What is the safety and feasibility of online therapeutic dancing for people with Parkinson's disease?

This is a tele-medicine project where people with mild-Parkinson’s disease (Hoehn & Yahr stages 0-2.5) will participate in a four-week pilot of twice weekly one-hour dancing, dance steps and routines, exercises and physical activities at home, using the internet and led by a trained dance teacher. They will at first connect in real-time via a video communications platform. The Dance Instructor Manual, Video-conferencing Guide, Assessor Manual and Participant Workbook were designed specifically for this study. Dance Instructor training & preparation: The Dance Instructors will commence weekly training with the Project Manager for 6 weeks prior to the intervention. The meetings will consist of education, planning and safety monitoring meetings with the Project Manager and provision of a Dance Instructor Manual and Video-conferencing Guide. As preparation they will each complete choreography templates and three videos each for the class phases (warm-up, active phase, cool-down). Choreography from the templates will be included in the manual. The videos will be preparation for the intervention delivery. A test-run class will be conducted with each dance instructor prior to study commencement. The templates and videos will be stored on a secure university research drive, accessed only by the Project Manager and Lead Investigator, and will not be provided to, or used by, the participants. Each participant will be assigned to one dance instructor for the four weeks. They will be participating in one-to-one “live” online classes twice per week for four consecutive weeks on days and times that are mutually agreeable. Weekly meetings will continue throughout the intervention period. Class content: Each class will include a warm-up phase (five minutes), an active dance plus exercise phase (30 minutes incorporating rest/drink breaks) and a cool down phase (five minutes). There will be a mixture of dance genres (Tango, Irish, Tap, Salsa, Creative, Waltz and other genres at the discretion of the dance teacher) and rhythmical music types, matched and personalised to the individual preferences of participants.The classes will emphasize movement control, coordination, strength, flexibility, balance, mobility and reduction in disability. The exercise intensity will be moderate and assessed by, for example, Borg RPE or subjectively by the Instructor and the post-class response. Participants will be advised to do the classes at the mid-phase of their levodopa medication cycle where applicable. Participants receiving deep brain stimulation may not have a mid-cycle. Adherence will be measured by a session attendance checklist completed by the Dance Instructor, electronic surveys after each class and weekly documented phone calls from the project manager. Information resources: There will be a Dance Instructor Manual as a resource for the Dance Instructors and it will contain information about Parkinson’s disease, therapeutic dancing, safety, risk management, use of digital platforms and examples of choreography.An accompanying Participant Workbook will give advice for key elements on which to focus e.g. “Focus on your feet; focus on the fast tapping of your fingers; focus on your breathing; focus on your balance and hold the chair…” as well as how to safely structure the home environment and how to check safety of furniture and equipment.There will be a participant guide to using videoconferencing. There will be an Assessor Manual for the pre- and post-intervention testing. There will be a Fidelity Checklist to evaluate that the intervention is delivered as planned. Qualitative study: Participant experience will be explored with individual in-depth interviews via video conferencing within two weeks of the end of the intervention. There will be one interview per participant and interviews will be conducted by an experienced Qualitative researcher. The interview schedule will use prompts for participant opinions of the dance classes, what aspects were enjoyable or not enjoyable, experience of the online delivery, any environmental or safety problems and any suggestions for changes to the format or presentation. Each interview will take approximately 45 minutes and will be audio-recorded for independent verbatim transcription. Data will be thematically analysed within a phenomenological framework by two independent researchers. Consensus meetings will be used to identify the main themes. These themes will be supported by quotations from the participant data.