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Abstract

Music therapy has emerged as a promising complementary intervention for Parkinson's disease (PD). PARKinSOUND, a non-randomized clinical trial, evaluated the feasibility of a community orchestra intervention for individuals with PD (n = 22), compared to a control group (n = 21). After the intervention, the orchestra group showed a modest improvement in depressive symptoms compared to baseline (Beck Depression Inventory: −0.5, p = 0.049) and controls (−5.5, p = 0.011), while motor scores (MDS-UPDRS III) remained stable. Self-reported overall improvements (PGI-C) were also higher in the orchestra group (p = 0.003). Although placebo effects may partly explain the benefits, these findings suggest emotional benefits and perceived overall improvement, providing insights for future research.

Plain language summary

Parkinson disease (PD) is a long-term condition that affects movement and can also cause problems like depression, memory issues, and reduced quality of life. While medications are important, experts agree that people with PD can benefit from a more holistic approach—one that includes social and emotional support. Music, in particular, has shown promise in helping people with PD feel better both physically and emotionally.

In this study, called PARKinSOUND, researchers tested whether participating in a community orchestra could benefit people with PD. Over six months, 43 people with PD chose to join either an orchestra group or a control group. The orchestra group attended 15 three-hour rehearsals and performed in a final concert. Participants could choose from various accessible instruments or sing. The study aimed to see if this activity was not only enjoyable but also helpful for mood, movement, and overall well-being.

After the program, the orchestra group showed a small but meaningful improvement in depression symptoms, and they noticed positive changes more frequently than the control group. Their movement abilities stayed about the same. Importantly, no side effects were reported, and everyone in the orchestra group said they enjoyed the experience and would do it again. They described the experience with words like joyful and hopeful.

Although it is possible that some of the improvements were due to participants expectations or enthusiasm (a placebo effect), this pilot study suggests that creative activities like making music together can support emotional well-being in PD. These early results support the idea that music-based programs could be a valuable addition to traditional care and deserve further study.

Keywords

Parkinson's disease quality of life non-pharmacological intervention disease modification therapeutics

Background

The global prevalence and burden of Parkinson's disease (PD) have been increasing in recent decades, highlighting the need for a comprehensive approach to its management.¹ Recognizing this, the Movement Disorders Society's Task Force on Parkinson's Wellness and Holistic Health emphasizes that PD care should extend beyond pharmacological treatments, encouraging healthcare providers to adopt a multidisciplinary approach that integrates medical and pharmacological therapies with social and lifestyle interventions.² In this context, art interventions can empower individuals with PD, addressing challenges related to self-esteem, enhancing personal problem-solving skills, and promoting overall well-being.³

Regarding the studies conducted, the pioneering work of Pacchetti et al. (1998 and 2000) laid the foundation for evaluating the effects of active group music therapy on emotional, motor, and quality of life outcomes in PD patients.^4,5 Systematic reviews, including one that covered 58 studies from 2015 to 2020, support the positive effects of music therapy on both motor and non-motor symptoms in Parkinson's disease.⁶ Among these, a controlled study with 30 PD participants found that walking trials using internal and external cues at varying cadences led to adjustments in gait speed, cadence, and stride length, suggesting that self-voiced movement may enhance gait stability in PD.⁷ Tamplin et al. emphasized the therapeutic potential of singing, which engages neural and structural mechanisms similar to speech; their ParkinSong intervention indicated possible improvements in vocal volume and respiratory function in PD patients.⁸

Participating in a community orchestra guided by a maestro combines musical creation and playing an instrument or singing. This requires motor training, maintaining attention, and following visual and auditory cues from the conductor to know when and what to play. To date, no studies have explored the impact of establishing a community orchestra specifically for individuals with PD. Nonetheless, a similar approach was tested in the United Kingdom with stroke patients.⁹ The results indicated that 86% of the patients reported better attention and memory, and nearly half improved independence in daily activities.

Methods

PARKinSOUND consisted of a pilot non-randomized controlled trial to assess the feasibility and potential effects of participation in a PD community orchestra. Patients were recruited over a six-month period through an open call promoted in the Neurology Department at Braga Hospital, on social media, and via local institutions. There were no musical pre-conditions for participation, prior musical experience, the ability to read music, or having played in a group were not required.

A total of 43 individuals with Parkinson's disease were enrolled, with 22 assigned to the intervention group and 21 to the control group.

Participants attended one session per week, with each session lasting 3 h. Over three months, the intervention consisted of 15 weekly rehearsals, culminating in a 1-h live performance.

