Chronic pain conditions are responsible for the loss of quality of life and the increments in health care costs [
Physical activity is a relevant therapy for the primary and secondary prevention of different chronic pain conditions [
The artistic and creative concept of dance may be close to the notion of “creative arts therapies”, which are interventions that use artistic media to approach the participant on a creative level and may have benefits in different populations [
There are numerous concretions of the social and cultural phenomenon of dance. Among those types of dance that fulfill with the previously mentioned concept of artistic and creative dance, we can mention the Dance Movement Therapy, Biodance, Aquatic Biodance, or Belly Dance. The American Dance Therapy Association (ADTA) defines Dance Movement Therapy as the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical integration of the participant. Biodance involves the movement accompanied by music, inducing experiences capable of modifying the organism at the physiological, affective, motor, and existential levels [
To the best of our knowledge, there is no systematic review of the literature on the effectiveness of dance-based programs in patients with fibromyalgia [
Therefore, the aim of this study was to systematically review the effectiveness of dance-based programs in patients with fibromyalgia, as well as calculate the overall effect size of the improvements through a meta-analysis.
The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) [
The Cochrane Library, Physiotherapy Evidence Database (PEDro), PubMed, TRIP, and Web of Science (WOS) were selected to identify articles included in this systematic review. The search was performed using the keywords “fibromyalgia” and “dance” together with the logical operator “AND”. Search engines were configured to only present clinical trials. Duplicate articles were manually excluded. Figure
Study flow diagram.
The articles were included if they met the following inclusion criteria: (a) the intervention program should be based on dance, (b) the target population were people with fibromyalgia, (c) the study was a randomized controlled trial (RCT), and (d) article was in English or Spanish. The following exclusion criteria were set: (a) the study was presented as a summary at a conference or seminar and (b) dance interventions involved only the repetitions of movements without a creative, emotional, or cultural components. This last criterion was previously used in a recent systematic review focused on the effectiveness of dance interventions to improve health in the elderly. That study defined dance as a form of artistic expression and excluded aerobic fitness classes taught to music, such as Zumba and step-aerobics [
To evaluate the risk of bias, the PEDro scale [
Risk of bias and level of evidence.
| External | Internal | Statistics | PEDro Score | Level of Evidence | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | ||
| |||||||||||||
| ✓ | ✓ | ✓ | ✓ | 3 | B | |||||||
| ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 8 | B | ||
| ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | B | |||||
| ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | B | |||||
| ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | B | |||||
| ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 8 | B | ||
| ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 7 | B |
✓: criteria fulfilled; 1: the election criteria were specified; 2: the subjects were randomly assigned to the groups (in a cross-over study, the subjects were randomly distributed as they received the treatments); 3: the assignment was hidden; 4: the groups were similar at the beginning in relation to the most important prognostic indicator; 5: all subjects were blinded; 6: all the therapists who administered the therapy were blinded; 7: all evaluators who measured at least one key result were blinded; 8: the measurements of at least one of the key results were obtained from more than 85% of the subjects initially assigned to the groups; 9: results were presented for all subjects who received treatment or were assigned to the control group, or when this could not be, the data for at least one key result were analyzed by “intention to treat”; 10: the results of statistical comparisons between groups were informed for at least one key result; 11: the study provides punctual and variability measures for at least one key outcome; score: each criterion met (except the first) adds 1 point; B: level of evidence from randomized studies but without double blindness,
The level of evidence was established using the guidelines from the Dutch Institute for Healthcare Improvement (CBO) [
Data extraction was performed by one of the authors (AMG) and then checked by another author (JCA). The following information was extracted: participants, intervention, comparisons, results, and study design (PICOS) following the steps of the PRISMA methodology. Table
Characteristics of the sample and the protocol.
Characteristics of the Sample | Protocol | |||
---|---|---|---|---|
| Size (N) | Age (SD) | Control Group Treatment | Dance Based Group Treatment |
| 36∗ | 57 (7.20) | None | Dance Movement Therapy |
| ||||
| 36∗ | 57 (7.20) | None | Dance Movement Therapy |
| ||||
| 59∗ | 54.2 (6.2) EG | None | Biodance |
| ||||
| 39∗ | 55.41 (7.46) | Stretching exercise program: global and specific stretches of different muscle areas. | Biodance in a pool with a water temperature of 29°C, preceded by a shower at 33-35°C. |
| ||||
| 31∗ | 54.5 (7.5) EG | Multidisciplinary program based on: Pool exercises. Activity in the exercise room. Psychological-Educational Therapy. | Biodance |
| ||||
| 75∗ | 49.5 EG | None | Belly Dance |
| ||||
| 59∗ | 55.45 (7.80) EG | Stretching exercise program: Slow and coordinated breathing stretches. | Biodance in a pool with a water temperature of 29°C, preceded by a shower at 33-35°C. |
Duration and activities of the intervention.
