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Dear Authors,
Thank you for your submission to PeerJ.
The Reviewers' comments and suggestions have been adequately addressed. Therefore, the manuscript can be accepted for publication.
Kind regards,
Marialaura Di Tella
[# PeerJ Staff Note - this decision was reviewed and approved by Jafri Abdullah, a PeerJ Section Editor covering this Section #]
The authors have made the changes I suggested in my review and the manuscript has improved considerably.
Correct
Correct
The manuscript is written in a good English, and the background is explained well.
The experimental design is well described.
The findings are important and correct.
The results and conclusions are correct.
Dear Authors,
Thank you for submitting your manuscript to PeerJ.
The reviewers have indicated some additional revisions that should be made to the paper. Please take these suggestions into consideration and revise the manuscript accordingly.
Kind regards,
Marialaura Di Tella
I have two aspects that, if the authors pay attention, would improve the manuscript:
- Not wanting to study daily rhythmicity does not mean that the timing of measurements should not be controlled, since the time of day determines the values of both biological and behavioral variables, mood and symptoms, as well as quality of life, both in healthy people and even more so in patients with mental disorders. The response in the letter is not very convincing (Regarding the promotion of arousal and circadian rhythm changes, unfortunately, we did not assess how dance interventions may positively impact circadian rhythms. However, our primary focus was on the alleviation of clinical symptoms and cognitive deficits through dance interventions, with rhythm changes not being the main objective of this study). For the adequate study of a main objective, the control of all factors that may influence it should be considered as much as possible. - The problem with the sample and the parametric or nonparametric analyses is that Figure 3 doesn't clearly show the distribution in both groups: the loss and the remaining patients. I suggest revising the figure to improve the information provided regarding inclusion and the patients ultimately studied. Patients "lost during intervention" in each group can be indicated in boxes prior to the last ones, which contain the final number studied.
Correct
Correct
no comment
No comment
In the revised version, authors well addressed my questions and I have no comment.
The planning and performing of the study is good, and the structure of this research article is well done. The English language is good.
THe experimental design is well done.
The findings, namely that dancing is helpful to improve schizophrenia symptoms is valid.
This is good research article which shows to improve schizophrenia symptoms.
Dear Authors,
Thank you for submitting your manuscript to PeerJ.
The Reviewers pointed out some methodological limitations that should be addressed in order for the paper to be considered for publication. Please take all Reviewers' comments into consideration and revise your manuscript accordingly.
Kind regards,
Marialaura Di Tella
This report examines whether dance intervention can improve the symptoms and cognitive function of patients with chronic schizophrenia. There were no major problems with the flow from the presentation of the hypothesis to the research method, results, and discussion, and the effectiveness of the dance intervention has been confirmed. This paper examines the effects not only of simple aerobic exercise, but also of dance, which involves thinking while moving. Any comments regarding which patients are suitable for this therapy and which are not suitable for it would be appreciated.
There are other studies on dance intervention for schizophrenia. For example, see the paper PMID: 38875423. In this study, the control group was an aerobic exercise group, which is good because it allows for comparison by exercising while thinking. In the future, if possible, it would be good to perform a dance intervention after the end of the trial in the patient group enrolled in aerobic exercise and observe changes in cognitive function. Alternatively, adding a crossover study may allow for the detection of differences between aerobic exercise and dance intervention.
The data is reliable, as it also provides specific diagrams of the dance intervention.
Some patients may refuse exercise therapy, so comments on how to introduce this dance intervention smoothly would be helpful to readers.
The study is of interest, since any activity added to the usual treatment in chronic schizophrenic patients that provides positive data should be considered. However, the authors should make an in-depth review of the present version:
- Given the small sample size and especially the loss of patients in the aerobic exercise group, it would be convenient to assess in the title and throughout the manuscript whether it refers to preliminary data. It seems excessive to refer to a controlled trial considering the limitation of participants included and data finally available.
- It is necessary to develop the known neurocognitive impairment of patients with schizophrenia and in this sense the work of Benaiges et al. (Progress in Neuropsychopharmacology & Biological Psychiatry, 2013, 40, 298-305; 2013, Human Psychopharmacology. Clinical and Experimental, 2013, 28, 29-39) should be assessed for the complete neurocognitive assessment they perform. In addition, they work not only on the impact on patients with schizophrenia but also on comparisons with dual schizophrenia (comorbidity with substance use disorder). It is the norm and not the exception in the clinic of mental disorders, with those of the psychotic spectrum being the most frequent. If there is data on drug use, along with tobacco and caffeine, it would be interesting to add them to the characterization of both groups of patients. The introduction should be considerably expanded with clinical and neurocognitive aspects of schizophrenia, as well as quality of life in chronic patients. An element to be debated is also that with the implemented activity, a better quality of wakefulness of patients has been promoted, which is altered at the level of circadian rhythmicity in a specific way (European Archives of Psychiatry and Clinical Neuroscience, 2024, 274, 279-290). Avoid, on the other hand, making reference to other pathologies such as Parkinson's and dementia in relation to the interventions.
– Suicide attempts (Journal of Affective Disorders, 2024, 365, 381-399) and premorbid functioning (Progress in Neuropsychopharmacology & Biological Psychiatry, 2021, 110, 110-310) are factors related to cognitive performance in patients with schizophrenia. It would be interesting for the authors to take this into account and, if this information is available, to analyze it in the study or to assess its absence as limitations.