Participants selected their preferred instrumental section, including percussion, vocals, strings, wind instruments, and electronic music devices tailored for accessibility. No formal music reading was required.

Evaluations occurred at baseline and one week post-intervention. All assessments were conducted by a neurologist with no participation in rehearsal sessions or music direction. The assessment battery included the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Hoehn and Yahr scale (H&Y), Non-Motor Symptoms Questionnaire (NMSQuest), Parkinson's Disease Questionnaire (PDQ-39), Beck Depression Inventory (BDI), and Montreal Cognitive Assessment (MoCA). Additionally, self-reported musical skills were evaluated at baseline using the Goldsmiths Musical Sophistication Index (Gold-MSI). Subjective changes following the intervention were assessed with the Patient Global Impression of Change (PGI-C), a 7-point scale [very much improved (1) - worse (7)]. At the final evaluation, orchestra participants completed a short survey that included a 5-point Likert scale [very dissatisfied (1)—satisfied (5)] to rate their overall experience, and another scale to indicate how likely they would be to participate in similar future activities [very unlikely (1)—likely (5)].

Feasibility was assessed through indicators such as participant adherence rates, attendance frequency, acceptability measured by participant satisfaction, and an analysis of the logistical and resource requirements for program implementation.

Due to the nature of the intervention and the limited number of potential participants, a convenience sample was used, with the sample size determined by the number of individuals willing to participate. Results are presented in the following text and descriptively in Table 1, with all continuous variables presented by the median and interquartile range (IQR), and categorical variables described by the frequency (n and %). Categorical variables were analyzed using Pearson's Chi-square or Fisher's exact test as appropriate. Continuous variables were assessed for normality using the Shapiro–Wilk test and visual inspection. As many variables deviated from normality and sample sizes were modest (n < 50 per group), we elected non-parametric methods, which do not assume normal distribution and are more robust for small samples. Between-group comparisons at baseline and post-intervention were analyzed using the Mann–Whitney U test, and within-group comparisons across time points were performed with the Wilcoxon signed-rank test. Statistical comparisons were calculated using SPSS software (version 27), with significance determined for P-values <0.05.

Table 1.

Results table.

	Orchestra group					Control/non-intervention group					Difference between groups^b
Independent variable	Baseline (n = 22)		Post-intervention (n = 22)		Difference within the group^a (p-value)	Baseline (n = 17*)		Post-intervention (n = 17)		Difference within the group^a (p-value)	Baseline (p-value)	Post-intervention (p-value)
Age – mean ± SD	57	(13.0)	-		-	64.0	(14.0)	-		-	0.233	-
Sex – n (% female)	40.9		-		-	41.1		-		-	0.987	-
Years of disease	6.0	(3.0)	-		-	6.0	(6.0)	-		-	0.812	-
Years of schooling	12.0	(8.0)	-		-	6.0	(5.0)	-		-	0 . 002	-
H&Y	2.0	(0.0)	-		-	2.0	(1.0)	-		-	0.553	-
MoCA	23.0	(5.0)	-		-	21.0	(6.0)	-		-	0.111	-
Gold-MSI**	134.0	(22.0)	-		-	120.0	(27.0)	-		-	0.052	-
Minutes since last intake of levodopa at evaluation	84.0	(350.0)	105.0	(238.0)	0.372	210.0	(188.0)	150.0	(143.0)	0.201	0.726	0.116
MDS-UPDRS-TOTAL	46.5	(37.0)	46.5	(42.0)	0.889	49.0	(41.0)	61.0	(30.0)	0.079	0.876	0.246
MDS-UPDRS-I	9.0	(8.0)	7.5	(8.0)	0.250	10.0	(16.0)	10.0	(8.0)	0.924	0.989	0.201
MDS-UPDRS-II	10.0	(10.0)	9.0	(14.0)	0.943	9.0	(13.0)	10.0	(11.0)	0.833	0.865	0.854
MDS-UPDRS-III	24.5	(17.0)	25.5	(22.0)	0.808	24.0	(22.0)	38.0	(24.0)	0 . 010	0.395	0 . 039
MDS-UPDRS-IV	3.0	(8.0)	3.0	(6.0)	0.617	2.0	(6.0)	1.0	(7.0)	0.964	0.604	0.651
BDI	5.0	(11.0)	4.5	(7.0)	0 . 049	10.0	(12.0)	10.0	(10.0)	0.572	0.251	0 . 011
NMSQ**	9.5	(10.0)	10.0	(9.0)	0.527	11.0	(15.0)	10.0	(8.0)	0.089	0.246	0.737
PDQ-39**	37.0	(39.0)	34.5	(46.0)	0.163	38.0	(44.0)	43.0	(48.0)	0.524	0.542	0.512
PGI-C	-		3	(1.0)	-	-		4	(2.0)	-	-	0 . 003

