Inability to perform because of pain/injury in elite adult Irish dance: A prospective investigation of contributing factors

Development of an Online Dance Injury Surveillance System (ODISS): A Delphi Consensus, Usability, and Feasibility Study

OBJECTIVES

To develop an optimal outline for an online dance injury surveillance system (ODISS) based on expert consensus from a Delphi survey and evaluate the system's usability and feasibility within a fictional folk-dance academy setting.

BACKGROUND

Dance is characterized by intensive training and performance, which can elevate susceptibility to injuries. Robust surveillance systems are required to understand and mitigate this injury risk. Current systems exhibit limitations and lack uniformity.

METHODS

A Delphi panel of 35 stage 1 experts were recruited through snowball sampling from online professional networks, professional dance associations, organizations, and academies. Inclusion criteria were ≥18 years of age, fluent in English, and worked as dance academics or researchers, clinicians, instructors, managers, or competitive or professional dancers. These stage 1 experts were provided with a preliminary outline of a dance injury surveillance system that covered 6 domains: dancer demographics and screening, exposure monitoring, injury identification and classification, injury management, dancer recovery and system access. Stage 1 experts then voted on the importance of and provided feedback on different design elements within each domain across 2 Delphi survey rounds to determine a consensus system design outline. A pilot system was then developed and evaluated by stage 2 experts, who were end-users and included dance instructors and administrators from various dance academies/institutions recruited through direct invitations. These stage 2 experts utilized the System Usability Scale (SUS) and System Feasibility Measure (SFM) based on application to a fictional folk-dance injury scenario.

RESULTS

In survey round 1, the stage 1 experts reached consensus to include 30 elements and exclude 3 elements and demonstrated mixed opinion on 30 elements that were revised into 14 elements for further consideration in round 2. All but 1 element reached consensus to include after round 2. System testing demonstrated low marginal usability (SUS score: 58.2% ± 11.6%). Stage 2 experts agreed or strongly agreed the system was feasible for 86.7% ± 10.3% of SFM statement ratings. Key areas for improvement identified from stage 2 expert feedback were a need for an improved user interface and strategies to reduce data entry time burdens. A common suggestion was to integrate more dropdown and checkbox response options within the interface to increase efficiency of data entry.

CONCLUSION

This study established a Delphi-consensus on the essential design elements for an ODISS. Expert evaluation resulted in a usable and feasible online system that can be used to improve future dance injury surveillance research across dance populations.Level of EvidenceThe usability and feasibility portion of the study falls under Level 3 evidence according to the Centre for Evidence-Based Medicine (CEBM) hierarchy. Whereas the Delphi portion of the study is at Level 5 Evidence on the CEBM hierarchy.

An Exploration of Low Back Beliefs of Male Pre-Professional and Professional Dancers

BACKGROUND

Globally, male dancers are affected by low back pain (LBP) up to 2.5 times more than female dancers. While female dancers' beliefs around LBP and dance-specific low back movements exist, no research has explored male dancers' beliefs. This study aimed to (1) examine the low back beliefs of Australian male professional and pre-professional dancers, and (2) determine if beliefs toward common low back movements and lifting differed when current LBP or history of disabling LBP (DLBP) were considered.

METHODS

40 male dancers (mean age [SD] 26.9 years [7.9]) from a range of dance backgrounds (all participating in ballet) were recruited to complete a cross-sectional survey comprising a beliefs questionnaire considering dance-specific movement and lifting tasks, the Back Pain Attitudes Questionnaire (Back-PAQ) and the Athletic Fear Avoidance Questionnaire (AFAQ). Primary analysis included initial descriptives, a repeated measures ANOVA for movement-specific beliefs and visual thematic analysis for written responses within the belief's questionnaire. Secondary subgroup analysis included independent T-tests for those with/without current LBP and those with/without a history of DLBP.

