Group singing improves quality of life for people with Parkinson's: an international study

An Ethnographic Study of Patient Life Experience in Early-Stage Parkinson's Disease in the United States and Germany

INTRODUCTION

Existing qualitative research on early-stage Parkinson's disease draws on patients' reported disease experience, aiming to capture the symptoms and impacts most relevant to patients living with the disease. As a complement to this research, the present study investigated the patient experience of early-stage Parkinson's disease from a holistic, ethnographic perspective. We explored the attitudes, beliefs, and social structures that shape how people understand and adapt to life with early-stage Parkinson's disease.

METHODS

Researchers interviewed 30 people with early-stage Parkinson's disease, 10 relatives, and 10 neurologists and movement disorder specialists in the USA and Germany. Many of these interviews took place in-person, allowing researchers to spend time in participants' homes and witness their daily lives. A multidisciplinary team of social scientists, clinical researchers, and patient organization representatives led the mixed-methods study design and analysis. In-depth ethnographic interviews yielded qualitative insights, with a quantitative survey following to assess their prevalence in a larger sample of 150 patients.

RESULTS

In addition to developing a patient life experience pathway of early-stage Parkinson's disease, we identified five key thematic findings that provide insight into how the clinical features of the disease become meaningful to patients on the context of their daily lives, family relations, and subjective well-being: (1) People with early-stage Parkinson's disease start coming to terms with their disease before receiving a medical diagnosis; (2) Acceptance is not a finalized achievement, but a cyclical process; (3) People with early-stage Parkinson's disease "live in the moment" to make the future more manageable; (4) Slowing disease progression is an important goal driving the actions of people with early-stage Parkinson's; and (5) People with early-stage Parkinson's disease value information that is grounded in lived experience and relevant to their stage of disease progression.

CONCLUSION

This holistic, ethnographic approach to patient life experience provided five key thematic findings that complement insights from qualitative and quantitative datasets on early-stage Parkinson's disease. An enhanced understanding of how early-stage Parkinson's symptoms impact patients' health-related quality of life and their broader social lives can help us better understand how patients make decisions about their usage of healthcare services and therapies.

If Art Were a Drug: Implications for Parkinson's Disease

Parkinson's disease (PD) is a chronic and complex neurodegenerative disorder. Conventional pharmacological or surgical therapies alone are often insufficient at adequately alleviating disability. Moreover, there is an increasing shift toward person-centered care, emphasizing the concept of "living well". In this context, arts-based interventions offer great promise, functioning as platforms for creative expression that could provide novel mechanisms to promote quality of life. Here we present a qualitative review of arts-based interventions for PD, including music, dance, drama, visual arts, and creative writing. For each, we discuss their applications to PD, proposed mechanisms, evidence from prior studies, and upcoming research. We also provide examples of community-based projects. Studies to date have had relatively small sample sizes, but their findings suggest that arts-based interventions have the potential to reduce motor and non-motor symptoms. They may also empower people with PD and thereby address issues of self-esteem, foster personal problem-solving, and augment holistic well-being. However, there is a paucity of research determining optimal dosage and symptom-specific benefits of these therapies. If art were a drug, we would have to perform appropriately powered studies to provide these data before incorporating it into routine patient care. We therefore call for further research with properly designed studies to offer more rigorous and evidence-based support for what we intuitively think is a highly promising approach to support individuals living with PD. Given the possible positive impact on people's lives, arts-based approaches merit further development and, if proven to be effective, systematic inclusion within integrated management plans.

"Out and proud…. in all your shaking glory" the wellbeing impact of a dance program with public dance performance for people with Parkinson's disease: a qualitative study

PURPOSE

To explore if and how Parkinson's disease dance class participation and public performance contributes to perceptions of wellbeing.

MATERIALS AND METHODS

A qualitative design using audio-recorded one-on-one semi-structured interviews with five class participants and three teachers/volunteers from two metropolitan Dance for Wellbeing class locations. Data were inductively thematically analysed by three researchers.

RESULTS

Five themes illustrated the experience of dance class and performance for people with Parkinson's Disease: 1) 'the enabling learning environment'; 2) 'physical benefits from class participation; 3) 'mental/psychological benefits from class participation'; 4) 'social benefits from class participation; 5) 'sense of self and life engagement from class participation'. Themes 4 and 5 in particular were considered to be 'magnified by public performance', providing an opportunity for solidarity within the group and a supportive avenue for "coming out" and living publicly with the PD diagnosis.