All results presented as median (Interquartile Range). H&Y: Hoehn and Yahr scale; MoCA: Montreal Cognitive Assessment; Gold-MSI: Goldsmiths Musical Sophistication Index; BDI: Beck depression inventory; NMSQ: Non-Motor Symptoms Questionnaire; PDQ-39: The Parkinson's Disease Questionnaire; PGI-C: Patient Global Impression of Change |*Control/non-intervention group had 21 participants at recruitment, but 4 participants were excluded | **Missing values: 3 for Gold-MSI; 1 for BDI; 2 for NMSQ; 2 for PDQ-39 |Statistical tests used: a- Wilcoxon Signed Rank Test; b- Mann-Whitney U test.

Results

A total of 43 patients were recruited: 22 in the orchestra/intervention and 21 in the control/non-intervention group. Four participants were excluded due to loss to follow-up related to difficulties traveling to attend assessments, all in the control group.

At baseline, no significant differences were found between groups except for education level, higher in the intervention group [Median (IQR): 12.0 (8.0) vs. 6.0 (5.0) years of schooling, p = 0.002]. Participants had a median disease duration of six years, and 92% received levodopa treatment. Self-reported musical skills were higher in the orchestra group, though not significantly different.

Post-intervention, motor scores remained stable in the intervention group [MDS-UPDRS III at baseline 24.5 (17.0) vs. 25.5 (22.0) after the intervention, p = 0.808] but increased in the control group [baseline 24.0 (22.0) vs. 38.0, after the intervention, p = 0.010]. Depressive symptoms showed a modest but statistically significant improvement in the intervention group [Beck Depression Inventory at baseline 5.0 (11.0) vs. 4.5 (7.0) after the intervention, p = 0.049]. Quality of life (PDQ-39) and non-motor symptoms (NMSQuest) did not change significantly within or between groups. The orchestra group had a more favorable perception of improvement than the control group [PGI-C orchestra group 3.0 (1.0) vs. control group 4.0 (2.0), p = 0.003]. No side effects were reported during the intervention.

All orchestra participants rated their experience as highly satisfying and expressed willingness to continue participating in similar activities. When asked to describe their experience in one word, common responses included “hopeful,” “gratifying,” and “joyful.” Adherence to rehearsals was high, with a median attendance rate of 86.6% (13 of 15 sessions) and there were no dropouts in the intervention group. No adverse events were reported. The final concert, attended by approximately 500 people, also served as an opportunity to raise public awareness about PD and the role of creative therapies.

Discussion

This study reports an innovative non-pharmacological, music-based intervention aimed at managing symptoms of individuals with PD. Our findings suggest that participation in a structured orchestra may contribute to stabilization of motor symptoms, as reflected by unchanged MDS-UPDRS III scores in the intervention group, in contrast to significant worsening in controls. While encouraging, these findings should be interpreted cautiously as effect sizes, especially in motor outcomes, raise the possibility of placebo effects. Furthermore, the absence of specific fine motor assessments, such as detailed measures of bradykinesia or hand dexterity, limits interpretation of motor outcomes. Future studies should incorporate wearable or digital technologies, to more accurately capture motor changes.

The observed improvement in depressive symptoms may be attributed to the social, emotional, and motivational aspects of the intervention. This is consistent with previous studies showing that music therapy interventions significantly reduced depressive symptoms and enhanced mood in PD patients.¹⁰ Regarding the lack of change in PDQ-39, it is worth noting that quality-of-life questionnaires may require larger sample sizes or longer follow-up to detect significant change. This mirrors observations in systematic reviews on music therapy in PD, which show heterogeneous results in quality of life outcomes.¹¹

The Patient Global Impression of Change scores revealed a more favorable perception of improvement in the orchestra group than the control. This result suggests that, although motor symptoms have not improved, participants in the orchestra group felt better overall. In fact, all patients reported being very satisfied with the intervention and expressed willingness to participate again. When asked to define their feelings towards this intervention, patients described mainly words related to happiness and hope, and we do believe that this was a major outcome in our study that we were unable to translate to objective measures. As reported in a different artistic intervention, the patient's experience contributes as scientific knowledge, shaping care and increasing the intervention's relevance to participants’ lives.¹²