RESULTS

Fourteen dancers reported current LBP and 30 reported a history of DLBP. Dancers held generally negative beliefs toward the low back (Back-PAQ mean 123.1 ± 9.7) with neither subgroup demonstrating significant between-group difference (P < .05). Dance-specific flexion movements were seen as safer than extension movements (P < .05), and more extended-spine lifting was seen as safer than more flexed-spine lifting (P < .05). Dancers experiencing current LBP held less positive beliefs surrounding some dance-specific movements.

CONCLUSIONS

Dancers hold negative general beliefs toward the low back irrespective of current or historical DLBP, however their beliefs surrounding dance-specific movements were relatively positive. Dancers' beliefs surrounding some movements were affected by the presence of current LBP, in particular an arabesque and a fish dive.

Irish Dancing Injuries and Associated Risk Factors: A Systematic Review

Irish dance is growing in popularity, evolving to a more athletic and demanding dance style. The aim of this study is to conduct a systematic review, previously registered with PROSPERO, to identify the prevalence, incidence, and the injury pattern among Irish dancers and analyse the associated risk factors. Six online databases and two dance-specific science publications were searched systematically. Studies were included if the patterns of injuries among Irish dancers were evaluated or the factors associated with injury were analysed, published in English or Portuguese, in peer-reviewed scientific journals. Four reviewers assessed the quality and level of evidence using the Downs and Black criteria and a modified Oxford Centre of Evidence-Based Medicine 2009 model, respectively. Eleven articles were included, eight of Level 3c (cross-sectional) and three of Level 3b (prospective). Mean DB percentage score was 63% ± 7.2%. Prevalence ranged from 72.2% to 92.6%, affecting mostly the foot/ankle complex. Only two articles reported incidence, which ranged from 3.4 to 10.6 injuries/1000 h danced depending on injury definition. Psychological factors, elite level, and insufficient/poor sleep were associated with musculoskeletal injury. Injury prevalence and incidence is high in Irish dancers, with the foot and ankle being more affected. Due to heterogeneity in injury definitions, methods, and populations, along with the need for improvement in studies quality, recommendations were made for future research.

Longitudinal Validation of a Specific Measure of Fear Avoidance in Athletes: Predicting Time from Injury to Return to Sports Competition

Purpose

We developed the Athlete Fear Avoidance Questionnaire (AFAQ) to measure fear avoidance in athletes. Previous fear avoidance scales were developed for the general population and have demonstrated significant predictive capabilities regarding rehabilitation. No research to date has examined the association between athlete fear avoidance as measured by the AFAQ and the rehabilitation time in athletes.

Patients and Methods

Fifty-nine athletes who were injured during sport season participated in the study (40 males and 19 females). At injury onset, all participants completed self-report functional questionnaires. In addition, we measured multiple aspects of fear avoidance including athlete fear avoidance (AFAQ), kinesiophobia (TSK), and pain catastrophizing (PCS). Finally, we assessed pain severity and interference, as well as depression. Once the athletes were able to return to competition all participants answered the questionnaires again. Pearson correlations and a regression analysis were used to identify relationships between function, psychological variables, pain, and return to competition time.

Results

The AFAQ yielded the strongest correlation with return to competition time (r=0.544, p<0.001). In addition, function at initial injury time and pain interference were also significantly correlated with return to competition time (r=0.442, p<0.001 and r=0.356, p=0.006 respectively). Athlete fear-avoidance combined with function at the time of injury explained 34% of the variance of return to competition time in the multivariate regression model (p<0.001).

Conclusion

Athlete fear-avoidance as measured by the AFAQ is associated with rehabilitation time and returning to competition in injured athletes. Psychosocial factors including athlete fear avoidance may explain why some athletes take longer to rehabilitate than others and should be evaluated in athletes who are taking longer than anticipated to complete their rehabilitation. Reducing athlete fear avoidance may facilitate rehabilitation in future studies.