CONCLUSION

Dance performance magnifies health and wellbeing experiences of people with Parkinson's disease when part of an enabling, inclusive and emotionally and physically safe learning dance class environment. Elements of holistic benefits, as well as the fun and playful nature of the experience may be important elements to consider for motivation, recruitment and retention in this population.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals should consider the use of dance class as an art-based activity that has a holistic therapeutic benefit.Flexible and fun environments are constructive for dancers to sustain attendance and interest.Rehabilitation professionals can be cognisant of the impact of public dance performance as 'coming out' with Parkinson's Disease.

Cross-Cultural Differences in Stigma Associated with Parkinson's Disease: A Systematic Review

BACKGROUND

Stigma is an important social attitude affecting the quality of life (QoL) of people with Parkinson's disease (PwP, PD) as individuals within society.

OBJECTIVE

This systematic review aimed to 1) identify the factors associated with stigma in PD and 2) demonstrate culture-based diversity in the stigmatization of PwP. We also reported data from the Turkish PwP, which is an underrepresented population.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a literature search of the PubMed/Medline electronic database was performed covering the last 26 years. Articles on self-perceived stigma in PD with a sample size >  20 and quantitative results were included. Data were extracted by independent reviewers.

RESULTS

After screening 163 articles, 57 were eligible for review, most of which were from Europe or Asia. Only two studies have been conducted in South America. No study from Africa was found. Among the 61 factors associated with stigma, disease duration, sex, and age were most frequently studied. A comparison of the investigated factors across the world showed that, while the effect of motor impairment or treatment on stigma seems to be culture-free, the impact of sex, education, marriage, employment, cognitive impairment, and anxiety on stigma may depend on culture.

CONCLUSION

The majority of the world's PD population is underrepresented or unrepresented, and culture may influence the perception of stigma in PwP. More diverse data are urgently needed to understand and relieve the challenges of PwP within their society.

Moving online: Experiences and potential benefits of digital dance for older adults and people with Parkinson's disease

BACKGROUND

Dance provides a range of beneficial effects for older adults including individuals with age-related neurological conditions such as Parkinson's disease (PD). The COVID-19 pandemic accelerated the development of at-home dance programs delivered digitally through live and pre-recorded media, but little is known about how participants may engage with and benefit from these resources.

OBJECTIVE

This study explored experiences and potential benefits of digital dance participation among healthy older adults and people with PD.

METHODS

An online survey consisting of fixed-choice and open questions was designed in collaboration with dance program providers and distributed between June and November 2020.

RESULTS

Healthy older adults (N = 149) and people with PD (N = 178) participating in at-home dance programs reported frequent engagement and a range of benefits. People with PD reported greater levels of motor (e.g., ease of movement, balance) than non-motor (e.g., energy, confidence) outcomes, while healthy older adults reported similar numbers of motor and non-motor outcomes. Positive outcomes were associated with the use of movement imagery during dance in both groups, while singing was associated with benefits in people with PD and vocalising was associated with benefits in older adults. At-home dance resources were found to offer convenience and flexibility, but participants missed the interaction, support, and routine provided by in-person classes. The majority expressed a preference to continue with both digital and in-person participation in the future. Qualitative analysis of participants' comments further revealed that digital participation could help to maintain connection and well-being, as well as identifying further considerations for improving accessibility and facilitating digital engagement.

CONCLUSIONS

At-home dance appears to be accessible, engaging, and potentially beneficial for older adults and people with PD, although barriers to participation should be addressed. Digital resources will be increasingly important to enable cost-effective, large-scale provision of home-based therapeutic activities.

Participants' perspective on a COVID-19 online vocal group stimulation for people with Parkinson's disease

