Dance/Dance Therapy

Dance/Dance Therapy

PEP Topic 
Fatigue
Description 

Dance or movement therapy is rhythmic body movement. Its use in therapy promotes spontaneous movement expression that can allow people to enact thoughts and feelings and reduce tension. Dance/movement therapy is the psychotherapeutic use of movement as a process that furthers the physical and psychological integration of individuals with cancer. Dance and movement therapy have been studied for their effects on anxiety, depression, and fatigue in patients with cancer.

Effectiveness Not Established

Systematic Review/Meta-Analysis

Bradt, J., Goodill, S. W., & Dileo, C. (2011). Dance/movement therapy for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, CD007103.

doi:10.1002/14651858.CD007103.pub2
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Purpose:

To compare the effects of dance/movement therapy to standard care and other interventions for patients with cancer.  

Search Strategy:

Databases searched were Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index, CANCERLIT, International Bibliography of Theatre and Dance, ProQuest Digital Dissertations, ClinicalTrials.gov, and Current Controlled Trials National Research Register.

An extensive listing of specific search keywords per database was provided.

Studies were included in the review if they were

  • Randomized, controlled trials
  • Quasiexperimental designs
  • Studies comparing dance/movement therapy to usual care or usual care and another intervention.

The exclusion criteria were not specified.

Literature Evaluated:

In total, 15 references were retrieved.

Criteria for quality evaluation from the Cochrane Handbook for Systematic Reviews was applied.  Studies were deemed to be of very low quality.

Sample Characteristics:

  • Two studies were included in the final review.
  • In total, 68 patients with breast cancer were included.

Results:

One study examined the effect of movement therapy on fatigue.  Analysis showed a stardardized mean difference (SMD) of 0.89 (95% confidence interval [CI] [0.14, 1.63]).  No strong positive findings were found for body image in patients with breast cancer in mood or distress. One study showed a moderate significant effect on quality of life (SMD = 0.89; 95% CI [0.21, 1.57]).

Conclusions:

Findings suggested that dance therapy may be beneficial in women with breast cancer to improve fatigue and quality of life.  However, the quality of the evidence was very low, and only two small studies were found.

Limitations:

  • The studies were of low quality.
  • Only two studies were included.

Nursing Implications:

Exercise has been shown to be effective in reducing fatigue in several types of patients with cancer.  Dance/movement therapy can be seen as another type of exercise that can be beneficial.

Bradt, J., Shim, M., & Goodill, S.W. (2015). Dance/movement therapy for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, 2015(1). 

doi: 10.1002/14651858.CD007103.pub3
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Purpose:

STUDY PURPOSE: To update a previous review examining the effects of dance therapy on psychological outcomes in patients with cancer
 
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy:

DATABASES USED: Cochrane Collaboration, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, International Bibliography of theater and dance, Proquest Dissertations, and ClinicalTrials.gov
 
KEYWORDS: Detailed search terms per database are provided
 
INCLUSION CRITERIA: Any study in which dance or movement therapy was compared to standard care alone or standard care combined with other therapies
 
EXCLUSION CRITERIA: Interventions provided by an individual other than a formally trained dance or movement therapist or trainee in a formal dance or movement therapy program

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: 708 in update (770 in initial review)
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Authors evaluated risk of bias and applied the Grades of Recommendation, Assessment, Development, and Evaluation Scale (GRADES) for levels of evidence

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED = 3 (2 studies included in meta-analysis)
  • TOTAL PATIENTS INCLUDED IN REVIEW = 207
  • SAMPLE RANGE ACROSS STUDIES: 31–139 patients
  • KEY SAMPLE CHARACTERISTICS: One study conducted in Hong Kong

Results:

Two studies examined effects on depression. These were rated as having a very low quality of evidence using the GRADES system. The pooled effect of two studies showed no effect for depression. Two studies that reported anxiety showed no statistically significant effect on anxiety. Pooled results from two studies showed no support for an effect on fatigue. One study showed greater vigor with dance compared to standard care (SMD = 1.44, p = 0.0004). One study showed no significant effect for pain.

Conclusions:

No conclusions could be drawn regarding effect of dance or movement therapy.

Limitations:

The quality of the evidence was very low, and two of the three trials showed a moderate risk of bias rating.

Nursing Implications:

The findings of research regarding the effects of dance or movement therapy are inconclusive because of the few available studies of low quality. Additional, well-designed research to determine any potential benefits of dance versus other types of exercise and movement therapy is needed. The impact of movement as a creative art therapy is uncertain.

