

Foster et al. [33]

2013

62 (52) 26 in each group

Single-bind RCT

Community-based tango dance program (1 h twice weekly for 12 months)

No intervention

0, 3, 6, and 12 months

Unified Parkinson’s Disease Rating Scale sections (MDS-UPDRS); Beck Depression Inventory; Activity Card Sort (ACS)

• Total Activity Retention: significant improvement in the AT group (77 % to 90 % (p = 0.006)), Control group remained stable (around 80 % (p = 0.60)).

• Significantly higher number of New Social activities in AT (p = 0.003), not in the Control group (p = 0.71)

• Total current participation: significant main effect of time for the tango group (F(3, 48) = 4.05, p = 0.01); not for the control group

Findings on physical function, mobility, and depression were not reported.

Duncan & Earhart [10]

2014

10; 5 in each group

RCT

Community-based AT dance class (1 h twice weekly for 24 months)

No prescribed exercise

0, 12, 24 months

Movement Disorder Society-Unified Parkinson Disease Rating Scale (MDS-UPDRS) I-III, Mini-Balance Evaluation Systems Test (Mini-BESTest), GAITRite: gait velocity (forward and backward), TUG and dual-task Timed Up and Go, 6MWT, and FOG Questionnaire

• MDS-UPDRS III: significant group-by-time interaction (F[2, 8] = 17.59; p < 0.0001) (better scores in the AT group at 12 and 24 months), scores for AT group better than controls at all three assessments

• Significant group-by-time interaction also for MDS-UPDRS II and I, Mini-BESTest, and 6MWT

• Significant interaction between group and time for the dual-task TUG (F [2, 8] = 3.7; p = 0.048)

• No interactions or main effects for the other assessed gait measures

Hackney et al. [34]

2007

19 PD + 19 healthy controls

RCT

20 tango classes (2× 1 h / week within 13 weeks) (n = 9 controls + 9 with PD)

Active control: 20 exercise classes (2× 1 h within 13 weeks) (n = 10 controls +10 with PD)

0, 13 weeks

Activities-specific Balance Confidence (ABC) Scale; Modified

• Functional reach: PD AT: pre 9.6 ± 2.3; post: 10.12 ± 3.6; Exercise PD group: pre 8.8 ± 2.6; post: 9.2 ± 3.8 One leg stance: PD AT: pre 9.9 ± 10.0; post: 10.3 ± 11.0; Exercise PD group: pre: 6.9 ± 11.3; post: 8.3 ± 4.4

• Walking Velocity: no significant changes

• AT PD group was more confident about balance compared to the Exercise PD group (independent t-test: p = 0.005)

• High enjoyment of intervention in both groups (social support, promotion of community involvement)

Falls Efficacy Scale; Philadelphia

Geriatric Center Morale Scale (Depression); Functional reach, One Leg Stance Test; Walking velocity

Hackney et al. [24]

2007

19, AT: 9; ES: 10

RCT

20 (21?) tango classes (1 h) within 13 weeks (2/week)

Active control: 20 exercise classes (1 h) within 13 weeks

0, 13 weeks

Unified Parkinson’s Disease Rating Scale (UPDRS); self-reported Freezing of gait; Berg Balance Scale (BBS), gait velocity, TUG, FOG questionaire

• UPDRS: significant improvements in both groups. No significant differences between groups; no group with time interaction

• BBS: Significant improvements in AT group (pre: 46.8 ± 1.0, post: 50.6 ± 1.0; P = 0.01; ES = 0.90); not in the exercise group (pre: 45.4 ± 0.9, post: 47.1 ± 0.9; P = 0.20; ES = 0.27). No significant main effect of group; No significant interaction of group with time

• FOG: no significant effects; trends toward a reduction in reported freezing in both groups (tango: ES = 0.24; exercise: ES = 0.30).

• TUG: no significant effects, but trend toward improvement in AT (ES = 0.37), but not in EG (ES = 0.02)

• Velocity of Walking and Dual-Task Walking: no significant results

Hackney et al. [36]

2009

14 (12)

Uncontrolled pre-post study

10 Argentine tango dance lessons (1.5 h) within 2 weeks

/

0, 2 weeks

BBS; Unified Parkinson’s Disease Rating Scale Motor Subscale 3 (UPDRS); gait velocity, functional ambulation profile, step length, stance and single support percent of gait, TUG, 6MWT; computerized GAITRite walkway; forward walking (FW) and three trials of backward walking (BW)

Significant improvement on:

• BBS (ES = 0.83, p = 0.021),

• Unified Parkinson Disease Rating Scale Motor Subscale III (ES = −0.64, p = 0.029), and

• percent of time spent in stance during forward walking (ES = 0.97, p = 0.015)

Non-significant improvements:

• TUG (ES = −0.38, n.s.)

• 6MWT (ES = 0.35, n.s.)

Hackney et al. [22]

2009

75 (61)

4 arm RCT

20 1 h lessons (twice weekly) of Tango (n = 17) or Waltz/Foxtrot (n = 17) or Tai Chi (n) = 13) within 13 weeks

No intervention (n = 17)

0, 13 weeks

Unified Parkinson’s Disease Rating Scale Motor Subscale 3 (UPDRS-III)), Parkinson Disease Questionnaire (PDQ 39)

Significant improvements in AT group at post-testing:

• Mobility: (p = 0.03),

• Social Support (p = 0.05) and

PDQ-39 SI (p < 0.01)

No significant changes in HRQoL were noted in the Tai Chi, Waltz/Foxtrot, or no Intervention group

Shorter duration group had better scores than longer duration group for Mobility, Communication, and PDQ-39

Hackney et al. [16]

2009

58 (48),

3 arm RCT

20 lessons of Tango (n = 14) or Waltz/Foxtrot (n = 17) (2×

1 h per week) \control (n = 17)

No intervention (n = 17)

0, 13 weeks

Unified Parkinson’s Disease Rating Scale Motor Subscale 3 (UPDRS);

• UPDRS: AT ES = 0.19 (n.s.); WF d = 0.22 (p = 0,089); C d = −0.48 (p = 0.002)

• BBS: AT ES = 0.92 (p = 0.001); WF d = 0.93 (p < 0.001); C d = −0.13 (n.s.)

