Implementation of health education interventions at Dutch music schools.

A randomized controlled trial was conducted comparing the effects of a biopsychosocial course (PRESTO-Play) vs. physical activity promotion (PRESTO-Fit) to reduce disability related to musculoskeletal disorders in music students. The current study provides an external validation and a formative and process evaluation, allowing for a better interpretation of results. First, a group of experts was asked to complete a structured evaluation of design and content of the trial. Second, quantitative and qualitative data were analysed from different stakeholders (students, therapists and conservatory staff) using questionnaires, logs, field notes and emails to evaluate fidelity, dose delivered, dose received, reach and context. Results are presented descriptively. Two authors independently identified key responses that were merged into themes. Although no difference in disability was found between interventions, closer evaluation revealed that participants in PRESTO-Play reported that they learned about prevention of physical complaints and were more satisfied with course contents compared with PRESTO-Fit. Study design and contents of the interventions were found to be valid, with an appropriate dose delivered. Feedback from students and logs suggested that behavioural change and psychosocial principles in PRESTO-Play might have not been implemented optimally. Only moderate fidelity in both groups and too little contrast between interventions could have influenced results. Low attendance rates and a presumed lack of generalization further decreased possible effectiveness. Context greatly influenced implementation. Implementing a future health course with closer collaboration with the institution could optimize accessibility and communication, encourage attendance and enhance motivation for behavioural change.

The Musician as (In)Active Athlete?: Exploring the Association Between Physical Activity and Musculoskeletal Complaints in Music Students.

OBJECTIVE: Musicians are often compared to athletes because of the physical exertion required to play music. The aim of this study was to explore the physical activity level of music students and to study its relationship with musculoskeletal complaints. A second goal was to assess associations between physical activity and pain, quality of life, and disability. METHODS: This cross-sectional study among third- and fourth-year music students used an electronic survey including measures for physical activity (SQUASH-Short Questionnaire to Assess Health-enhancing physical activity), musculoskeletal complaints (DMQ-Dutch Musculoskeletal Questionnaire), disability (DASH-Disability Arm, Shoulder, Hand questionnaire) and quality of life (Short Form-12). Students were classified as compliers or non-compliers with moderate- and vigorous-intensity physical activity recommendations. Statistical analysis was done using (non)parametric tests (t-test, Pearson chi-square test, Mann-Whitney U-test) and correlational testing. RESULTS: Participants were 132 students, 63.6% female, with a median age of 23 yrs (range 21.3-25.0). 67% reported musculoskeletal complaints in the past 7 days. Their median physical activity level was 6,390 MET-min/wk, and 62% and 10% of the students accomplished recommendations for moderate-intensity and vigorous-intensity physical activity levels, respectively. No significant differences were found in prevalence of musculoskeletal complaints between students who met moderate- or vigorous-intensity physical activity recommendations and students who did not. Physical activity level was not associated with musculoskeletal complaints (r=0.12, p=0.26). Higher pain intensity was associated with a lower quality of life (r=-0.53 p<0.01) and higher disability (r=0.43, p<0.01). CONCLUSIONS: Music students are mainly involved in light- to moderate-intensity physical activities and rarely in vigorous-intensity activities. No correlation was found between physical activity level in the past months and musculoskeletal complaints in music students.

Energy expenditure in brass and woodwind instrumentalists: the effect of body posture.

OBJECTIVE: Body posture appears to influence fatigue and musculoskeletal complaints in musicians. Our aim was to determine energy expenditure and to investigate whether energy expenditure is affected by body posture in brass and woodwind instrumentalists. METHODS: Eighteen musicians (10 women, 8 men; 6 brass, 12 woodwinds), with a mean age of 39 ± 14 years and mean body mass index of 23.8 ± 4.9 kg/m², played their instruments for 30 minutes twice: once in nonoptimized body posture (posture A), and once in a posture according to the postural exercise therapy method Mensendieck (posture B). Patients were randomized to the order of postures in a crossover design AB/BA. Playing sessions were preceded and followed by 60 minutes of rest. Energy expenditure was measured in a respiration chamber with indirect calorimetry. Basal metabolic rate was measured with a ventilated hood. RESULTS: Mean metabolic equivalents (MET) for playing a wind instrument in the sitting position in a nonoptimized posture and posture according postural exercise therapy were 1.69 (SD 0.18) and 1.80 (SD 0.22), respectively. Percent change between resting metabolic rate and total energy expenditure while playing was 32% (95% CI 25-39%) in posture B and 23% (95% CI 17-30%) in posture A (p = 0.021). CONCLUSION: Average physical activity while playing a wind instrument approximates 1.8 MET. Our data show an association between energy expenditure and body posture while playing a brass or woodwind instrument: playing a musical instrument in a posture according to postural exercise therapy leads to higher energy expenditure as compared to a nonoptimized body posture. These results suggest that fatigue and the general feeling of lack of energy after playing a musical instrument are not related to actual higher energy expenditure.

The influence of work and treatment related factors on clinical status and disability in patients with non-specific work-related upper limb disorders.

OBJECTIVE: To assess the influence of work- and treatment-related factors on clinical status and functional disability in patients with non-specific work-related upper limb disorders (WRULD). PARTICIPANTS: 182 computer workers with non-specific WRULD, 18-50 years old, not having specific WRULD nor incomplete medical records. METHODS: Retrospective cohort study among computer workers with non-specific WRULD; average follow-up 4 years. Medical records at time of diagnosis and during treatment period and a follow-up questionnaire were used. SETTING: Outpatient department of Rehabilitation Medicine, University Hospital Maastricht. OUTCOME MEASURES: Non-specific WRULD (clinical status) and Disabilities of Arm, Shoulder and Hand (DASH) at follow-up. RESULTS: 103 patients (57%) returned the questionnaire. Of these, 14% developed a chronic pain syndrome, 9% recovered, 77% worsened slightly. None of the selected work- and treatment-related factors were significantly associated with clinical status. "Number of working hours per week before diagnosis" was negatively (b=-0.66, p=0.00) and "other therapies during treatment" (b=8.76, p=0.02) positively associated with DASH. CONCLUSIONS: Computer workers with non-specific WRULD have a poor prognosis. Working more hours before diagnosis seems not predictive for disability while having undergone other therapies during treatment period does. Prospective cohort studies are recommended to unravel the associations found.

Pain catastrophizing and lower physical fitness in a sample of computer screen workers with early non-specific upper limb disorders: a case-control study.

In computer workers psychological factors and physical fitness may play an important role in the onset and course of non-specific work-related upper limb disorders (WRULD) beyond socio-demographic factors. Based on our experiences in daily practice we assumed that pain catastrophizing and other psychological variables such as perfectionism, anxiety state and trait, and low physical fitness, are possibly associated with the occurrence of WRULD. We aim to study the association between pain catastrophizing, perfectionism, anxiety (state and trait), physical fitness, sex and level of education and the occurrence of WRULD, controlling for age as a confounder. Eighty-eight computer workers with early non-specific WRULD, who had been recruited for an intervention study, were compared with 31 healthy computer workers (controls) recruited from different departments of a university. This cross-sectional case-control study examined the influence of aforementioned variables on WRULD by means of logistic regression analyses. Among the different predictor variables investigated, pain catastrophizing (OR=1.37; 95%CI 1.17-1.59) and lower physical fitness had a positive relationship with WRULD (OR=0.65; 95%CI 0.48-0.87). According to this study, pain catastrophizing and lower physical fitness seem to be associated with early non-specific WRULD in computer workers. Prospective studies are needed to unravel these relationships.