MUSIC-PD: A Delphi-Derived, Culturally Adaptable Music Therapy Protocol for Parkinson's Disease Rehabilitation

Music-based interventions have shown promise in Parkinson's disease (PD) rehabilitation. However, variability in intervention design, delivery, dose, and documentation limits clinical translation.

The aim of the study was to develop a consensus-based music therapy protocol for PD, designed to permit cultural and linguistic adaptation.

A PRISMA-informed evidence-mapping review identified music-based and rhythm-based interventions relevant to PD rehabilitation. Findings informed a modified Delphi process involving a multidisciplinary expert panel of movement disorder neurologists, qualified music therapists, and people with PD. Round 1 generated qualitative inputs on therapeutic domains, safety, feasibility, and cultural adaptation. These were synthesized into 36 structured statements and rated in Round 2 using a 5-point Likert scale. Consensus was predefined as ≥80% agreement.

The evidence map included 32 studies and identified 3 therapeutic clusters: motor/gait rehabilitation, voice-respiratory communication, and nonmotor cognitive-affective engagement. Of the 36 Delphi statements, 33 reached consensus. High-convergence domains included patient-preferred familiar music, cultural adaptation, rhythmic auditory stimulation for gait rehabilitation, multidomain symptom targeting, and vocal rehabilitation. The final framework was organized into LAYA-Locomotor Auditory Yielding Activation Module, NADA-Neurocognitive and Affective Domain Activation Module, and RAGA-Respiratory Aerodynamic Glottal Activation Module. The protocol incorporated session-selection rules, safety screening, difficulty levels, active and/or receptive therapy components, flexible pragmatic session guidance, caregiver-supported practice, and a proposed session-planning/documentation resource.

MUSIC-PD provides a structured, Delphi-derived, and panel-approved framework for integrating music-based interventions into multidisciplinary PD rehabilitation. It translates evidence and multidisciplinary consensus into a protocol intended for prospective feasibility, fidelity, safety, and efficacy evaluation.