From a feasibility standpoint, high adherence, absence of adverse events, and consistently positive feedback are encouraging. The inclusive design, allowing participants to choose instruments based on their preferences and abilities, fostered engagement across a heterogeneous cohort. Previous studies have shown that music therapy can positively impact motor and non-motor outcomes irrespective of musical background, supporting the applicability of a non-selective inclusion.^4,5,13

Nonetheless, logistical challenges must be considered. All four dropouts occurred in the control group and were attributed to transport-related issues, suggesting that the intervention group may have included more motivated or less burdened individuals. While this points to potential self-selection bias, it also reflects real-world constraints and underscores the importance of accessibility in implementing such interventions.

Beyond clinical feasibility, our findings highlight the broader value of cross-sectoral collaboration. The project successfully engaged professionals not traditionally involved in healthcare—such as musicians, local authorities, and community stakeholders. Municipal institutions provided funding and physical spaces for rehearsals and the final performance, demonstrating how cultural infrastructures can support therapeutic objectives. Community attendance at the final concert, amplified by media coverage in national newspapers and television, further contributed to public awareness of Parkinson's disease.

However, replicability of this model depends on several contextual preconditions, including access to instruments, rehearsal spaces, trained facilitators, and institutional engagement. Moreover, participants needed sufficient cognitive and physical capacity to participate in group activities. While these factors contributed to the success of our intervention, they may limit its generalizability. The use of non-parametric statistical tests, necessitated by our small sample size and non-normal data distributions, further constrains the generalizability and statistical power of our results.

In conclusion, the community orchestra model appears feasible, well-tolerated, and potentially beneficial for motor symptoms, mood, and patient-perceived outcomes. While larger, controlled studies are required to confirm and expand upon these findings, our results encourage further exploration of resource-oriented, integrative therapies tailored to the needs of people with Parkinson's disease.

Supplemental Material

sj-docx-1-pkn-10.1177_1877718X251381089 - Supplemental material for PARKinSOUND: Impact of participation in an orchestra in patients with Parkinson's disease

Supplemental material, sj-docx-1-pkn-10.1177_1877718X251381089 for PARKinSOUND: Impact of participation in an orchestra in patients with Parkinson's disease by Sofia Lopes, MD, Sofia Marques, MD, Andreia Ferreira, MD, Ana Rita Silva, MD, Octavia Costa, MD, Sara Varanda, MD, Gisela Carneiro, MD, Pedro Santos, Ana Goios, PhD, Margarida Rodrigues, MD in Journal of Parkinson's Disease

Footnotes

Acknowledgments

The authors would like to express their gratitude to all participants and their families for their commitment to this study. We extend our appreciation to the municipal cultural spaces of Braga for providing rehearsal and performance venues. We are also grateful to the musicians who led the orchestra and to the entire musical team for their dedication in guiding the participants through the creative process. Finally, we thank the Municipality of Braga and Zambon S.A.U. for their financial support and all those who contributed to raising awareness for Parkinson's Disease through this initiative.

Authors' roles

Sofia Lopes: Design; execution (patient evaluation); analysis; writing; editing of final version of the manuscript.

Sofia Marques: Execution (patient evaluation); analysis; writing.

Andreia Ferreira: Execution (patient evaluation); analysis; writing.

Ana Rita Silva: Design; execution (patient evaluation); analysis.

Octavia Costa: Execution - patient evaluation.

Sara Varanda: Execution - patient recruitment.

Gisela Carneiro: Execution - patient recruitment.

Pedro Santos: Execution (coordination of the musical team and rehearsals organization).

Ana Goios: Analysis; writing; editing of final version of the manuscript.

Margarida Rodrigues: Design; execution (patient recruitment, patient evaluation; coordination of logistics); analysis; writing; editing of final version of the manuscript.

Funding

The present study received financial support from the Municipality of Braga and Zambon S.A.U.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Financial disclosures of all authors (for the preceding 12 months)

– Margarida Rodrigues has received honoraria from serving on the scientific advisory board for Zambon, Abbvie, TEVA and BIAL, and has received fees for speaking at conferences from Abbvie, Bial and Zambon

– Ana Goios is an employee and holds shares of P95 Clinical & Epidemiology Services.

No Financial disclosures for the other authors.

Supplemental material

Supplemental material for this article is available online.

ORCID iDs

Andreia Ferreira

Ana Rita Silva

Octavia Costa

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Supplementary Material

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