The Association Between Poor Sleep and the Incidence of Sport and Physical Training-Related Injuries in Adult Athletic Populations: A Systematic Review

BACKGROUND

The importance of achieving an adequate amount of sleep to optimize health and athletic performance is well recognized. Yet, a systematic evidence compilation of the risk for sport-related injury in adult athletic populations due to poor sleep does not exist.

OBJECTIVE

To examine the association between poor sleep and sport and physical training-related injuries in adult athletic populations.

DATA SOURCES

Electronic databases were searched using keywords relevant to sleep quantity and quality, and musculoskeletal injury and sport-related concussion (SRC).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included in this systematic review if they were comprised of adult athletic populations, reported measures of sleep quantity or quality, followed participants prospectively for injury, and reported an association between sleep and incidence of sport or physical training-related injury.

STUDY APPRAISAL

The methodological quality of each study was assessed using the Newcastle-Ottawa Scale for Cohort Studies.

RESULTS

From our review of 12 prospective cohort studies, we found limited evidence supporting an association between poor sleep and injury in adult athletic populations. Specifically, there is (a) insufficient evidence supporting the associations between poor sleep and increased risk of injury in specific groups of athletic adults, including professional or elite athletes, collegiate athletes, elite or collegiate dancers, and endurance sport athletes; and (b) limited evidence of an association between poor sleep and increased risk of SRC in collegiate athletes.

CONCLUSIONS

The current evidence does not support poor sleep as an independent risk factor for increased risk of sport or physical training-related injuries in adult athletic populations. Given the methodological heterogeneity and limitations across previous studies, more prospective studies are required to determine the association between sleep and injury in this population.

The relationship between the functional movement screen, star excursion balance test and the Beighton score in dancers

Objectives: To determine the association between the Functional Movement Screen (FMS), Star Excursion Balance Test (SEBT) and the Beighton Score (BS) in dancers with implications for performance and injury.Methods: The study was of cross-sectional design and included 47 female university dancers (age: 20.4 ± 0.7 years, height: 160.5 ± 5.8 cm; mass: 55.6 ± 4.8 kg). Participants completed the FMS and the anterior, posteromedial and posterolateral reach components of the SEBT and hypermobility was assessed via the BS.Results: A fair significant correlation existed between FMS composite and total BS (r = 0.37, p = 0.01). For individual elements of the screening tools, there were 24 significant correlations between the FMS and the BS, 11 significant correlations between the FMS and SEBT and 4 significant correlations between the SEBT and BS.Conclusion: The FMS and the BS correlations highlighted the importance of the deep squat in functional movement and the relationship between FMS mobility elements and the BS. The significant correlation between the FMS and the BS may suggest that they capture similar information. The active straight leg raise and shoulder mobility measurements should be considered key elements to measure during screening.

Sport-related injury and pain classification

Pain is common in athletes, and pain management in sport has traditionally been equated with injury management. Although both pain and injury interfere with sport performance, they are not synonymous. Acute musculoskeletal injury commonly manifests as nociceptive pain, inflammatory pain, or both. Pain that persists beyond expected injury recovery must account for all potential contributors to pain, including ongoing biomechanical abnormalities, underlying pathophysiology, and psychosocial issues. Pain chronification involves multiple pathophysiologic and neurobehavioral processes that lead from acute injury-related pain to subacute and chronic pain, and must be distinguished from an ongoing biomechanical overuse pattern. The foundation of pain management in athletes is proper pain classification, which involves assessing for any combination of nociceptive/inflammatory pain, neuropathic pain, central sensitization, and autonomic/motor/affective manifestations of pain. Understanding this foundation is critical because there are scant evidence-based guidelines for the management of pain in sport. This chapter will explore the relationship of sport-related injury and pain, and will provide a management framework that is consistent with International Olympic Committee consensus.

Dance exposure, wellbeing and injury in collegiate Irish and contemporary dancers: A prospective study

OBJECTIVES

Dance exposure and determinants of wellness in Irish dance (ID) and contemporary dance (CD) are under-investigated in pre-professional, collegiate cohorts. This study prospectively investigated these variables in ID and CD participants for one year.

