Dance as an Adjunct therapy for Neurological rehabilitation – Creative Enrichment for Recovery (DAN-CER): Program Design and a Mixed Methods Pilot Protocol to Assess Feasibility and Acceptability (Preprint)
Authors: Pretty Danielle , Norwood Michael , Ownsworth Tamara , Dungey Kelly , Jones Susan , Gomes Zara , Kendall Elizabeth 
Published: December 2024

BACKGROUND

Dance is a novel recreational activity that has potential to improve psychosocial outcomes in inpatient neurorehabilitation. However, adapted dance programs in neurorehabilitation are only beginning to emerge.

OBJECTIVE

There are three aims of the paper. 1. Describe the process of designing Dance as an Adjunct therapy for Neurological rehabilitation – Creative Enrichment for Recovery (DAN-CER), a dance program for use in an inpatient neurorehabilitation environment. 2. Describe the program using the TIDieR checklist. 3. Describe the protocol that will be used to evaluate the pilot program.

METHODS

DAN-CER was co-developed in three phases with patients in a neuroscience rehabilitation ward, clinicians, and dance teachers. Phase 1 (knowledge seeking) of the dance program development commenced in September 2022. Meetings and workshops with stakeholders occurred over a 2-year period. Further to this, in phase two (information gathering), three patients with acquired brain injury, and two allied health staff attended focus groups. Together the input from all stakeholders was considered in the development of the program. Phase 3 (refining) concluded the program development in late October 2024. A mixed methods study will be conducted to pilot the DAN-CER program in a neuroscience ward over 6 weeks. To assess feasibility and acceptability, accrual and protocol adherence will be collected and reported as count data, displayed using a flow chart. Following the program, perceptions of the dance classes will be collected through semi-structured interviews with patient participants and health care staff. Interview transcripts will be analysed thematically. Using a single case, 1 phase (B phase) non-experimental design methodology, the immediate impact of the dance sessions on positive and negative affect and fatigue (using the PANAS and the VAS-F respectively) will be measured pre and post each session in a small number of patients. Results will be plotted visually and reported individually. Additionally, all dance patients will have their mood and wellbeing assessed at baseline as a ‘wellness check-in’ (using the Depression Anxiety Stress Scale -21 and the Warwick-Edinburgh Mental Wellbeing Scale). This will be repeated at the conclusion of the program or when participants are discharged. A change index will be used to assess changes.

RESULTS

Dance classes and assessments began in late October 2024, and data collection is expected to be completed in late December 2024.

CONCLUSIONS

The summation of the mixed methods data will indicate the feasibility and acceptability of the DAN-CER program in inpatient neurorehabilitation. Specifically, the repetition of fatigue and affect score reported as case studies will provide critical insight into its individual level impact and account for daily fluctuations. Qualitative data will provide rich insight that captures important challenges, barriers, impressions and any perceived benefits of DAN-CER. Results will inform program and measurement adaptions required for a larger, more rigorous study.