• TUG: AT ES = 0.45 (n.s.); WF d = 0.03 (n.s.); C d = −0.24 (n.s.)

• 6 min walk test: AT ES = 0.63 (p < 0.001); WF d = 0.50 (p < 0.001); C d = −0.06 (n.s.)

• FOG: AT ES = 0.18 (n.s); WF d = 0.02 (n.s.); C d = −0.22 (n.s.)

Forward & backward walking:

• Forward single support time (s): AT ES = 0.21 (n.s.); WF d = 0.08 (n.s.); C d = −0.33 (p = 0.008)

• Backward stride length (m):

AT ES = 0.57 (p = 0.001); WF d = 0.47 (p = 0.018); C d = −0.16 (n.s.)

• Backward single support time (s):

AT ES = 0.41 (n.s.); WF d = 0.24 (n.s.); C d = −0.57 (p = 0.027)

BBS; TUG; 6MWT; FOG questionnaire, GAITRite walkway (tested forward and backward gait), exit questionnaire (experience and enjoyment)

Hackney et al. [23]

2010

39

RCT

20 lessons of partnered Tango (2× 1 h per week) within 10 weeks (n = 19 ➔ 12)

Non-partnered Tango (n = 20 ➔ 15)

0, 10 weeks, and 1 month follow up

Unified Parkinson’s Disease Rating Scale Motor Subscale 3 (UPDRS); BBS, tandem stance (TS), one leg stance (OLS), TUG, 6MWT; comfortable and fast-as-possible gait were assessed along a 5 m instrumented, computerized GAITRite walkway

Primary:

• BBS: significant improvement in both groups /Follow up BBS: pAT d = 0.38; npAT d = 0.22

Secondary:

Significant improvements in both groups in comfortable and fast-as possible walking velocity, tandem stance time, one leg stance, cadence and double support percent (post-testing)

AT group (non-partnered)

improved as much as the partnered AT group.

Partnered AT group expressed more interest in continuing and enjoyed the intervention more than the non-partnered AT group.

Exit questionnaire (program experience)

McKee & Hackney [15]

2013

33 (31)

N-RCT

20 community-based adapted tango lessons (1.5 h) over 12 weeks (n = 24)

Education lessons (1.5 h sessions) (n = 9)

0, 1 week after, and 10–12 weeks follow up

Unified Parkinson’s Disease Rating Scale motor subscale III (UPDRS-III); Beck Depression Inventory (BDI); Composite Physical Function Index (CPF); Montreal Cognitive Assessment (MoCA) and BBS, PD Questionnaire-39, FOG Questionnaire; Cognitive measures (MoCA, Reverse Corsi Blocks, Brooks Spatial Task), and other measures (i.e. SF12)

• Cognition:

- group by time interaction on the Brooks (tango improved, F (2,22) = 5.457, p =0.012) between pre and post (p = 0.017); no significant improvement in control group

-MoCa: main effect of time (F(2,62) = 4.75, p = 0.012)

• Disease severity and motor:

-UPDRS (follow up): Significant improvement for AT (d = 0.31), decrease for EC (d = 0.34) p < .05

-FAB: main effect of time (F(2,56) = 3.463, p = 0.038); significant improvement in the AT group (p = 0.004)

• Psychosocial:

No significant effects for SF-12 and PDQ-39 as well as FOG

Fullerton Advanced Balance Scale (FAB); Four-Square Step Test, Single-Dual Timed Up and Go, every day fall incidence outside of class

Secondary outcomes: adverse events, participant satisfaction

Hackney et al. [17]

2010

1

Case study (wheel chair user, age 86 years

20 lessons of partnered Tango (2× 1 h per week)

/

0, 10 weeks follow-up = 4 weeks after post-testing

BBS, 6MWT, and functional reach test. Parkinson Disease Questionnaire-39 UPDRS-III, blood pressure, resting heart rate, activities Balance Confidence Scale, exit questionnaire to assess program experience for the caregiver: Zarit Burden Interview (Short form)

• Improvements for: 6MWT, BBS and functional reach

• Improved reported balance confidence and quality of life (

Parkinson Disease Questionnaire-39 summary index)

• Gains maintained at follow-up

• Caregiver’s experienced burden increased with time (Zarit Burden Interview)

Kaski et al. [35]

2014

1, 79 years

Case study

transcranial direct current stimulation (tDCS) during tango dancing

2 ‘tango + tDCS’ and 2 ‘tango + sham’ in a randomised double-blind fashion

2 days assessment across the whole dances and before/ after each dance session

Trunk motion and balance. separate experimental session: the isolated effect of tDCS on gait without tango dancing

• Trunk peak velocity during tango: Significantly greater during tDCS compared to sham stimulation (p = 0.02 for pitch and p = 0.02 for roll)

• Significant improvement in TUG (p = 0.02) and 6 m walk (p = 0.01), overall gait velocity (n.s.) and peak pitch trunk velocity (n.s.) with tDCS compared to sham

The average sagittal (pitch) and coronal (roll) trunk peak-to-peak velocity was measured across the whole dance

Tinetti gait index questionnaire, 6MWT and TUG, gait velocity, and peak pitch trunk velocity