Preventing musculoskeletal complaints in music students: a randomized controlled trial.

BACKGROUND: Musculoskeletal complaints in music students are common. Little is known about effectiveness of interventions. AIMS: To assess whether a biopsychosocial prevention course is better at reducing disability due to musculoskeletal disorders compared with physical activity promotion. METHODS: This was a multicentre randomized controlled trial with intention-to-treat analysis. Participants were first- and second-year students from five conservatories, randomized to experimental or control groups. The experimental group participated in 11 classes on body posture playing the instrument according to postural exercise therapy, and performance-related psychosocial aspects. The control group participated in five classes promoting physical activity according to national guidelines. The primary outcome was disability using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, including the performing arts module. Secondary outcomes were pain, quality of life, playing-related musculoskeletal disorders and health behaviour. Outcomes were assessed at six points, from baseline until 2-year follow-up. RESULTS: One hundred and seventy participants were randomized to experimental (n = 84) or control (n = 86) groups. Loss to follow-up was 40% during the trial and 69% at 2-year follow-up. The dropout rate was equal in both groups. Overall, there were no significant differences between groups for any outcome adjusted for baseline characteristics: percentage disability, odds ratio was 1.31, 95% confidence interval (CI) 0.69-2.51; general DASH, ß = -0.57, 95% CI -3.23 to 2.09; and performing arts module, ß = -0.40, 95% CI 5.12-4.32. CONCLUSIONS: A biopsychosocial prevention course tailored for musicians was not superior to physical activity promotion in reducing disability. Large numbers lost to follow-up warrant cautious interpretation.

Systematic review: risk factors for musculoskeletal disorders in musicians.

BACKGROUND: Although many musicians suffer from musculoskeletal disorders, aetiological factors are unclear. AIMS: To systematically search for and synthesize the best available evidence on risk factors for musculoskeletal disorders in musicians. METHODS: A database search was performed in PubMed, EMBASE, CINAHL, Pedro, OTseeker and Psychinfo. A manual search was conducted in the journals Medical Problems of Performing Artists and Psychology of Music. Studies with an objective to investigate determinants associated with playing-related musculoskeletal disorders were included. Papers were selected based on adequacy of statistical methods for the purpose of the study. Search, first screening and selection were performed by one author. Two reviewers independently performed the final selection using full-text reports. Methodological quality assessment was performed by two reviewers independently. RESULTS: One case-control and 14 cross-sectional studies were included. Methodological quality was in general low. Large heterogeneity existed in study design, population, measurement of determinant and outcome and analysis techniques. Data were presented descriptively. Consistent results were found indicating that previous musculoskeletal injury, music performance anxiety, high levels of stress and being a female playing a stringed instrument seemed to be associated with more musculoskeletal disorders. Influence over or support at work, orchestra category/status, exercise behaviour and cigarette smoking seemed to be unrelated with musculoskeletal disorders. No conclusions could be made on causality, as the current data only represent cross-sectional associations. CONCLUSIONS: Because of lack of prospective studies, no causal relations could be identified in the aetiology of (playing-related) musculoskeletal disorders in instrumental musicians.