– Parametric statistical analyses, with only 5 patients in a group, are not the most appropriate. Without considering application conditions, a minimum of 10 cases per group/condition is required to be applicable. Non-parametric statistics should be chosen. In addition, it is important to provide the effect sizes along with the p-values.
– The groups do not differ in their epidemiological and clinical characteristics considering the patients at the start, but do those who have dropped out contribute changes or some specific characteristic that can be associated with the dropout and can explain the results?
– After the theoretical and analytical adjustments, the discussion should be improved, with very measured statements given the limitations of the study but with greater theoretical foundation than the current one and detailing practical aspects to continue studying in the future. In this sense, it is of interest to collect whether these interventions can be cost-effective in the comprehensive treatment of patients with schizophrenia.
See basic reporting.
See basic reporting.
The manuscript is written in clear and professional English, with an appropriate structure for a research article. The introduction provides a good overview of the background and rationale for the study, with relevant literature references. The figures are generally of good quality and well-labeled, although some improvements could be made to enhance clarity (see Additional comments). The authors have provided access to their raw data, which is commendable.
The research question is well-defined, relevant, and meaningful. The study addresses an identified knowledge gap by investigating the specific effects of dance intervention on clinical symptoms, cognitive function, and physiological indicators in patients with chronic schizophrenia. The study design is appropriate, with a randomized controlled trial comparing a dance intervention group to an aerobic exercise group. The methods are described in sufficient detail to allow for replication, although some clarifications would be beneficial (see Additional comments). The research question is well-defined, relevant, and meaningful. The study addresses an identified knowledge gap by investigating the specific effects of dance intervention on clinical symptoms, cognitive function, and physiological indicators in patients with chronic schizophrenia. The study design is appropriate, with a randomized controlled trial comparing a dance intervention group to an aerobic exercise group. The methods are described in sufficient detail to allow for replication, although some clarifications would be beneficial (see Additional comments). The research question is well-defined, relevant, and meaningful. The study addresses an identified knowledge gap by investigating the specific effects of dance intervention on clinical symptoms, cognitive function, and physiological indicators in patients with chronic schizophrenia. The study design is appropriate, with a randomized controlled trial comparing a dance intervention group to an aerobic exercise group. The methods are described in sufficient detail to allow for replication, although some clarifications would be beneficial (see Additional comments).
The statistical analysis appears to be generally sound, although a more detailed examination of the data would be necessary to confirm this. The authors have used appropriate statistical methods for analyzing their data, including repeated-measures ANOVA and partial correlation. The results are presented clearly, and the conclusions are well-stated and linked to the original research question. However, there are some concerns about the potential impact of certain factors on the interpretation of the results (see Additional comments).
Lines 50-52: Please clarify the specific change being referenced. Is it the change from baseline to the end of the trial?
Lines 79-80: A recent meta-analysis suggests that currently approved first- and second-generation antipsychotics are insufficient for improving cognitive impairment in schizophrenia.
Line 85: Restlessness is a known extrapyramidal side effect. This section needs to more clearly demonstrate the limited effectiveness of first- and/or second-generation antipsychotics on both negative and cognitive symptoms. Furthermore, please provide additional evidence supporting the claim that these side effects hinder the recovery of negative and/or cognitive symptoms in patients with schizophrenia.
Lines 183-215: The manuscript mentions a learning procedure for the dance group. Was the baseline assessment conducted before or after this learning procedure? How was the impact of this learning procedure on patient outcomes assessed? Did the aerobic exercise group undergo a similar learning process?
Figure 4: This figure indicates significant improvements in HVLT-R and CPT-IP in the dance intervention group. Visually, the dance group appears to reach a similar level to the aerobic exercise group by the end of the trial, while the aerobic exercise group shows less change from baseline. While the manuscript states no significant difference in overall cognitive function at baseline (Line 288), were there significant differences between the two groups in HVLT-R or CPT-IP specifically at baseline? How might this potential difference impact the interpretation of the results? Given that all MCCB subdomains were assessed, please include a supplementary table detailing the changes in each subdomain to provide a comprehensive view of cognitive function changes.
Lines 394-402: The manuscript notes a link between CYS-C levels and CPT-IP in the dance intervention group, and mentions the association of CYS-C with cognitive function in other neuropsychiatric disorders. Could CYS-C levels predict cognitive function (specifically CPT-IP) at baseline or at the end of the trial? Given that the dance group exhibited lower CPT-IP scores and lower CYS-C levels compared to the aerobic exercise group (as shown in Figures 4 and 5), could regression analysis of CYS-C levels against CPT-IP scores be used to better understand the cognitive profile of these patients (at least partially)?
Clear and unambiguous, professional English used throughout. Literature references, sufficient field background/context provided. Professional article structure, figures, tables. Raw data shared.
THe methods and the presentation of the results are very good. The aims and the scope of the journal are considered. The article meets the standards of the journal.
THe results and the conclusions are good, however dance therapy can lead to extrapyramidal symptoms, such as convulsions of the eyes. The paragraphs meet the standards of the journal.
Negative effects of the dance therapy should also be indicated, for example EPS and the fact that a schizophrenic patient cannot do so many exercises, needs time to rest.
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