Psychometric Properties of the Dance Functional Outcome Survey (DFOS): Reliability, Validity, and Responsiveness

Translation, cross-cultural adaptation, reliability and validity of the Brazilian Portuguese version of the 'Fit to Dance?' survey

BACKGROUND

The 'Fit to Dance?' survey has been used in a number of studies to understand the health and wellbeing of dancers. These data have not been collected in Brazil as there is no validated questionnaire available in Brazilian Portuguese, culturally validated in Brazil with a scope as broad and comprehensive as that of 'Fit to Dance?'.

OBJECTIVE

Translate into Brazilian Portuguese and culturally validate the questionnaire 'Fit to Dance?' in Brazil.

METHODS

This was a validity and reliability study of the Brazilian Portuguese version of the 'Fit to Dance?'

SURVEY

The stages of the research were: translation into the target language (Brazilian Portuguese), translation synthesis, translation validation and cross-cultural adaptation by a committee of experts in Dance Medicine and Science (DMS), reverse translation into English, pilot study (test/retest), and final version of the questionnaire.

RESULTS

The questionnaire was applied to 21 dancers of different dance genres, with an age average of 25 ± 7.0 years. Cronbach's alpha (0.705), ICC (0.984) and Kappa (0.794) results reached adequate values.

CONCLUSION

The Brazilian Portuguese version of the questionnaire 'Fit to Dance?' is effective, has adequate levels of validity and reliability, and can be used to report injuries and aspects of health and well-being of Brazilian dancers.

Development and Feasibility of an Adolescent Dancer Screen

Background

Adolescent dancers are at high risk for injuries due to the physical demands of dance training and the physiological changes that occur during adolescence. Though studies report high injury rates, there are few standardized screening tools available for adolescent dancers.

Hypothesis/Purpose

To develop and describe a standardized, feasible, evidence-based, and clinically relevant screen for adolescent dancers.

Study Design

Descriptive Epidemiology Study.

Methods

Dancers at two suburban pre-professional dance studios, in two cohorts, participated in the Columbia Adolescent Dancer Screen (CADS) that includes dance injury history, health questionnaires (EAT-26, SF-36, DFOS), aerobic capacity, range of motion, strength, balance/orthopedic special tests, and dance technique. Participants were asked to complete a weekly injury surveillance questionnaire derived from the Dance-Specific Oslo Sports Trauma Research Centre Questionnaire on Health Problems for 14 weeks following the screening. Feasibility was assessed using process and content analysis in four areas: practicality, demand, implementation, and adaptation.

Results

Descriptive data were collected from 32 female dancers aged 11-17 with cohort one averaging 18.57 dance hours per week and cohort two averaging 10.6 dance hours per week. The screen was practical, able to screen seven to eight dancers per hour utilizing nine assessors and requiring a one-hour commitment from dancers. Cost and space requirements were considered and kept to a minimum while utilizing portable equipment. All screening slots were filled with all dancers agreeing to follow-up injury surveillance, indicating high demand. The screen was implemented with two cohorts with revisions to improve efficiency applied for the second cohort.

Conclusion

The CADS is a feasible screening tool for adolescent dancers that overcomes barriers by being pragmatic, evidence-based, and efficient. Screening can be implemented to obtain baseline values, inform wellness recommendations, and establish relationships with medical professionals.

Level of Evidence

Level 3b.

Development of a Multidimensional Pain Questionnaire in Professional Dance (MPQDA): a pilot study

Background

Pain is part of the everyday life of professional dancers. It can indicate health risks and impair the ability to work. Suitable screening tools can be used to identify pain and its risk potential. A comprehensive, multidimensional, differentiated assessment tool for pain in professional dance does not currently exist.

Methods

An initial questionnaire was developed in German and English and was assessed in a qualitative pretest. In a field study with a cross-sectional design including n = 72 dancers from Germany (n = 36 responses each in the English and German language versions), the questionnaire was optimized by item analysis, its psychometric properties (dimensionality, construct validity, reliability) were examined and the ability of the pain dimensions to classify the subjective ability to work in training was analyzed (ROC analysis).

Results

The developed Multidimensional Pain Questionnaire in Professional Dance (MPQDA) was reduced and optimized in its psychometric properties. Following questions were reduced in their items or answer categories: pain localizations (from 20 to 15 regions), accompanying symptoms (from 6 to 3 items), sensory and affective pain quality (from 20 to 10 items), pain frequency (from 4 to 3 answer categories), and the motives of working with pain (from 14 to 12 items). Regarding the subjective ability to work in training, the variables of the ability to work in rehearsals and in performances, as well as the accompanying symptoms of tension and mobility restrictions, showed a relatively good classification ability (Area under the Curve (AUC) ≥ 0.7 in the 95% confidence interval) and significant, moderate to strong correlations (Somers' D > 0.25, p < 0.05). The classification ability of the other pain dimensions was largely absent or poor.

Conclusion

The MPQDA differentiates various pain dimensions in professional dancers and is available in a compatible manner in German and English. The clinical relevance needs to be explored further in the future.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00580-5.