| Intervention duration (weeks) | Session duration (minutes) | Weekly frequency (days) | Total time (hours) | Activities included in session |
---|---|---|---|---|---|
| 24 | 60 | 1 | 24 | Exercises based on different themes: Body, space and group awareness. Expression and quality of movement. Movement about feelings, images and words. Differentiation of feelings and integration. Video interpretation. |
| |||||
| 24 | 60 | 1 | 24 | Exercises based on different themes: Body, space and group awareness. Expression and quality of movement. Movement about feelings, images and words. Differentiation of feelings and integration. |
| |||||
| 12 | 120 | 1 | 24 | 35-45 minutes, verbalization phase (information and experiences). 75-80 minutes, phase of dance movements according to the demands of the instructor and music, individually, in pairs and in groups. |
| |||||
| 12 | 60 | 2 | 24 | 10 minutes, warm-up and stretching. 40 minutes, biodance movements (walking or slow movements of limbs). 10 minutes, stretching. |
| |||||
| 16 | 120 | 1 | 32 | 35-45 minutes, verbalization phase (information and experiences). 75-80 minutes, phase of dance movements according to the demands of the instructor and music, individually, in pairs and in groups. |
| |||||
| 16 | 60 | 2 | 32 | Warm up exercises, movements of upper limbs, scapular area, trunk, hip, displacements (progression in difficulty). Exercises back to calm. CD at home to practice exercises. |
| |||||
| 12 | 60 | 2 | 24 | 10 minutes, flexibility and breathing. 40 minutes, basic movements of expression and creative dance including upper and lower members, according to music, expressing emotions generated by melodies, other people and interaction. All with cooperation between members. 10 minutes, relaxing exercises. |
Effects of dance interventions on pain.
| Instrument | Measurement range | Sample | Activity | CG | EG | P | Effect on CG | Effect on EG | Found Effect | Effect Size | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n CG | n EG | CG | EG | Mean Pre-T | SD | Mean Post-T | SD | Mean Pre-T | SD | Mean Post-T | SD | ||||||||
| VAS | 0-10 | 16 | 20 | None | DMT | NR | NR | NR | NR | NR | NR | NR | NR | D | ||||
| |||||||||||||||||||
| VAS | 0-10 | 16 | 20 | None | DMT | NR | NR | NR | NR | NR | NR | NR | NR | D | ||||
Global Assessment of Well-being and Pain | 0-5 | 16 | 20 | None | DMT | NR | NR | NR | NR | NR | NR | NR | NR | A | |||||
| |||||||||||||||||||
| Algometer EFFEGI, FPK 20, Italy) | 0-90 | 32 | 27 | None | Biodance | 50.3 | 1.77 | 47.29 | 1.91 | 48.38 | 1.94 | 53.39 | 2.08 | A | -3.01 | 5.01 | 8.02 | 4.33 |
Algometer EFFEGI, FPK 20, Italy) | 0-18 | 32 | 27 | None | Biodance | 16.16 | 0.38 | 16.38 | 0.46 | 16.77 | 0.42 | 15.32 | 0.5 | A | 0.22 | -1.45 | -1.67 | -4.18 | |
FIQ | 0-10 | 32 | 27 | None | Biodance | 7.3 | 0.3 | 8 | 0.3 | 6.9 | 0.4 | 6.1 | 0.3 | AB | 0.7 | -0.8 | -1.5 | -4.29 | |
| |||||||||||||||||||
