The annual frequency of injury among dancers has been reported to range between 23-84% while as many as 95% of professional dancers have ongoing pain. The discrepancy between the number of reported injuries and the amount of pain reported at any given time could be related to the definition of injury, or how dancers' themselves perceive injury with respect to pain and activity limitation thresholds. For many reasons, dancers may be dancing through or past what health care providers may conceive as injury. This can put them at risk of further or chronic injury. The purpose of this study is to understand at which point pain limits a dancer's ability to continue to perform and whether this is influenced by available medical services, a supportive dance environment, or other factors. In addition, the issue of non-reporting of injuries will be studied. This is very important as this will affect all measures of injury frequency and risk for dancers.

Brief Rationale and Objective:

The annual frequency of injury among dancers has been reported to range between 23-84% while as many as 95% of professional dancers have ongoing pain. The discrepancy between the number of reported injuries and the amount of pain reported at any given time could be related to the definition of injury, or how dancers' themselves perceive injury with respect to pain and activity limitation thresholds. For many reasons, dancers may be dancing through or past what health care providers may conceive as injury. This can put them at risk of future recurrent or chronic injury. The purpose of this study is to gain insight into professional dancers' perception of musculoskeletal (MSK) injury in order to understand at which point pain limits a dancer's ability to continue to perform and to determine what factors influence a dancer's perception of injury and decision to seek or not seek care. We will investigate whether this is influenced by available medical services, a supportive dance environment, or other factors. In addition, the issue of non-reporting of injuries will be studied. This is very important because it affects all measures of injury frequency and risk for dancers.

Research Questions:

The purpose of this study will be to answer the following questions: 1) What is the prevalence of MSK injury-related pain in the dance company? 2) What are the pain and activity limitation thresholds for a dancer to consider him/herself injured? 3) What factors are associated with considering him/herself injured? 4) What constitutes a major or a minor injury to a dancer? 5) How are dancers reporting their injuries? 6) How many dancers are not reporting their injuries and what are the reasons? 7) Do the answers to the above questions differ between countries (Canada, Israel, Sweden, Denmark) that have varying levels of social and medical support for dancers?

Design and Methodology:

Design: Cross-sectional survey. Study Population: All dancers employed by: The National Ballet of Canada, Toronto Dance Theatre, Batsheva Dance Company and Ensemble (Israel), The Kibbutz Contemporary Dance Company (Israel), the Royal Swedish Ballet (Sweden), and the Royal Danish Ballet (Denmark). Total approximate number of participants is 294. Methods: Two questionnaires will be distributed to participants. The Self-Estimated Functional Inability because of Pain (SEFIP) questionnaire is a validated tool for dancers which has shown good agreement with actual pain found on physical examination. The SEFIP will be used in order to measure pain and functional deficits. An additional questionnaire will be used to gain further information regarding the above research questions. There will be an area for the dancers to include any additional comments in relation to these subjects in order to capture further qualitative data. Data Analysis: Descriptive statistics will be reported in the form of percentages and means with standard deviations. Non-parametric tests will be used to analyze categorical variables. 95% confidence intervals will be reported for each analysis. The qualitative data captured in the open-ended questions will be analyzed for common themes in order to provide further explanation for the quantitative data as well as to provide additional information for further research.

Significance:

A recent systematic review of the dance injury literature stressed the necessity of a standardized definition of injury for future research studies involving dancers. This study will attempt to address the dancer's perspective in regards to perception of injury. We believe this international study will provide insight into the frequency and reporting of dance-related pain and some potential factors that influence this. Ultimately, we hope to improve the health-related quality of life for dancers with musculoskeletal injury.

Inclusion Criteria:

• All dancers employed by the National Ballet of Canada, Toronto Dance Theatre, Batsheva Dance Company and Ensemble, Kibbutz Contemporary Dance Company, the Royal Swedish Ballet, and the Royal Danish Ballet will be included in the study. Additional dance companies from Sweden, Israel, Denmark and Canada (and other countries) may be invited to participate. If so, then identical protocols will be followed for all companies.

Exclusion Criteria:

• Any dancer less than 18 years of age will be excluded from the study.

Professional Dancers