An Updated Systematic Review of Turnout Position Assessment Protocols Used in Dance Medicine and Science Research

Turnout, or external rotation of the lower limbs, is an integral part of classical ballet technique. Contributions of lower limb structures to turnout can be separated into HER (hip external rotation) and NHCTO (non-hip contributions to turnout). This study aimed to review systematically methods used to measure turnout in dance medicine and science research, thereby updating the literature since the Champion and Chatfield review of 2008. CINAHL, EMBASE, PubMed, and Web of Science were searched in January 2018 by two independent reviewers. Peer-reviewed studies measuring turnout in dance were included, except those published prior to March 23, 2006, as that was the last date of publication included in the previous review. Abstracts, theses, and editorials were excluded. From each study, study design, population (sample size, sex, age, genre of dance, and level of training), details of the protocol used, and result of turnout measurement were extracted, as well as reliability data. All included studies were assessed for risk of bias, using either Newcastle-Ottawa scale, AXIS tool, or PEDro scale as appropriate for each study design. A total of 41 studies met the inclusion criteria. Twenty-eight studies measured HER, nine measured NCHTO, and 22 measured total turnout (TTO). An increased number of studies investigated TTO (N = 22; N = 4 passive TTO) and NHCTO (N = 9) since 2006. All studies scored above half the points attainable from their respective tools. Results suggest HER remains the most common protocol for measuring turnout (N = 28), despite the fact it disregards input from structures below the hip. It is concluded that researchers should focus on quality of reporting of protocols to ensure repeatability and facilitate comparison of results. Future studies should include absolute reliability and validity testing of all currently used protocols so that standardization can be fully achieved.

Are the Current Balance Screening Tests in Dance Medicine Specific Enough for Tracking the Effectiveness of Balance-Related Injury Rehabilitation in Dancers? A Scoping Review

Aims: This review sought to determine the extent to which balance screening tests in dance medicine are representative of dance movements and to determine if such tests can be used to empirically track the effectiveness of balance-related injury rehabilitations in dancers. Methods: A five-step scoping review method was used. Multiple databases and reference lists of identified studies were searched to obtain original research published between 2000 and 2020 that described the balance screening tests used for data collection. Articles were excluded if they were: qualitative studies, reviews, opinion papers, consensus statements, conference proceedings, or used questionnaires to collect balance performance data. Results: Fifteen of the 31 studies included in this review used different models of force platforms in their balance screenings. The Star Excursion Balance Tests (SEBT) and its variants were used by 12 studies, single-leg stance with eyes opened or eyes closed on stable versus unstable surfaces was used by six studies, Airplane test (n = 6 studies), Pirouette Test (n = 3 studies), Romberg and variants of modified Romberg Tests (n = 3 studies) were also used for balance screening. Conclusion: Currently, there is no specific screening test that can be used empirically to screen balance performances among dancers. None of the currently available balance screening tests are specific enough for tracking the effectiveness of balance-related injury rehabilitation or for making a return to dance decision after balance-related injury rehabilitation.

Health Literacy for Collegiate Dancers: Provision and Perceptions of Health-Related Education in University Dance Programs

Dancers have unique health issues, including high injury rates and functional, nutritional, and psychological concerns. Thererfore, developing dancers with high health literacy is crucial. This study examines 1. the types of health-related information offered in university dance programs, and 2. the perceptions of dance stakeholders (administrators, faculty, and students) toward health-related education provided to dancers in these programs. Participating stakeholders (N = 104) from 11 countries completed a web-based survey examining health-related offerings for dance students at their instituitions. Eighty-four participants (81%) indicated that health-related information was delivered at their instituition. The most commonly offered topics included functional dance anatomy (N = 82, 98%), recognizing dance injuries and illnesses (N = 66, 79%), and strength and conditioning for dancers (N = 61, 73%). Participants rated recognizing dance injuries and illnesses (N = 72, 69%), basic personal health (N = 70, 67%), and nutrition (N = 68, 65%) as the top three "extremely important" topics, even if these were not offered at their institution. Faculty and administrators reported similar attitudes toward topic importance as those reported by students. Fifty-five respondents (65%) reported textbooks were used to deliver health-related information, and content was also provided via journal articles (N = 58, 69%), organizational web sites (N = 39, 46%), and social media (N = 16, 19%). Reported barriers to providing adequate education included lack of dance faculty expertise to deliver course content (N = 7) and receiving care from practitioners lacking in knowledge of dance medicine (N = 5). Participants generally agreed that making health-related information available was important, and 81% of respondants indicated that it was formally offered at their institution. Variability was noted regarding topics rated "highly important," as compared to which topics were already provided. These findings offer insight into the current status of health-related education provided to dance students and can be used to improve curricula in university dance programs.