| VAS | 0-10 | 20 | 19 | Stretch. | Aquatic Biodance | 8.3 | 0.73 | 7.95 | 1.19 | 7.16 | 2.34 | 5.42 | 2.19 | B | -0.35 | -1.74 | -1.39 | -0.22 |
Questionnaire McGill - Melzack | 0-78 | 20 | 19 | Stretch. | Aquatic Biodance | 39.7 | 8.31 | 35.25 | 4.88 | 39.58 | 3.3 | 28.68 | 6.69 | B | -4.45 | -10.9 | -6.45 | -0.22 | |
Algometer Wagner FPI 10 – USA | 20 | 19 | Stretch. | Aquatic Biodance | |||||||||||||||
FIQ | 0-10 | 20 | 19 | Stretch. | Aquatic Biodance | 7.07 | 1.8 | 6.69 | 1.75 | 7.2 | 1.68 | 5.33 | 2.12 | A | -0.38 | -1.87 | -1.49 | -0.28 | |
| |||||||||||||||||||
| Algometer (FPK 20; Effegi, Alfonsine, Italy) | 0-90 | 18 | 13 | Multid. | Biodance | 44.55 | 2.3 | 50.26 | 2.76 | 48.8 | 3.09 | 56.05 | 3.71 | D | 5.71 | 7.25 | 1.54 | 0.57 |
Algometer (FPK 20; Effegi, Alfonsine, Italy) | 0-18 | 18 | 13 | Multid. | Biodance | 17.02 | 0.43 | 15.83 | 0.82 | 16.36 | 0.58 | 13.8 | 1.1 | D | -1.19 | -2.56 | -1.37 | -2.75 | |
SF- 36 | 0-100 | 18 | 13 | Multid. | Biodance | 18.6 | 3 | 32.7 | 4.8 | 23.7 | 3.8 | 30 | 6.1 | D | 14.1 | 6.3 | -7.8 | -2.32 | |
FIQ | 0-10 | 18 | 13 | Multid. | Biodance | 7.9 | 0.4 | 6.3 | 0.4 | 8.2 | 0.6 | 6.4 | 0.5 | D | -1.6 | -1.8 | -0.2 | -0.40 | |
| |||||||||||||||||||
| VAS | 0-10 | 37 | 38 | None | Belly Dance | 7.5 | 1.3 | 7.3 | 1.7 | 7.7 | 1.7 | 4.7 | 2.6 | A | -0.2 | -3 | -2.8 | -1.84 |
SF-36 | 0-100 | 37 | 38 | None | Belly Dance | 25.7 | 13.4 | 29.1 | 21.1 | 29.6 | 17.5 | 46 | 19.2 | A | 3.4 | 16.4 | 13 | 0.83 | |
| |||||||||||||||||||
| VAS | 0-10 | 30 | 29 | Stretch. | Aquatic Biodance | 7.77 | 1.1 | 7.33 | 1.3 | 7.17 | 1.8 | 5.17 | 2.1 | AB | -0.44 | -2 | -1.56 | -0.27 |
Questionnaire McGill - Melzack | 0-78 | 30 | 29 | Stretch. | Aquatic Biodance | 39.43 | 8.2 | 37.2 | 6.2 | 39.28 | 3.3 | 29.97 | 6.7 | AB | -2.23 | -9.31 | -7.08 | -0.25 | |
Algometer Wagner FPI 10 – USA | 0-18 | 30 | 29 | Stretch. | Aquatic Biodance | 14.7 | 3.4 | 13.63 | 2.6 | 14.72 | 3.9 | 9.66 | 4.2 | AB | -1.07 | -5.06 | -3.99 | -0.36 | |
FIQ | 0-10 | 30 | 29 | Stretch. | Aquatic Biodance | 7.7 | 1.2 | 7.8 | 1.1 | 6.93 | 1.9 | 5.45 | 1.8 | AB | 0.1 | -1.48 | -1.58 | -0.27 |
EG: experimental group; CG: control group; n: sample size; SD: standard deviation T: test; P: P-value; VAS: visual analog scale; FIQ: fibromyalgia impact questionnaire; NR: not reported; N/A: not applicable; A: significant changes of experimental group versus control group; B: changes in experimental group; C: changes in group control; D: no significant changes; Multid.: multidisciplinary; Stretch.: stretching; DMT: Dance Movement Therapy.
Effects on other variables.
| Instrument | Measures | CG | EG | P. | Found Effect | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean Pre-T | SD | Mean Post-T | SD | Mean Pre-T | SD | Mean Post-T | SD | |||||
| Blood Samples | Dehydroepiandrosteronsulphate | NR | NR | NR | NR | NR | NR | NR | NR | D | |
Blood Samples | Cortisol | NR | NR | NR | NR | NR | NR | NR | NR | D | ||
