Summary of findings for the main comparison. Dance Movement Therapy (DMT) compared to standard care or waiting list control for depression.
| DMT compared to standard care or waiting list control for depression | ||||||
| Patient or population: patients with depression Settings: hospital, school, community mental health services Intervention: Dance movement therapy Comparison: standard care or waiting list control | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Standard care or waiting list control | DMT | |||||
| Depression score SCL‐90‐R depression sub‐scale (13 items); HAM‐D. Scale from: 0 to 84 (HAM‐D) or 52 (SCL‐90‐R depression sub‐scale). | For those (adult) studies using the HAM‐D scale, the control group was standard care, though for one of these two studies (Röhricht 2013) this was also a waiting list group for the intervention. For the adolescent study using the SCL‐90‐R depression subscale, a waiting list control was used. | The mean depression score in the intervention groups was 0.67 standard deviations lower (1.4 lower to 0.05 higher) | 147 (3 studies) | ⊕⊝⊝⊝ very low1,2, 3 | SMD ‐0.67 (‐1.4 to 0.05), with a lower score indicating less severe depression. Using Cohen's rule of thumb, SMD ‐0.67 is considered a medium effect. However, the confidence interval crosses the line of no effect and into the possibility of a very small negative effect. The proportion of information from studies at high risk of bias is sufficient to affect the interpretation of results. It is not possible, therefore, to state with confidence that DMT has an effect in either direction. |
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| Drop‐outs drop‐out numbers in each arm | Study population | OR 1.82 (0.35 to 9.45) | 31 (1 study) | ⊕⊕⊝⊝ low2 | ||
| 200 per 1000 | 313 per 1000 (80 to 703) | |||||
| Low4 | ||||||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Social and occupational functioning SCL‐90‐R. Scale from: 0 to 52. | The mean social and occupational functioning in the control groups was 51.1, adjusted to a T score in relation to the Korean adolescent population. | The mean social and occupational functioning in the intervention groups was 6.8 lower (11.44 to 2.16 lower) | 40 (1 study) | ⊕⊝⊝⊝ very low2, 3 | A lower score indicates increased social and occupational functioning. | |
| Quality of life MANSA. Scale from: 12 to 84. | The mean quality of life in the control groups was 2.9 | The mean quality of life in the intervention groups was 0.3 higher (0.6 lower to 1.2 higher) | 22 (1 study) | ⊕⊕⊝⊝ low2 | A higher score indicates improved quality of life. | |
| Self esteem Rosenberg. Scale from: 0 to 30. | The mean self esteem in the control groups was 9.9 | The mean self esteem in the intervention groups was 1.7 higher (2.36 lower to 5.76 higher) | 21 (1 study) | ⊕⊕⊝⊝ low2 | A higher score indicates increased self esteem. | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 The quality of evidence for the depression score was downgraded two points because of heterogeneity across studies. This may be due either to age of participants, outcome measure used, blinding, the intervention, or some combination of these factors but the exact cause could not be established. However, the one study of adolescents is the lowest methodological quality of all three studies in this review, presenting a high risk of bias which is likely to affect results. This also used a different measure from the other two studies. One of the adult studies blinded allocation and assessment, but the other does not report. It is not possible to blind participants or therapist for this form of treatment, though clearly there is heterogeneity in the rigour employed with respect to blinding. One (adult, Chinese) study used a therapist of low training level; whilst this is consistent with the situation in that country regarding the development of professional practice standards, it may represent heterogeneity in the treatment intervention. 2 The quality of evidence on all measures was downgraded by two points because of imprecision caused by a low sample size.
3 The quality of evidence for both the depression and social/occupational functioning outcomes was downgraded by two points because both of these included a study which used the depression sub‐scale of the SCL‐90‐R. This is not deemed to be a reliable measure, due to the fact that it relies on self‐report.
4 The attrition risk due to reported drop‐out rate is deemed to be low. Only one study (Röhricht 2013) reported any drop‐outs, and although drop‐out rates were approximately 11% higher in the DMT group than in the control, the odds ratio is calculated as 1.82 [0.35, 9.45], which is not significant.