Exploring the integration of drama therapy with neurorehabilitation in adults with acquired neurological conditions: a quasi-experimental pilot study

Neurological disorders frequently impair emotional expression, social interaction and psychological wellbeing dimensions inadequately addressed by conventional rehabilitation protocols alone [1, 2]. Drama therapy, an action-oriented expressive modality employing theatrical techniques, offers a complementary approach to address these psychosocial dimensions during neurological recovery [3, 4]. To explore the feasibility and preliminary signals of potential benefit of structured drama therapy as an adjunctive intervention alongside conventional neurorehabilitation in improving psychosocial and functional outcomes in individuals with acquired neurological conditions. A quasi-experimental pilot study with a single-group pre-test and post-test design was conducted in India in December 2025. Seven participants (mean age 45.3 ± 12.8 years) with hemiplegia and paraplegia received 6 weeks of drama therapy (three 60-minute sessions weekly) concurrently with conventional physiotherapy. Primary outcomes included perceived stress (Perceived Stress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg Self-Esteem Scale), insomnia severity (Insomnia Severity Index), group cohesion (Group Climate Questionnaire) and quality of life (Short Form-36 Health Survey). Analysis employed paired t-tests with exploratory inferential statistics appropriate for small pilot samples. Within-group improvements from baseline to post-intervention were observed in perceived stress (mean change: −5.57 points, 95% CI 1.44–9.70; t = 3.38, p = 0.013), depression (mean change: −0.86 points, 95% CI 0.03–1.69; t = 2.52, p = 0.045), self-esteem (mean change: +5.14 points, 95% CI 3.75–6.53; t = 8.72, p < 0.001), Physical Component Summary of quality of life (mean change: +6.38 points, 95% CI 4.20–8.56; t = 6.50, p = 0.0007) and Mental Component Summary (mean change: +13.79 points, 95% CI 12.18–15.40; t = 17.43, p < 0.0001). Group engagement increased significantly (t = − 7.25, p < 0.01) and conflict decreased (t = 3.10, p < 0.05). Anxiety (t = 1.00, p = 0.356) and insomnia severity ( p > .05) showed no significant change. Effect sizes were uniformly large; however, these estimates are inherently unstable in samples of n = 7 and are very likely inflated. They should not be interpreted as reliable indicators of true treatment magnitude and require replication in adequately powered studies. Effect size estimates are provided primarily for descriptive purposes and to inform future sample size estimation and should not be interpreted as reliable indicators of true treatment magnitude in this small exploratory sample. This exploratory pilot study provides preliminary evidence that drama therapy integrated with conventional neurorehabilitation is feasible and associated with within-group improvements in psychosocial wellbeing, self-esteem and quality of life. However, the single-group design, small sample ( n = 7), lack of control comparator, concurrent conventional therapy and subacute recovery phase (approximately 8–9 weeks post-event) preclude causal inference. Observed changes may reflect natural neurological recovery, non-specific therapeutic attention, concurrent rehabilitation or socialization effects. These hypothesis-generating findings support the need for adequately powered randomized controlled trials with active control groups to definitively establish efficacy, isolate mechanisms and determine long-term sustainability of potential benefits.