Informed Consent

You are being invited to participate in a research study on Prevalence & Pattern of
Musculoskeletal Injuries in Dancers. This research project is being conducted by Miss. Shruti
Kotian of MGM School of Physiotherapy across various dance academies.
There are no known risks if you decide to participate in this research study, nor are there any
costs for participating in the study. The information you provide will help me understand what
are the most common injuries in a dancer and the factors aggravating it. The information
collected may not benefit you directly, but what I learn from this study should provide general
benefits to dancers and researchers.
Any information that is obtained in connection with this study will remain confidential and will
be disclosed only with your permission or as required by law. Confidentiality will be maintained
by means of a code number to let Ms. Shruti know who you are. We will not use your name in
any of the information we get from this study or in any of the research reports.
You can choose whether or not to be a part of this study. If you volunteer to be in this study, you
may withdraw at any time without consequences of any kind. You are free to ask your queries
about the same. You may also refuse to answer any question you do not wish to answer.
Your participation in this study is voluntary. If you choose to participate, please fill the
questionnaire. If you have any questions or concerns about completing the questionnaire or about
being in this study, you may contact me at 08898620205 or at shrutikotian13@gmail.com

I understand the procedures described above. All questions have been answered to my
satisfaction, and I volunteer to participate in this study. I have been given a copy of this form.

Name & Signature of Subject

Name & Signature of Witness

Date

Date:

DANCE QUESTIONNAIRE:
Personal History:

Name:
Age:

Gender ...

Marital status: .....

Occupation: .....
Address:

Phone:
Medical History
1) Are you on any medications?
2) Any medical family history:

3) Did you undergo any surgery in the past 1 year: .....

If Yes, please specify:
If your gender is Female, answer the following
Gynaecological History
1) During menses do you continue to dance?

.....

a] If Yes, does it have any effect on your dancing capacity?

.....

2) Do you relate your irregular menses to your dance performance?

Obstetric history:
1) No of children:
2nd child

2) Age of your children: 1st child

3) Delivery:

.....

3rd child

............

4) After how many months did you resume dancing after your delivery?
1st delivery
2nd deliver
3rd delivery
Dance Profile:
1) Type of dance you are primarily trained or getting trained:
Bharatnatyam

Kathak

Kuchupudi

Folk

Contemporary

Ballet

Odissi

Kathakali

Jazz

Salsa

HipHop

Any other:

Dance Questionnaire Version 10 ; dated 20/10/2014 MGM School of Physiotherapy

2) Current level of training:

Professional

Teacher

Former dancer

Choreographer

Student

Performer

3) Do you have any formal dance qualification? ....

I f Yes, Please specify (degree & duration)
School/Company where you primarily study/perform:
4) How many hours of training do you take in a typical Day?

Hours

5) How many days of training do you take in a typical Week?

Days

6) How many performance months do you have in a typical Year?

Months

7) At what age did you begin dance training?

Years old

8.) How many years have you invested in dancing (training + practise) till date?
9) Have you discontinued dancing in between?

Years

....

a] If Yes, since how long (duration/age)

b] What was the reason for that?
10) Have you reduced frequency of dancing hours?

....

a] If Yes, since how long (duration/age)

b] What was the reason for that?
11) Do you warm-up before Class? ....

a] What does your warm-up consist of?

Walking

Spot marching

Dance steps

Free exercises

Any other
12) Do you perform stretching exercise after class?
Always

Usually

Sometimes

Rarely

Never

Any other
13) Do you do any other form of exercise on a regular basis?
If Yes, answer the following questions:
a] Type of Exercise .....
b] Is your exercise supervised?

....

....

c] Frequency (# of times per week you do this other exercise):

times per week

Dance Questionnaire Version 10 ; dated 20/10/2014 MGM School of Physiotherapy

d] Intensity: How hard is your Exercise Program for you to do?

(Borg Rating Perceived Exertion Scale)

........
e] Duration (how long per session do you typically exercise):

minutes per session

14) Are you a part of any dance performance troupe? .....

Performance Profile:
1) Performance location:

...

2) When is peak performance period* of dance during the year?

Jan- March
April-June
July- Sept
Oct-Dec

(*peak performance period is attaining or being at the highest or maximum level in the number of dance performances in a
specified period of time.)
3) Type of dance performance:

......

4) On an average how many competitions do you have in a year? (Share details)

5) On an average how many performances do you have in a year? (Share details)
6) Do you get enough rest time between 2 performances? .....
If Yes, please specify duration of rest period
7) How many hours of practice/rehearsals do you undertake during your peak performance period?
hrs/day

days/week

8) Do you indulge in Relaxation during Competitive season?

a] If Yes, which are the forms you routinely practise
Yoga
Pranayama
Music Therapy

.....
Any Other

9) During Competitive season do you adopt any other coping strategies ?

a] If Yes, which are they? .....

.....

Any other
10) Do you attend/ participate in any dance seminars .....
If Yes, Please specify (duration & type of seminar)
11) At what age do you think you will stop your active dancing career?
12) If you were a former dancer, a] At what age did you expect to finish your active dancing career?
b] At what age did you actually stop?
Dance Questionnaire Version 10 ; dated 20/10/2014 MGM School of Physiotherapy

c] And what could be the probable reasons for the sameAge

Financial issues

Health issues/ injuries

Competition between other dancers

New career

any other

d] What was the time between when you stopped dancing& you took up new career
e] Are you still associated with dancing?

......

f] If Yes, which of the following activities are you involved in?