The COVID-19 related confinement and social distancing had negative consequences on the health of individuals living with Parkinson's Disease (PD). In collaboration with a non-profit organization, we developed and implemented a daily online vocal stimulation group named “Musculation de la Voix” (MdlV) in April 2020. To better understand the potential of MdlV to diversify existing services available to people with PD experiencing vocal symptoms, this study aimed to explore participants' experience and perception of MdlV in terms of participation, motivations, feelings, perceived changes, and appreciation. The 45 individuals who registered to the Summer 2020 Semester of MdlV were invited to complete an online ten-question survey. Responses to the four close-ended questions were analyzed using descriptive statistics while statements provided in response to the six open-ended questions were subjected to an inductive qualitative content analysis. Thirty seven participants completed the survey. Results revealed that the sample of respondents was mostly constituted of individuals who were engaged in this activity since its very beginning (62,2%), participated daily (59,5%), intended to keep participating in the activity (97,3%), and had never received speech-language therapy (SLT) services before (72,97%). The qualitative analysis yielded one theme relating to prior services: “Previous SLT services are variable and perceived as beneficial but with limitations,” and three themes pertaining to MdlV: “Seeking improvement and support as initial motivations to engage in MdlV,” “Unanticipated benefits and desired gains catalyzing motivation to participate in MdlV,” and “Perceived limitations of MdlV and persisting needs.” Our study participants' engagement and motivation toward MdlV as well as the benefits they perceived in relation to this activity suggest that an online vocal stimulation group may be a promising complement to currently limited SLT services. As limitations and persisting needs were also identified, future studies are required to elucidate what aspect of MdlV works, for whom and how.

"It's Not the Same": A Comparison of the Psychological Needs Satisfied by Musical Group Activities in Face to Face and Virtual Modes

According to the social identity approach to health, group memberships influence people’s mental health to the extent that they identify with their group. Emerging evidence suggests that music groups, such as choirs, enhance mental health via group identification and the satisfaction of various psychological needs; however, more research is required to understand these processes in other types of music groups. Furthermore, the coronavirus disease 2019 (COVID-19) social distancing restrictions in 2020 prevented music groups from meeting face to face (F2F). Some music groups adapted virtually, but the rate of adaptation of various music activities is unknown, as is the impact of such adaptations on participants’ group identification, psychological need satisfaction, and mental health. We explored these questions using a cross-sectional survey with 257 participants (M_age = 46 years, 78% female) of singing (n = 172), instrumental (n = 48), and dance groups (n = 37). Participants rated group identification and psychological needs satisfaction retrospectively for their music group in F2F mode and then for the group in adapted mode, along with mental health 12-item short form health survey (SF-12). Results showed that instrumental groups (60%) were less commonly adapted to virtual mode than singing (83%) and dance (86%) groups. Group identification and average psychological needs satisfaction (M = 4.04 and 3.50 out of 5) scores were significantly lower for groups in virtual mode than in F2F mode (M = 4.53 and 4.14, respectively). Psychological needs satisfaction did not mediate the relationship between group identification and SF-12 mental health. Despite this, values on group identification and psychological need satisfaction remained high, which suggests that virtual music groups may be beneficial during the COVID-19 pandemic and in contexts where F2F groups are less accessible.

A systematic review of active group-based dance, singing, music therapy and theatrical interventions for quality of life, functional communication, speech, motor function and cognitive status in people with Parkinson's disease

BACKGROUND

Parkinson's disease (PD) is a common neurodegenerative condition associated with a wide range of motor and non-motor symptoms. There has been increasing interest in the potential benefit of performing arts as a therapeutic medium in PD. While there have been previous reviews, none have considered all performing arts modalities and most have focused on dance. This systematic review examined the potential benefit of all active group-based performing arts interventions for quality of life, functional communication, speech, motor function and cognitive status.

METHODS

Searches were conducted in February 2020 on five scholarly databases. Supplementary searches were conducted. Included studies were quantitative in design, and assessed the potential benefit of any active group-based performing arts intervention for quality of life, functional communication, speech, motor function or cognitive status in people with PD. Full text papers were eligible for inclusion, as were conference abstracts since January 2018. Screening, data extraction, narrative synthesis and quality assessment were conducted independently by two reviewers. Quality assessment used the SURE checklists.

RESULTS

Fifty-six studies were eligible for inclusion in this systematic review, reported in 67 publications. Published from 1989 to 2020, these studies included a total of 1531 people with PD from 12 countries, and covered four broad performing arts modalities: dance, singing, music therapy and theatre. Dance remains the most commonly studied performing arts modality for PD (38 studies), while there were 12 studies on singing interventions, four on music therapy, and only two on theatrical interventions. There was evidence for a beneficial effect of all four performing arts modalities on at least some outcome domains.

CONCLUSIONS

This is the first systematic review to assess the potential benefit of all active group-based performing arts interventions in PD. The evidence suggests that performing arts may be a useful therapeutic medium in PD. However, a substantial limitation of the evidence base is that no studies compared interventions from different performing arts modalities. Moreover, not all performing arts modalities were assessed for all outcome domains. Therefore it is not currently possible to determine which performing arts modalities are most beneficial for which specific outcomes.