DESIGN

Prospective study.

SETTING

University-level institutes of dance, United Kingdom (UK) and Ireland.

PARTICIPANTS

Fifty (ID = 21, CD = 29) full time students of dance at Trinity Laban Conservatoire of Music and Dance, (UK) and the University of Limerick, Ireland.

MAIN OUTCOME MEASURES

Weekly hours of dance, general health, sleep quality, injury defined as "any pain or injury that impacted upon their ability to dance".

RESULTS

Dance exposure varied considerably for both genres across the year. CD participants danced for more hours weekly (p < 0.001). Overall injury incidence (time-loss and non-time-loss) was 10.6 and 8.4 injuries per 1000 h dancing for ID and CD groups respectively. 70.4% of injuries were non-time-loss. Better sleep (p = 0.007) and general health (p < 0.001) scores were negatively correlated with days lost/impacted by injury. CD participants reported a significantly higher dance exposure in the week prior to a time-loss injury than during the previous four weeks (p = 0.044).

CONCLUSIONS

Dance exposure is erratic in these cohorts with dancers frequently performing when injured. Poor sleep, general health, and increased dance exposure may be associated with injury.

Screening Tools as a Predictor of Injury in Dance: Systematic Literature Review and Meta-analysis

BACKGROUND

Dance involves movements of complexity and physical intensity which result in stress on the body. As a consequence, dancers are at risk of injury which can impact on their well-being. Screening tools are used for injury prevention to identify those dancers at risk of injury. The aim of this study was to investigate which screening tools can predict injury in dancers, encompassing all dance genres, levels and ages.

METHODS

An electronic search of seven databases from their inception to December 2017 was conducted. The databases were the Allied and Complementary Medicine Database (AMED), CINAHL, eBOOK Collection (EBSCOhost), MEDLINE, Cochrane Database of Systematic Reviews, SPORTDiscus and PEDro: the Physiotherapy Evidence Base. The following search terms were used: (i) Dance AND injury AND Screening, (ii) Screening AND dance and (iii) Musculoskeletal AND Screening AND Dance. Studies were assessed using a 20-point scoring tool, and eligible studies were included in a meta-analysis.

RESULTS

The mean methodological quality score was 12.2 points. Injured dancers had a significantly higher compensated turnout range of motion than non-injured dancers: pooled mean difference of compensated turnout (23.29°; 95% CI 14.85-31.73; P < 0.00001; I2 = 0%). Injured dancers had significantly greater functional turnout range of motion when compared to non-injured dancers: pooled mean difference of functional turnout (14.08°; 95% CI 7.09-21.07; P < 0.0001; I2 = 0%). There also some evidence for use of hip range of motion as a predictor of dance injury.

CONCLUSIONS

Some evidence exists for the potential use of dance-specific positions as a predictor of injury. A number of studies were limited by a lack of prospective injury design, injury definition and self-reporting of injury.

Life history and point prevalence of low back pain in pre-professional and professional dancers

OBJECTIVES

To investigate lifetime history and point prevalence of low back pain (LBP) in pre-professional and professional dancers and to identify any demographic or physical factors associated with LBP in dancers.

DESIGN

Cross-sectional study.

SETTING

One pre-professional ballet school, two pre-professional university dance programs, and a professional nationally touring ballet company.

PARTICIPANTS

Male and female classical ballet and contemporary dancers aged 12 years old and above.

MAIN OUTCOME MEASURES

Lifetime history and point prevalence of LBP.

RESULTS

A total of 110 (n = 19 male) dancers (mean (SD) 17.8 (2.9) years old) participated in the study, which represented 50% of the population invited to participate. A 74% lifetime prevalence of LBP was reported by dancers. Point and 12 month prevalence were 24 and 64%, respectively. No significant association was observed between LBP and any demographic or physical variables.

CONCLUSION

Pre-professional and professional dancers have an increased vulnerability to LBP. The development of LBP within this population is complex and may not be associated with individual factors measured in this study.