Research Evidence Summaries

Ho, R.T., Fong, T.C., Cheung, I.K., Yip, P.S., & Luk, M.Y. (2016). Effects of a short-term dance movement therapy program on symptoms and stress in patients with breast cancer undergoing radiotherapy: A randomized, controlled, single-blind trial. Journal of Pain and Symptom Management, 51, 824–831. 

doi: 10.1016/j.jpainsymman.2015.12.332
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Study Purpose:

To investigate the effectiveness of dance movement therapy on treatment-related symptoms

Intervention Characteristics/Basic Study Process:

The program consisted of six 1.5-hour sessions of dance movement therapy twice weekly for three weeks during radiotherapy. Therapy involved use of stretching, movement to exercise upper extremities, improvisational dance, and expressive movement. Participants were encouraged to share experience and communicate and to relate movement to personal experiences of breast cancer and treatment. Patients were randomized to the intervention or a wait-list control group.

Sample Characteristics:

  • N = 139 (ITT analysis), 127 with complete data   
  • MEAN AGE = 49 years
  • FEMALES: 100%
  • CURRENT TREATMENT: Combination radiation and chemotherapy
  • KEY DISEASE CHARACTERISTICS: All had breast cancer, and about 80% were also receiving chemotherapy
  • OTHER KEY SAMPLE CHARACTERISTICS: Over half were married, and 65% had education at secondary level or below.

Setting:

  • SITE: Single site   
  • SETTING TYPE: Outpatient    
  • LOCATION: Hong Kong

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment

Study Design:

  • Single-blind randomized controlled trial

Measurement Instruments/Methods:

  • Perceived Stress Scale (PSS)
  • Brief Pain Inventory (BPI)
  • Brief Fatigue Inventory (BFI)
  • Hospital Anxiety and Depression Scale (HADS)

Results:

All patients showed decline in fatigue scores over time with no difference between groups. Sleep disturbance declined in the study group and increased slightly in the control group, but differences were not significant. Anxiety and depression remained stable in both groups. Pain severity and pain interference declined in the dance group and increase in the control group (p < 0.05). The size of effect for pain was moderate (d = 0.35). Perceived stress declined in the dance group compared to controls (p < 0.05). The program had a high completion rate.

Conclusions:

Participation in this group dance movement therapy was associated with decline in pain severity and interference.

Limitations:

  • Risk of bias (no appropriate attentional control condition)
  • There is no description of the type of pain, use of any pain medications, or other interventions in either group. The group interaction may have had as much to do with any reduction in symptoms as the actual dance activities.

Nursing Implications:

The dance movement therapy program used here combined rhythmic and expressive movement with group sharing and support. The contribution of each of these components cannot be differentiated, but results showed positive benefits in terms of pain and perceived stress. There were a number of study limitations; however, the program completion rate was high, and there were no adverse effects, suggesting that this type of intervention can be practical to provide during active radiotherapy treatment.

Sturm, I., Baak, J., Storek, B., Traore, A., & Thuss-Patience, P. (2014). Effect of dance on cancer-related fatigue and quality of life. Supportive Care in Cancer, 22, 2241–2249. 

doi: 10.1007/s00520-014-2181-8
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Study Purpose:

To evaluate the effect of dance on relieving fatigue in patients with cancer undergoing active cancer treatment

Intervention Characteristics/Basic Study Process:

This study consisted of two groups, one with supportive consultation, fatigue counseling, nutrition counseling, psychooncology, and 10 60-minute dance classes for five weeks, and the other with everything except the dance class.

Sample Characteristics:

  • N = 40  
  • AGE RANGE = 26–71 years
  • MALES: 3 (7%), FEMALES: 37 (93%)
  • KEY DISEASE CHARACTERISTICS: Breast, ovarian, gastrointestinal, and other cancers; patients receiving chemotherapy, radiation, and hormonal therapy in the adjuvant, neoadjuvant, and palliative care settings

Setting:

  • SITE: Single-site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Berlin

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment

Study Design:

Nonrandomized intervention

Measurement Instruments/Methods:

  • Fatigue Visual Analog Scale (VAS)
  • European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30)
  • 6-Minute Walk Test (6MWT)
  • Functional Assessment of Chronic Illness Therapy (FACIT)
  • Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F)

Results:

Fatigue was measured at baseline and at the end of the study for both groups. There was significant reduction in fatigue in the dance group while fatigue essentially was unchanged in the control group. The study also demonstrated improved scores on the social and emotional functioning scales and in physical performance in the dance group.

Conclusions:

Dance could be an appropriate, multidimensional approach for the treatment of cancer-related fatigue.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no random assignment)
  • Key sample group differences that could influence results

 

Nursing Implications:

To encourage exercise or movement, this study offers a less monotonous approach compared to conventional fitness programs addressing cancer-related fatigue. Replication and a randomized study is needed to establish effectiveness.

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