Posterior Ankle Decompression With Os Trigonum or Stieda Process Resection in Dancers: Case Series Report and Review of the Literature

This case series reports the outcome of posterior ankle decompression and os trigonum or Stieda process resection utilizing an open posterolateral approach in 54 professional, pre-professional, and dedicated recreational dancers. All procedures were performed by a single surgeon at the same facility between 2008 and 2018. The surgical technique is described in detail. Data related to results of the surgery were gathered via follow-up questionnaire and verified by referencing the patients' medical records. Outcomes were self-assessed in terms of categories ranging from excellent through moderate to poor. Eighty-nine percent of the dancers (N = 48 of 54) chose excellent or good, 11% (N = 6) chose moderate, and none selected poor. These results were compared with those achieved in 17 previous studies reporting the use of both open (posterolateral and posteromedial) and arthroscopic/endoscopic techniques in dancers. This comparison found similarly favorable reported outcomes, but also great variation in methodology for determining patient reported outcomes (PROs). While the preferred surgical technique for posterior ankle decompression remains controversial, the open posterolateral approach utilized in this series resulted in high expectation of return to dance with minimal complications. The need for a dancer-specific PRO tool is discussed.

The Impact of Dance-Specific Neuromuscular Conditioning and Injury Prevention Training on Motor Control, Stability, Balance, Function and Injury in Professional Ballet Dancers: A Mixed-Methods Quasi-Experimental Study

BACKGROUND

Professional ballet dancers suffer high injury rates and are less likely than other athletes to specifically train to improve muscular strength, coordination, agility, speed and motor control because of heavy training demands, aesthetic appearances and financial barriers.

HYPOTHESIS/PURPOSE

The purpose of this study was to examine the effects of a supplemental conditioning program on professional and pre-professional contemporary ballet dancers. The authors hypothesized that those participating in a training program would reduce injury rate by improving their motor control, stability, balance and physical function. The authors aimed to observe the feasibility and qualitative phenomena related to a conditioning program from the dancer's perspective.

STUDY DESIGN

A mixed-methods study; within subject quasi-experimental design and qualitative interviews.

METHODS

Six professional classical and contemporary ballet dancers completed the five-week conditioning and injury prevention training program. Non-parametric analysis of baseline, posttest and four-month follow-up physical performance measures, subjective outcomes, and qualitative follow-up interviews, were reported.

RESULTS

Significant post-test improvements included: The Dance Functional Outcome Survey (Z= -2.2, p= 0.04), composite Modified Star Excursion Balance Test (Z= -2.2, p= 0.03 bilaterally), Single Leg Hop for Distance (Z= -2.02, p= 0.04), and Upper Extremity Closed Kinetic Chain Test (Z=-2.03, p= 0.04). Significant changes from baseline to the four-month follow up remained for: (1) Dance Functional Outcome Survey (Z= -2.2, p= 0.03), (2) Single Leg Hop for Distance (Z= -2.2, p= 0.03), and (3) Modified Star Excursion Balance Test composite maximum reach for the left lower extremity (Z= -2.2, p= 0.03).

CONCLUSION

Completing a conditioning and prevention program for professional ballet dancers was related to improved function, balance, hop distance/stability and upper extremity stability. Dancers found the program beneficial, identified barriers to participation, and elucidated factors making the program feasible and successful. More research is necessary to determine the effect of such programs on injury incidence.

LEVEL OF EVIDENCE

3b.

Cross-Cultural Adaptation of the Dance Functional Outcome Survey (DFOS) for Spanish Dancers

A growing number of research papers regarding Spanish-speaking dancers justifies the need for an adapted Spanish version of the Dance Functional Outcome Survey (DFOS). The objective of this study was to cross-culturally adapt and validate the DFOS for Spanish-speaking dancers. A sample of 127 healthy and injured professional and pre-professional dancers were recruited. Test-retest reliability of DFOS-Sp was examined using intraclass correlation coefficients. Construct validity compared DFOS-Sp to the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) using Pearson correlations. Principal component analysis identified factors and internal-item consistency. Sensitivity was evaluated by generating receiver operating characteristic and area under the curve analyses. A subgroup of 51 injured dancers were followed across three time-points to examine responsiveness using repeated measures analysis of variance. Injured scores were analyzed for floor and ceiling effects. The DFOS-Sp showed high test-retest reliability (ICC2,1 ≥ 0.92). DFOS-Sp scores had moderate construct validity compared with SF-36 physical component summary scores (r ≥ 0.56). Principal component analysis (PCA) supported uni-dimensionality explaining 58% of the variance with high internal consistency (α = 0.91).Area under the curve (AUC) sensitivity values were excellent (AUC ≥ 0.82). There were significant differences across time (p < 0.001), demonstrating responsiveness to change, with no floor or ceiling effects. The DFOS-Sp demonstrated acceptable test-retest reliability and validity in Spanish-speaking dancers, with comparable psychometric performance to the English-language version.