Training students

Conducting dance workshop

any other

Injury Profile
1) Do you suffer from any pain? - If yes, where? Back / Neck / shoulders / Hips / Knees / Ankles
(Please mark the part of body injured till date along with date of injury)

2) Have you ever had injuries that caused you to miss a dance performance or practise?

Dance Questionnaire Version 10 ; dated 20/10/2014 MGM School of Physiotherapy

......

3) Enumerate the injuries you have had till date

Part(s) Of Body:

4) Which of these was related to dance?

5) What was the reason for you to sustain this injury while dancing??
Tiredness

Stress

Environment

Overworked
Inadequate diet

Inadequate exercises

Unsuitable stage
Falls

Hard flooring Cold

Difficult Choreography

Inadequate practice

Inappropriate Techniques

6) Have you noticed a specific time when the injury occurs? Before Performance
At the peak of performance period
After performance
During Rehearsals/classes
Competitive season
7) Please specify the time slot missed/lost on dance practise/performance due to the injury occurred?

8) How did this injury/problem happen?

......

9) Did you seek medical attention for the same:

a] If Yes , how soon: .......

......

10) What are your current symptoms?

11) How long have you had this problem?

Days

12) What made it better?

13) Could you think of any suggestions that could prevent injury?
Classes by teachers who were aware of anatomical & body limitation
warm up exercises
Warm studios
Better flooring in theatres
Resident Physiotherapist

Adequate diet

Strengthening exercise

Fitness programs

Adequate rest

Any other
Dance Questionnaire Version 10 ; dated 20/10/2014 MGM School of Physiotherapy

14) Have you taken Physiotherapy or other medical treatment of any kind for this problem? .......
If Yes , describe treatment:
15) Did you get better? ......

a] If Yes,

% Relief

16) Psychological Readiness to return to dance

Which of this describes you the best when you resume dancing after an injury?
(Circle the appropriate options)
I have confidence enough to not concentrate on my injury
I have confidence in the injured body part to handle to demands of situation
I have confidence to give my 100% effort.
I am thinking about injury which may prevent me from being successful in competition
I have a tendency to be over-aggressive during competition.

17) Physiotherapy Awareness Index:

1. Are you aware of role of a Physiotherapist in management of your musculoskeletal injuries?

.....

2. What is your general idea of Physiotherapy?

3. Would you like to have Physiotherapy services as a part of your dance training routine?

.......

a] If Yes, in what form would you prefer? Individual basis/ Group session
4. When do you think a Physiotherapist can help you?
During Training period

During competition season

Only Post-injury

Improving your fitness

preventing injuries

treating injuries

General Relaxation
5. Do you think involvement of a Physiotherapist can help you enhance your dancing career?

.....
6
Dance Questionnaire Version 10 ; dated 20/10/2014 MGM School of Physiotherapy

Pain Sensitivity Questionnai re

This questionnaire contains a series of questions in which you should imagine yourself in certain
situations. You should then decide if these situations would be painful for you and if yes, how painful
they would be. Let 0 stand for no pain; 1 is an only just noticeable pain arid.10the most severe pain
that you can imagine or consider possible. Please mark the scale with a cross on the number that is
most true for you. Keep in mind that there are no "right" or "wrong" answers; only your personal
assessment of the situation counts. Please try as much as possible not to allow your fear or aversion of
the imagined situations affect your assessment of painfulness.

1. Imagine you bump your shin badly on a hard edge, for example, on the edge of a glass coffee
table. How painful would that be for you?

.....

0 = not at all painful 10 = most severe pain imaginable

2. Imagine you burn your tongue on a very hot drink.

.....

0 = not at all painful 10 = most severe pain imaginable

3. Imagine your muscles are slightly sore as the result of physical activity.

.....

0 = not at all painful 10 = most severe pain imaginable

4. Imagine you trap your finger in a drawer.

.....

O = not at all painful 10 = most severe pain imaginable

5. Imagine you take a shower with lukewarm water.

.....

0 = not at all painful 10 = most severe pain imaginable

6. Imagine you have mild sunburn on your shoulders.

.....

0 = not at all painful 10 = most severe pain imaginable

7. Imagine you grazed your knee falling off your bicycle;

.....

0 = not at all painful 10 = most severe pain imaginable

8. Imagine you accidentally bite your tongue or cheek badly whileeating.

.....

O = not at all painful 10 = most severe pain imaginable

9. Imagine walking across a cool tiled floor with bare feet.

.....

O = not at all painful 10 = most severe pain imaginable

10. Imagine you have a minor cut on your finger and inadvertently get lemon juice in the wound ..

.....

0 = not at all painful 10 = most severe pain imaginable

11. Imagine you prick your fingertip on the thorn of a rose.

.....

0 = not at all painful 10 = most severe pain imaginable

12. Imagine you stick your bare hands in the snow for a couple of minutes or bring your hands
in contact with snow for some time, for example, while making snowballs.

.....

0 = not at all painful 10 = most severe pain imaginable

13. Imagine you shake hands with someone who has a normal grip.

.....

0 = not at all painful 10 = most severe pain imaginable

14. Imagine you shake hands with someone who has a very strong grip.

.....

0 = not at all painful10= mostsevere pain imaginable

15. Imagine you pick up a hot pot by inadvertently grabbing its equally hot handles.

.....

0 = not at all painful 10 = most severe pain imaginable

16. Imagine you are wearing sandals and someone with heavy boots steps on your foot.

.....

0 = not at all painful 10 = most severe pain imaginable

17..lmagine you bump your elbow on the edge of a table ("funny bone").

.....

0 = not at all painful 10 = most severe pain imaginable

SAVE & SUBMIT