Blood Samples | Prolactin | NR | NR | NR | NR | NR | NR | NR | NR | D | ||
Blood Samples | Neuropeptide Y | NR | NR | NR | NR | NR | NR | NR | NR | D | ||
Saliva Samples | Cortisol | NR | NR | NR | NR | NR | NR | NR | NR | D | ||
Montgomery Asberg | Depression | NR | NR | NR | NR | NR | NR | NR | NR | D | ||
Video-interpretation Rating Scale | Mobility | NR | NR | NR | NR | NR | NR | NR | NR | A | ||
Video-interpretation Rating Scale | Perception of Movement Pain | NR | NR | NR | NR | NR | NR | NR | NR | A | ||
Video-interpretation Rating Scale | Life Energy | NR | NR | NR | NR | NR | NR | NR | NR | A | ||
| ||||||||||||
| Self-Figure Drawing Procedure | Self-Image | ||||||||||
Amount of Body Details | 11.9 | 1.9 | 8.9 | 1.9 | 11.1 | 1.9 | 16.1 | 1.9 | A | 8 | ||
Amount of paper use in percent | 50 | 7.4 | 40 | 6.2 | 48.8 | 7.4 | 68.8 | 6.2 | A | 30 | ||
Amount of Kilo Bytes when scanning | 136.8 | 6.9 | 135.5 | 12.1 | 148.4 | 6.9 | 156 | 12.1 | D | 8.9 | ||
Amount of Colours | 3.5 | 0.6 | 3.3 | 0.6 | 3.3 | 0.6 | 3.8 | 0.6 | D | 0.7 | ||
Comprehensive Psychopathologic Rating Scale | Depression | NR | NR | NR | NR | NR | NR | NR | NR | D | ||
Sense of Coherence | Coping Capacity of Life-Stressors | NR | NR | NR | NR | NR | NR | NR | NR | D | ||
Swedish Universities Scale of Personality | Personality Profile | NR | NR | NR | NR | NR | NR | NR | NR | D | ||
Global Assessment of Well-Being and Pain | Well-Being | NR | NR | NR | NR | NR | NR | NR | NR | A | ||
| ||||||||||||
| Eight-Polar Tactile-Electrode Impedanciometer (InBody 720, Biospace) | Body Composition | ||||||||||
Weight in Kilograms | 68.5 | 2.1 | 68.8 | 2 | 68.1 | 2.2 | 67.5 | 2.2 | D | -0.9 | ||
Waist Circumference | 87.8 | 1.9 | 86.1 | 1.9 | 87.1 | 1.9 | 86.5 | 1.9 | D | 1.1 | ||
Body Mass Index | 28.2 | 0.9 | 28.3 | 0.9 | 27.5 | 0.9 | 27.4 | 0.9 | D | -0.2 | ||
Body Fat Percentage | 38.6 | 1.2 | 37.2 | 1.6 | 37.2 | 1.2 | 31.4 | 1.6 | AB | -4.4 | ||
Muscle Mass in Kilograms | 22.6 | 0.5 | 22.7 | 1.4 | 23.3 | 0.5 | 27.2 | 1.5 | A | 3.8 | ||
“30-Second Shair Stand” Test | Lower Body Muscular Strength | 7 | 0.5 | 8 | 0.5 | 8 | 0.5 | 10 | 0.5 | B | 1 | |
Digital Dynamometer | Upper Body Muscular Strength | 15.7 | 1 | 17.3 | 1 | 18.1 | 1 | 18.4 | 1.1 | D | -1.3 | |
“Chair Sit and Reach” Test | Lower Body Flexibility | -13.2 | 2.7 | -15.7 | 2.9 | -11 | 2.8 | -6.3 | 3 | D | 7.2 | |
“Back Scratch” Test | Upper Body Flexibility | -7.3 | 2.4 | -9.3 | 2.4 | -6.5 | 2.4 | -5.8 | 2.5 | D | 2.7 | |
“Blind Flamingo” Test | Static Balance | 10 | 1 | 11 | 1 | 10 | 1 | 9 | 1 | D | -2 | |
“8-Feet Up and Go” Test | Motor Agility | 8.3 | 0.3 | 7.8 | 0.3 | 7.6 | 0.3 | 6.8 | 0.3 | B | -0.3 | |
“6-Minute Walk” Test | Aerobic Endurance | 456.6 | 12.7 | 457 | 13.1 | 448.7 | 13.5 | 480.9 | 13.8 | A | 31.8 | |
FIQ | Impact of the Syndrome | 0 | ||||||||||
Physical Function | 4.3 | 0.3 | 4.8 | 0.4 | 4.4 | 0.4 | 3.6 | 0.4 | A | -1.3 | ||
Fell-good | 8.3 | 0.4 | 8.8 | 0.4 | 7.6 | 0.4 | 6.1 | 0.5 | AB | -2 | ||
