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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