Study Designs
By Ya-Ti Lin


Self-Reported Musculoskeletal injuries in professional ballet dancers in Taiwan

Purpose of the study
I hope to draw a broad picture to view the demographic characteristics and understand the prevalence of musculoskeletal injuries and their potential associations with physical, psychosocial, and environmental factors among professional ballet dancers in Taiwan.
The objectives are to prevent further injuries among professional ballet dancers. From the study, I intend to draw a guideline of preventive strategies for Taiwanese ballet companies to minimize the devastating injuries, which can possibly ruin professional ballet dancers?careers.
  1. Provide with a blueprint of the demographic characteristics of professional ballet dancers in Taiwan and their ballet training histories and work loads
  2. Find the behaviors of professional ballet dancers in reporting their dance-related injuries and understand the burdens of injuries that can possibly pose on professional ballet dancers
  3. Understand the prevalence of ballet injuries and associate the ones with high prevalence with potential risk factors that are self-reported by professional ballet dancers
  4. Observe what, if any, are environmental hazards that can be associated with injuries in professional ballet dancers
  5. Use the study results to initiate all three phases of prevention in ballet companies in Taiwan
Basis for the Research
The population of professional ballet dancers is unique because they are not merely athletes whose work intensity is no less than the one of football players but also they are artists who constantly strive to perfect the subtle and esthetic details in their performances. This special population needs a lot more attention than what is now from healthcare staff and researchers. The misunderstanding from the healthcare community was published as one of the multiple barriers for dancers to receive a proper treatment (Betty, 2000). Therefore, increasing funding in ballet injury researches can dramatically help direct the population towards a healthier and less injury and pain ideology. Ballet injury epidemilogy is a relatively new interest in epidemiologic research. The current resources are too limited to conduct a large population-based cohort or case-control studies. Also, finding comparable controls for professional ballet dancers will be another challenging task due to the dancers?uniqueness in the ability to cope with physical and psychological stress. It is believed that the difficulties and limitations in conducting a ballet injury epidemiologic study have discouraged a lot of researchers who have once thought about this forgotten population. Nevertheless, I want to use the limited resource to generate my fullest possible from this study.
Type of Study Design
  1. Study population
    Samples are professional ballet dancers from the three major ballet companies, the Capital Ballet Company in Taipei, the Imperial Ballet Company, in Taichung, and the Kaohsiung City Ballet in Kaohsiung. All three are from northern, middle, and southern Taiwan respectively.
  2. Case ascertainment
    Dancers include principal dancers, soloists, and corps de ballet and they must be in the same company for at least 3 years to be included into the study. Due to the extremely unbalanced male-female ratio in ballet companies in Taiwan, the study only focuses on female dancers.
  3. Definitions
    The study is a cross-sectional survey to measure the prevalence. The study allows some assessments of associations for future causal thinking. Questionnaire is designed to specifically answer the questions this study wants to ask and the response rate is forecasted to be high from the previous experiences of other related studies done in other countries.
  4. Major variables
    Some anthropometric variables include age, height, weight Some basic personal variables such as years of dance training, years of being in the ballet companies, previous injuries, medical histories, flexibility scores using the Beighton’s Methods (can be evaluated on site), Range of motion (ROM) in the lower extremity using standard goniometers, number of performances per 6 months, total duration of training and rehearsal per 6 months, the hierarchy of position in ballet as principal dancers, soloists, or corps de ballet for the intensity measurement. Some major environmental variables are such as type of flooring surfaces and the temperature in studios and theaters.
    Also whether the daily one and a half hours of ballet class is properly organized in the designated sequence during both the barre exercises and also center practice. For example, the sequence in the center practice can be adagio(slow exercises), follow by pirouettes (turns), petit allegro (small jumps), and then the grand allegro(big jumps). Also the habits of warming up and cooling down are asked as a part of the behavioral assessment.
    Psychological variables are collected by asking about their stress level due to their profession as dancers and the tolerance levels about the pains they have sustained constantly.
  5. Outcomes
    By using the self-administered survey, some outcome variables are as follows. Injuries in the neck, shoulders, upper back, elbows, low back, wrists/hands, hips/thighs, knees, ankles/feet and with more specific injuries such as scoliosis, bunions, chondromalacia, knee ligament strain, stress fractures in the metatarsals, stress fractures of the middle third of the anterior tibia (where there are no muscle attachments), shin splints, tendonitis, hamstring strains and also the health concerns of amenorrhea and nutrition in dancers.
Analytic Approach
For the description of data, mean and range values were used. The chi-square test was applied for statistical evaluation of differences between groups. The level of significance was set at p<0.05.
Betty B., Kelman MN. Occupational Hazards in Female Ballet Dancers: Advocate for a forgotten population. AAOHN Journal 2000;48: 430-434.

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