Fatigue | 8.2 | 0.3 | 8.5 | 0.3 | 7.8 | 0.4 | 6.5 | 0.3 | AB | -1.6 | ||
Morning Tiredness | 8 | 0.3 | 8.11 | 0.4 | 8.4 | 0.3 | 6.4 | 0.4 | A | -2.11 | ||
Stiffness | 7.6 | 0.4 | 7.9 | 0.4 | 6.6 | 0.4 | 6 | 0.5 | B | -0.9 | ||
Anxiety | 7.4 | 0.4 | 7.9 | 0.4 | 6.2 | 0.5 | 5.2 | 0.5 | AB | -1.5 | ||
Depression | 6.1 | 0.5 | 7 | 0.5 | 5.7 | 0.6 | 4.9 | 0.6 | A | -1.7 | ||
Final Score | 70.1 | 2.1 | 74 | 2.8 | 66.9 | 2.9 | 56 | 3.1 | AB | -14.8 | ||
SF-36 | Health-related quality of Life | |||||||||||
Physical Functioning | 39.1 | 3.5 | 38 | 3 | 38.1 | 3.8 | 44.8 | 3.2 | D | 7.8 | ||
Physical Role | 5.2 | 3.3 | 3.3 | 2.6 | 6.8 | 3.6 | 10 | 2.8 | D | 5.1 | ||
General Health | 26.5 | 3 | 29 | 3.1 | 33 | 3.2 | 35.6 | 3.4 | D | 0.1 | ||
Vitality | 18.1 | 2.8 | 19 | 2.9 | 22.6 | 3 | 26.4 | 3.2 | D | 2.9 | ||
Social Functioning | 44.4 | 4.4 | 36.7 | 3.7 | 49.2 | 4.8 | 55.6 | 4 | AB | 14.1 | ||
Emotional Role | 33.4 | 8 | 38 | 8.1 | 39.4 | 8.8 | 48.8 | 8.9 | D | 4.8 | ||
Mental Health | 45.4 | 3.6 | 44.9 | 4.2 | 50.8 | 3.9 | 57.9 | 4.6 | D | 7.6 | ||
Hospital Anxiety and Depression Scale | Anxiety | 11.2 | 0.8 | 11 | 0.8 | 9.4 | 0.9 | 9.1 | 0.9 | D | -0.1 | |
Depression | 9.3 | 0.7 | 9 | 0.8 | 7.5 | 0.8 | 7.3 | 0.9 | D | 0.1 | ||
Vanderbilt Pain Management Inventory | Coping Strategies | |||||||||||
Passive Coping | 24.7 | 0.8 | 24.2 | 0.7 | 23.2 | 0.9 | 20.7 | 0.7 | D | -2 | ||
Active Coping | 16.1 | 0.7 | 16.1 | 0.7 | 16.5 | 0.7 | 16 | 0.7 | D | -0.5 | ||
Rosenberg Self-Esteem Scale | Self-Esteem | 28.2 | 1.1 | 25.4 | 1.2 | 28.4 | 1.2 | 28.3 | 1.3 | A | 2.7 | |
General Self-Efficacy Scale | Self-Efficacy | 25 | 1.3 | 25.5 | 1.3 | 26.9 | 1.4 | 27.9 | 1.4 | D | 0.5 | |
| ||||||||||||
| FIQ | Impact of the Syndrome | ||||||||||
Daily Life Activities | 1.27 | 0.45 | 0.99 | 0.44 | 1.17 | 0.58 | 0.62 | 0.57 | A | -0.27 | ||
Number of Days That Was Good the Last Week | 0.75 | 1.11 | 0.85 | 1.26 | 1.05 | 1.12 | 2.21 | 2.01 | A | 1.06 | ||
Absent Days at Work | 0.92 | 1.55 | 0.84 | 1.67 | 1.1 | 2.07 | 0.55 | 1.66 | D | -0.47 | ||
Fatigue | 7.85 | 1.18 | 7.45 | 1.39 | 7.95 | 1.35 | 6.31 | 1.85 | A | -1.24 | ||
Morning Tiredness | 8.15 | 1.03 | 7.55 | 1.66 | 7.95 | 1.26 | 6.89 | 1.85 | D | -0.46 | ||
Stiffness | 7.6 | 1.46 | 7.55 | 1.57 | 6.95 | 1.98 | 6.15 | 2 | A | -0.75 | ||
Anxiety | 7.15 | 1.26 | 7.9 | 1.37 | 7.16 | 1.6 | 5.52 | 2.26 | A | -2.39 | ||
Depression | 6.65 | 2 | 8.3 | 1.17 | 5.74 | 2.53 | 4.42 | 2.41 | A | -2.97 | ||
Inconvenience on Work | 7.8 | 1.28 | 7.2 | 1.57 | 7.58 | 1.53 | 5.42 | 2.19 | A | -1.56 | ||
Final Score | 69.55 | 12.96 | 69.23 | 12.89 | 67.08 | 10.51 | 52.16 | 16.18 | AB | -14.6 | ||
Beck Inventory | Depression | 19.35 | 7.7 | 16.7 | 6.66 | 18.05 | 9.83 | 16.05 | 7.39 | D | 0.65 | |
| ||||||||||||
| Eight-Polar Tactile-Electrode Impedanciometer (InBody 720, Biospace) | Body Composition | ||||||||||
Weight in Kilograms | 68.3 | 2.4 | 68.3 | 2.5 | 69 | 3.1 | 68 | 3.3 | D | -1 | ||
