Effect of dancing on freezing of gait in patients with Parkinson's disease: A systematic review and meta-analysis

BACKGROUND: Freezing of gait (FOG) is one of the major debilitating motor symptoms that affect Parkinson's disease (PD) patients' gait, OBJECTIVE: To investigate the effect of dancing on FOG, motor symptoms, and balance in patients with Parkinsonism. METHODS: Eight databases were searched for full-text English randomized control trials (RCTs). The freezing of gait (FOG) was the primary outcome while the balance and Unified Parkinson Disease Rating Scale (UPDRS-3) were the secondary outcomes. Methodological quality was evaluated by the Physiotherapy Evidence Database (PEDro) scale. Level of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Arandom-effect model of meta-analysis was used to calculate the standardized mean difference (SMD) at a 95% confidence interval (CI), and the effect size. RESULTS: A total of nine studies (263 patients) were included. Qualitative data related to participants, dancing type, measured outcomes, and follow-up were extracted. PEDro scale showed one fair-quality and eight high-quality studies. GRADE showed a low to very low level of evidence with moderate effect size on both UPDRS (SMD -70 [-1.04, -0.36]) and Balance (SMD 0.35 [0.08, 0.63]). CONCLUSION: Dance is an effective modality on improving UPDRS and balance with small effect on FOG. Further high-quality studies with high-quality of evidence are recommended to increase the confidence to the effect estimate and support the finding results.