Inclusion of Dancer Wellness Education Programs in U.S. Colleges and Universities: A 20-Year Update

During the 1990s dancer wellness education began to be codified and understood empirically in U.S. colleges and universities. Those efforts stemmed from a burgeoning knowledge base in dance medicine and science that continues to evolve. However, the current status of dancer wellness education remains largely undocumented. The purpose of this study was to explore the inclusion of dancer wellness education in U.S. colleges and universities. The results were derived from a cross-sectional study of 199 higher education dance administrators at 4-year institutions that were selected using stratified random sampling procedures with data collected through an online survey. Seventy-two participants (36.18%) completed at least part of the survey, and of those 62 (86.11%) completed the entire survey. The majority of dance programs were undergraduate-only (71%), not accredited by the National Association of Schools of Dance (67%), and emphasized dance performance and choreography (89%). Sixty percent offered a formal dancer wellness program, 70% had at least one dancer wellness specialist on faculty, and 20% offered training programs to become dancer wellness specialists. Fewer than half (42.19%) preferred their faculty to have college or university level study in dancer wellness, and only 17.19% required it. Of 11 possible curricular topics, the typical undergraduate program included 64.52% and the typical graduate program 51.87%. Regardless of program level, the top five topics were anatomy, kinesiology, somatics, dance conditioning, and dance injuries. The average school offered 58% of identified supplementary programs at "high levels." Only modest differences were found between programs based on degree level, accreditation status, or program affiliation. Although some positive trends in the evolution of dancer wellness education have occurred over the last two decades, there remains a need for ongoing advocacy and widespread implementation in U.S. colleges and universities.

Intra- and Inter-Rater Reliability of a Ballet-based Dance Technique Screening Instrument

OBJECTIVES: To investigate intra- and inter-rater reliability of a ballet-based Dance Technique Screening Instrument used by physical therapists (PTs) and student PTs (SPTs) with prior dance medicine or dance experience. METHODS: Ten pre-professional dancers were video-recorded in the sagittal and frontal planes while performing four dance sequences: 1) second position grand plié; 2) développé à la seconde; 3) single-limb passé relevé balance; and 4) jumps in first position. Dance videos and electronic versions of the demographics and scoring forms were provided through a secure online survey to 28 PTs and SPTs who served as raters. Raters reviewed a training video prior to scoring the 10 dancers. Raters were asked to repeat their assessments 1–2 wks later. Intraclass correlations (ICC) were assessed for all-raters, PTs, and SPTs for total and sequence scores. RESULTS: Twenty-eight raters assessed the videos one time. Inter-rater reliability was ICC=0.98 (CI95=0.96–0.99) (all-raters), with PTs and SPTs displaying similar values (ICC=0.96 and 0.96, respectively). Eighteen raters (11 PTs, 7 SPTs) repeated the video analysis. Intra-rater reliability was ICC=0.78 (CI95=0.72–0.83) with PTs ICC=0.81 and SPTs ICC=0.70. CONCLUSIONS: Correlations were high for all-raters. SPTs were as reliable as PTs in inter-rater comparisons. PTs exhibited higher intra-rater reliability compared to SPTs. These results substantiate the reliability of a standardized testing instrument to conduct dance technique assessment. Validity of this instrument was demonstrated in a previous study which found dancers with better technique were less likely to sustain injury. The ability to identify technique deficits can guide preventative programs that may reduce injury risk. LEVEL OF EVIDENCE: Level III.

Dancer Wellness. By M. Virginia Wilmerding and Donna H. Krasnow.

Dancer Wellness is a comprehensive text for dancers and dance educators to better understand health and wellness in the context of their craft. Though not intended for this purpose, this resource may also be a beneficial tool in allowing allied healthcare professionals to repackage knowledge that was obtained in a traditional (sports) medicine context to the otherwise unchartered world of dance medicine and science. As a former dancer turned sports medicine practitioner and researcher, I appreciate what this text has done to bridge the gap by transferring knowledge and skills across disciplines.