Waist Circumference | 86.9 | 2.7 | 88.1 | 2.8 | 87.2 | 3.4 | 85.5 | 3.5 | D | -2.9 | ||
Body Mass Index | 27.9 | 1.1 | 28 | 1.2 | 27.8 | 1.4 | 27.8 | 1.5 | D | -0.1 | ||
Body Fat Percentage | 38.4 | 1.7 | 37.8 | 1.9 | 36.5 | 1.9 | 35.9 | 2.2 | D | 0 | ||
Muscle Mass in Kilograms | 22.3 | 0.7 | 27.4 | 3.3 | 23.9 | 0.8 | 22.6 | 3.9 | D | -6.4 | ||
“30-Second Chair Stand” Test | Lower Body Muscular Strength | 8 | 0.6 | 8.2 | 0.6 | 7.7 | 0.8 | 8.2 | 0.7 | D | 0.3 | |
“Chair Sit and Reach” Test | Lower Body Flexibility | -17.6 | 4.5 | -7.7 | 2.9 | -15.7 | 5.8 | -6.9 | 3.7 | D | -1.1 | |
“Back Scratch” Test | Upper Body Flexibility | -7.3 | 2.4 | -9.3 | 2.4 | -6.5 | 2.4 | -5.8 | 2.5 | D | 2.7 | |
“8-Feet Up and Go” Test | Motor Agility | 8.1 | 0.4 | 7.9 | 0.4 | 7.8 | 0.5 | 6.6 | 0.5 | D | -1 | |
“6-Minute Walk” Test | Aerobic Endurance | 449.6 | 16.3 | 445.8 | 14.6 | 443.9 | 20.3 | 461 | 18.1 | D | 20.9 | |
Dinamómetro Digital | Upper Body Muscular Strength | 14.8 | 1.6 | 16.1 | 1.3 | 17.9 | 1.9 | 20.4 | 1.6 | D | 1.2 | |
“Blind Flamingo” Test | Static Balance | 12.2 | 1.1 | 10.6 | 1.3 | 9.6 | 1.5 | 9.6 | 1.7 | D | 1.6 | |
FIQ | Impact of the Syndrome | |||||||||||
Physical Function | 5.4 | 0.5 | 4 | 0.5 | 4.4 | 0.6 | 4.3 | 0.7 | D | 1.3 | ||
Well-Being | 8.7 | 0.5 | 7.8 | 0.7 | 8.6 | 0.6 | 6.7 | 0.8 | D | -1 | ||
Fatigue | 8.5 | 0.4 | 7.6 | 0.5 | 8.4 | 0.6 | 7.7 | 0.6 | D | 0.2 | ||
Morning Tiredness | 8.3 | 0.4 | 8.1 | 0.4 | 8.9 | 0.6 | 8.3 | 0.6 | D | -0.4 | ||
Stiffness | 7.6 | 0.5 | 6.1 | 0.6 | 8.3 | 0.7 | 7 | 0.8 | D | 0.2 | ||
Anxiety | 8.5 | 0.4 | 5.9 | 0.6 | 7.7 | 0.5 | 6.9 | 0.8 | D | 1.8 | ||
Depression | 7 | 0.7 | 4.9 | 0.7 | 7.8 | 0.9 | 6.3 | 0.9 | D | 0.6 | ||
Final Score | 74.6 | 3.1 | 62.9 | 3.7 | 77.7 | 3.9 | 64.9 | 4.7 | BC | -1.1 | ||
SF-36 | Health-related quality of Life | |||||||||||
Physical Functioning | 35.8 | 4.7 | 42.4 | 4.8 | 35 | 6 | 38.3 | 6.2 | D | -3.3 | ||
Physical Role | 0 | 0 | 9.7 | 4.6 | 9.1 | 5.6 | 4.5 | 5.9 | A | -14.3 | ||
General Health | 27.7 | 3.2 | 31.9 | 3.3 | 26 | 4 | 31.9 | 4.2 | D | 1.7 | ||
Vitality | 20.4 | 4 | 23.5 | 3.5 | 16.2 | 2.1 | 25.2 | 4.5 | D | 5.9 | ||
Social Functioning | 31.7 | 6.1 | 51.6 | 5.8 | 44.3 | 7.8 | 43.9 | 7.5 | A | -20.3 | ||
Emotional Role | 25.5 | 8.5 | 42.7 | 10.3 | 15.8 | 10.8 | 12 | 13.2 | D | -21 | ||
Mental Health | 41.7 | 4.5 | 53.3 | 4.6 | 37.3 | 5.8 | 44 | 5.9 | D | -4.9 | ||
Hospital Anxiety and Depression Scale | Anxiety | 11.9 | 1 | 10.4 | 1 | 12.1 | 1.3 | 11.9 | 1.3 | D | 1.3 | |
Depression | 9.6 | 1.1 | 8.5 | 1 | 9.1 | 1.4 | 8.5 | 1.3 | D | 0.5 | ||
Vanderbilt Pain Management Inventory | Coping Strategies | |||||||||||
Passive Coping | 25.6 | 0.7 | 21.4 | 0.9 | 23.7 | 0.9 | 22.2 | 1.2 | A | 2.7 | ||
Active Coping | 15.6 | 0.9 | 17 | 0.9 | 15.9 | 1.1 | 14.2 | 1.1 | D | -3.1 | ||
Rosenberg Self-Esteem Scale | Self-Esteem | 29.1 | 1.4 | 29.2 | 1.3 | 26.4 | 1.2 | 27.1 | 1.7 | D | 0.6 | |
