An Injury Prevention Program for Professional Ballet: A Randomized Controlled Investigation

Angelina M Vera, Bene D Barrera, Leif E Peterson, Thomas R Yetter, David Dong, Domenica A Delgado, Patrick C McCulloch, Kevin E Varner, Joshua D Harris, Angelina M Vera, Bene D Barrera, Leif E Peterson, Thomas R Yetter, David Dong, Domenica A Delgado, Patrick C McCulloch, Kevin E Varner, Joshua D Harris

Abstract

Background: Few investigations have examined dance-specific injury prevention programs (IPPs), and no published randomized controlled trials are available that evaluate IPPs for dance.

Hypothesis: The implementation of an IPP will significantly reduce the risk of injury in professional ballet dancers.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: A randomized controlled trial was designed that entailed a superiority model for the intervention group. All professional dancers from a single ballet company were eligible to participate. Randomization and allocation were performed before the start of the season. The control group practiced and performed without change to preexisting standard operating practice. The IPP group was instructed to perform a 30-minute exercise program 3 times per week over the 52-week study period. Injuries were recorded. Standard continuous and categorical data comparisons and correlations were used. Cox proportional hazards regression models for recurrent failures were used wherein the hazard ratio indicates the relative likelihood of injury in the control versus intervention groups.

Results: Of the 52 eligible dancers, 75% (n = 39) participated. Of these 39 dancers, 19 (9 males, 10 females; mean age, 26.6 ± 4.0 years) were randomized to the control group and 20 (11 males, 9 females; mean age, 25.1 ± 5.1 years) to the IPP group. No significant (P > .05) difference was found in baseline demographics between groups. A total of 116 injuries were recorded for the entire study population (49 IPP; 67 control). Traumatic and chronic injuries accounted for 54% and 46% of injuries, respectively. The injury rate was 82% less (IPP hazard ratio, 0.18; z = -2.29; P = .022) in the IPP group after adjustment for confounding variables, and time between injuries was 45% longer (IPP hazard ratio, 0.55; z = -2.20; P = .028) than for controls.

Conclusion: The present study is the first prospective randomized controlled investigation of an IPP for professional ballet. The results showed an 82% decrease in injury rate for the intervention group and an extended period from previous injury to subsequent injury.

Registration: NCT04110002 (ClinicalTrials.gov identifier).

Keywords: Beighton; Brighton; ballet; dance; injury prevention; injury rate.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: A.M.V. has received educational support from Arthrex/Medinc of Texas and DePuy. P.C.C. has received research support from DePuy and Arthrex/Medinc of Texas and speaking fees from Vericel/Aastrom Biosciences. K.E.V. has received consulting fees from DePuy, In2Bones, and Wright Medical and royalties from In2Bones and Wright Medical, and he has stock/stock options in In2Bones and Wright Medical. J.D.H. has received research support from Arthrex/Medinc of Texas, DePuy, and Smith & Nephew; consulting fees from NIA Magellan and Smith & Nephew; speaking fees from Ossur and Smith & Nephew; and royalties from SLACK. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2020.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram.

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