General Self-Efficacy Scale | Self-Efficacy | 26.1 | 1.9 | 27.1 | 1.5 | 24.1 | 2.4 | 23.1 | 1.9 | D | -2 | |
| ||||||||||||
| “6-Minute Walk” Test | Functional Capacity | 332 | 66.7 | 343 | 77.9 | 372.8 | 80.2 | 431 | 88.7 | A | 47.2 |
FIQ | Impact of the Syndrome | 6.34 | 1.29 | 5.9 | 1.86 | 5.89 | 1.39 | 4.26 | 1.81 | A | -1.19 | |
SF-36 | Health-related quality of Life | |||||||||||
Physical Functioning | 32.6 | 18.9 | 39.1 | 22 | 44.9 | 1.89 | 56.3 | 19.9 | D | 4.9 | ||
Physical Role | 8.8 | 17.9 | 13.8 | 26.5 | 24.7 | 32.2 | 36.5 | 32.4 | D | 6.8 | ||
General Health | 38 | 16.5 | 41.5 | 21.4 | 46 | 21.7 | 44.9 | 15.6 | D | -4.6 | ||
Vitality | 29 | 18.2 | 37.1 | 21.8 | 41.3 | 18.8 | 47.6 | 23.8 | D | -1.8 | ||
Social Functioning | 47.6 | 23.1 | 51.3 | 25.5 | 52.6 | 27.7 | 57.2 | 27 | D | 0.9 | ||
Emotional Role | 21.2 | 33.1 | 31.5 | 38.7 | 34.2 | 36.9 | 51.9 | 39.6 | A | 7.4 | ||
Mental Health | 43.4 | 24 | 46.2 | 22.6 | 46 | 19.9 | 52.3 | 20.8 | A | 3.5 | ||
Beck Inventory | Depression | 21.2 | 13 | 23.5 | 13.7 | 23.9 | 14.7 | 23.1 | 15.3 | D | -3.1 | |
State-Trait Anxiety Inventory, Part 1 | Anxiety | 52.8 | 8.1 | 51.8 | 9.4 | 50.5 | 7.68 | 49.4 | 10 | D | -0.1 | |
State-Trait Anxiety Inventory, Part 2 | Anxiety | 53 | 9.7 | 54.1 | 10.1 | 51.1 | 7.8 | 49.8 | 9.1 | D | -2.4 | |
Body Dysmorphic | Self-Image | 48.8 | 34.2 | 46.9 | 31.8 | 42.8 | 32.6 | 41.1 | 24.24 | A | 0.2 | |
| ||||||||||||
| FIQ | Impact of the Syndrome | ||||||||||
Daily Life Activities | 1.28 | 0.4 | 1.4 | 0.5 | 1.12 | 0.5 | 0.65 | 0.6 | AB | -0.59 | ||
Number of Days That Was Good the Last Week | 0.9 | 1.2 | 1 | 1.3 | 1 | 1.1 | 2.07 | 2.1 | AB | 0.97 | ||
Absent Days at Work | 1.33 | 1.6 | 1.22 | 1.8 | 0.73 | 1.7 | 0.38 | 1.3 | D | -0.24 | ||
Fatigue | 6.89 | 1.6 | 6.56 | 1.5 | 6.87 | 1.8 | 4.46 | 2.4 | AB | -2.08 | ||
Morning Tiredness | 7.77 | 1.3 | 7.57 | 1.2 | 7.59 | 1.3 | 6.66 | 1.9 | D | -0.73 | ||
Stiffness | 7.8 | 1.1 | 7.53 | 1.5 | 7.59 | 1.3 | 7.17 | 2 | D | -0.15 | ||
Anxiety | 7.03 | 1.5 | 6.47 | 1.7 | 6.86 | 1.8 | 6.41 | 1.9 | D | 0.11 | ||
Depression | 7.1 | 1.3 | 6.97 | 1.2 | 7.03 | 1.5 | 5.9 | 2.5 | AB | -1 | ||
Inconvenience on Work | 6.53 | 1.9 | 6.4 | 1.7 | 5.66 | 2.5 | 4.52 | 2.4 | D | -1.01 | ||
Final Score | 68.63 | 14.1 | 68.5 | 14.1 | 65.79 | 11.2 | 53.73 | 18 | AB | -11.95 | ||
Pittsburgh Sleep | Sleep Quality | 14.7 | 2.4 | 14.4 | 2.4 | 15.1 | 1.7 | 7.59 | 1.8 | AB | -7.21 | |
Center for Epidemiologic | Depression | 26.37 | 6.4 | 27.7 | 7.3 | 23.07 | 9.7 | 20.41 | 11.1 | D | -3.99 | |
State Anxiety Inventory | Anxiety | 44.97 | 4.5 | 44.87 | 5.1 | 45.17 | 3.9 | 38.79 | 5.8 | AB | -6.28 |
EG: experimental group; CG: control group; n: sample size; SD: standard deviation; T: test; FIQ: Fibromyalgia Impact Questionnaire; NR: not reported; NA: not applicable; A: significant changes of experimental group versus control group; B: changes in experimental group; C: changes in control group; D: not significative changes; P: P-value.
A random effects model was employed to measure the effect of dance-based programs on pain. Table
Figure
Table
The level of evidence in each study is shown in Table
Tables
Table
Table
The effects of dance therapy on pain are shown in Table
In four of the articles, the Fibromyalgia Impact Questionnaire (FIQ) was used to measure pain. In three of them, significant changes were obtained [
In two of the studies the McGrill-Melzack Questionnaire was used to measure pain. In the study by López-Rodríguez, Castro-Sánchez, Fernández-Martínez, Matarán-Peñarrocha, and Rodríguez-Ferrer [
In addition, in four of the articles the algometer was used. In two of them there were significant changes [
In two of the articles the SF-36 was used to measure pain. In one of them, authors reported significant changes [
Bojner-Horwitz, Kowalski, Theorell, and Anderberg [
The effects of dance therapy on other variables are shown in Table
Quality of life was measured in three articles through the SF-36. In this regard, two of the articles reported changes in the social dimension [
There are eleven measures of the depression symptoms but these measures were obtained with different instruments. In this regard, the most used tool was the FIQ (four articles), the Beck Inventory (two articles), and the Hospital Anxiety and Depression Scale (two articles). However, significant changes were only observed in two articles, [
Regarding anxiety, three studies reported significant changes [
The impact of the disease was assessed in five article using the FIQ [
Cardiorespiratory functional capacity was assessed in three articles through the “6-minute walk test”. Two articles reported significant improvements [
In addition, two articles reported significant differences in self-image, using the Examination of Body Dysmorphic Disorder [
In Figure
Effect sizes for pain of the articles included in the meta-analysis.
The overall effect size for pain was -1.64 with a 95% CI from -2.69 to -0.59 which is large according to the proposed classification (>0.8). The p-value was lower than 0.01 which means a significant reduction in pain. The heterogeneity level was large as the p-value of the Cochran Q-test was <0.01. Additionally, this was supported by the other computed coefficients: I2=92% and H=3.57. Publication bias statistics are not reported because analyses based on the funnel plot are not recommended when there are less than 10 articles and the heterogeneity is large [
This systematic review and meta-analysis aims to explore the effectiveness of dance-based intervention programs for patients with fibromyalgia. The main finding was that dance significantly reduces the level of pain in people with fibromyalgia. This reduction was observed in all five studies and can be considered as large according to the overall effect size (effect size of -1.64 with a 95% CI from -2.69 to -0.59 and p-value <0.01). Given the relevance of pain symptoms in fibromyalgia syndrome, there is evidence that therapies based on dance may be beneficial and clinically relevant for people with fibromyalgia. However, the large heterogeneity, the low number of studies, and the different types of control groups make that those conclusions must be taken with caution.
It must be noted that there were relevant differences in the interventions. Although all included articles were based on dance and have common aspects, there are differences due to the conception of the modality. In order to reduce the heterogeneity of dance interventions and following the criteria previously used by Hwang and Braun [
The different interventions based on dance included in this review were Biodance, on both land [
Regarding aquatic biodance, there were other relevant benefits apart from pain. Participants improved their fatigue, stiffness, anxiety, depression, and the impact of the disease. This may be in line with previous studies reporting that physical exercise in warm water is recommended for the management of chronic pain due to warm temperature and the buoyancy [
Depression symptoms were significantly reduced in three of the seven studies [
Although only artistic and creative dance interventions were included, other studies have investigated the effect of rhythmic exercises like Zumba on different variables in people with fibromyalgia. However, the poor methodological quality and the low number of participants make the extraction of conclusions very hard. The study by Assunção Júnior, de Almeida Silva, da Silva, da Silva Cruz, de Almeida Lins, and de Souza [
Impact of fibromyalgia was also reduced after dance interventions. All articles that used the FIQ observed a reduction that was higher than 14%, which is considered the minimal clinically important difference in fibromyalgia patients. This finding, along with the improvements in pain supports the notion of the benefits of dance in this population. The growing interest on new technologies and virtual reality may complement the dance-based interventions. Previous studies have showed an improvement in pain, quality of life, mobility skills, balance, and fear of falling, supporting the notion that physical exercise performed through virtual reality may be an excellent alternative to improve chronic pain [
The current systematic review and meta-analysis has some limitations. First, search was limited to studies in Spanish and English indexed in the mentioned electronic databases. Although all journals indexed in the Journal of Citations Reports are indexed in the consulted databases, it could be possible that some articles written in other languages have been omitted. Second, two of the studies did not report enough data to be included in the meta-analysis; thus only five of the seven articles were included, which means a relatively small sample size. Finally, findings and conclusions from this systematic review and meta-analysis must be taken with caution due to the large heterogeneity observed, the possible publication bias, and the different types of control groups.
Dance-based intervention programs can be an effective intervention for people suffering from fibromyalgia, leading to a significant reduction of the level of pain with an effect size that can be considered as large. Also, dance may improve quality of life and physical function, as well as reducing anxiety, depression, and the impact of the disease. However, findings and conclusions from this meta-analysis must be taken with caution due to the small number of articles and the large heterogeneity.
The funders played no role in the study design, the data collection and analysis, the decision to publish, or the preparation of the manuscript.
The authors declare that they do not have any conflicts of interest with the conducted research.
The author Daniel Collado-Mateo was supported by a grant from the Spanish Ministry of Education, Culture and Sport (FPU14/01283). The author Santos Villafaina was supported by a grant from the Regional Department of Economy and Infrastructure of the Government of Extremadura and the European Social Fund (PD16008). This study was cofunded by the Spanish Ministry of Economy and Competitiveness (Reference no. DEP2015-70356) in the framework of the Spanish National R+D+i Plan.