Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians.
TL;DR: The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes.
Abstract: Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favourable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.
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TL;DR: In this paper, the authors present a Table of Table of contents of the paper. But they do not discuss the authors' methodology. And they propose several acknowledgements and acknowledgements.
Abstract: .........................................................................................................................3 Acknowledgements........................................................................................................5 Table of
206 citations
TL;DR: There is considerable scope for improving music students' physical and psychological health and health-related behaviors through health education, and persuading senior managers, educators and students themselves that health education can contribute to performance enhancement.
Abstract: Context and aims: Many musicians suffer for their art, and health is often compromised during training. The Health Promotion in Schools of Music (HPSM) project has recommended that health education should be included in core curricula, although few such courses have been evaluated to date. The aim of the study was to design, implement and evaluate a compulsory health education course at a UK conservatoire of music.
Methods: The course design was informed by a critical appraisal of the literature on musicians' health problems and their management, existing health education courses for musicians, and the HPSM recommendations. It was delivered by a team of appropriately-qualified tutors over 5 months to 104 first-year undergraduate students, and evaluated by means of questionnaires at the beginning and end of the course. Thirty-three students who had been in their first year the year before the course was introduced served as a control group, completing the questionnaire on one occasion only. Items concerned: hearing and use of hearing protection; primary outcomes including perceived knowledge and importance of the topics taught on the course; and secondary outcomes including physical and psychological health and health-promoting behaviors. The content of the essays written by the first-year students as part of their course assessment served as a guide to the topics they found most interesting and relevant.
Results: Comparatively few respondents reported using hearing protection when practicing alone, although there was some evidence of hearing loss, tinnitus, and hyperacusis. Perceived knowledge of the topics on the course, and awareness of the risks to health associated with performing music, increased, as did self-efficacy; otherwise, there were negative effects on secondary outcomes, and few differences between the intervention and control groups. The topics most frequently covered in students' essays were managing music performance anxiety, and life skills and behavior change techniques.
Conclusion: There is considerable scope for improving music students' physical and psychological health and health-related behaviors through health education, and persuading senior managers, educators and students themselves that health education can contribute to performance enhancement.
49 citations
Cites background from "Evidence-informed physical therapy ..."
...These can be psychosocial, such as anxiety, stress, perfectionism, and/or physical, including playing conditions such as temperature or length of rehearsals and performance and insufficient break periods, past injury, awkward posture and instrumental technique, poor fitness level and suboptimal injury management (Zaza and Farewell, 1997; Bragge et al., 2006; Kaufman-Cohen and Ratzon, 2011; Leaver et al., 2011; Chan and Ackermann, 2014; Steinmetz et al., 2015; Kochem and Silva, 2017)....
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TL;DR: In Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors.
Abstract: Rationale, aims and objectives
Research examining the use of evidence-based practice (EBP) in physical therapy in many countries has revealed positive attitudes, varying degrees of EBP use and barriers at practitioner, patient and organizational levels. In contrast to these countries, Austria does not have an academic or research tradition in physical therapy. Engagement in EBP in countries such as Austria is unknown. The objectives of the study were to describe the current state of EBP engagement and identify factors associated with EBP engagement among Austrian physical therapists (PTs).
Methods
A cross-sectional online survey was conducted. Existing questionnaires and the theory of planned behaviour guided questionnaire development. Face and content validity and ease of use of the questionnaire were evaluated in pilot tests. Item-level response frequencies and percentages were determined. Simple and multiple regressions were used to identify factors associated with EBP engagement.
Results
The final sample size was 588 (response rate: 17.5%). Ten percent of participants fully agreed that they regularly use guidelines and standardized assessment tools in clinical practice. While 49.9% reported not using electronic databases for literature searching, 41.9% reported reading research articles 2–5 times per month. Most frequently cited barriers to EBP engagement were lack of scientific skills, lack of time and insufficient organizational support. Research awareness, attitude, behavioural control, involvement in research and degree level were final correlates of EBP engagement.
Conclusion
Austrian PTs show a low level of engagement in EBP. Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors.
38 citations
Cites methods from "Evidence-informed physical therapy ..."
...After in-depth discussion, we exchanged EBP with ‘evidence-informed practice’ (EIP), which had been suggested by one of the experts and is also used in the literature [39]....
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TL;DR: In this article, a selection of common sociocultural and systemic issues in music performance that might broaden practitioners' contextual knowledge of musicians are discussed. But, the authors do not address the impact of these issues on musicians' performance.
Abstract: While the domains of music and sport performance share many convergences, performance psychology and enhancement training is less common in music. Consequently, practitioners such as sport psychologists or psychotherapists are increasingly being used to work with musicians. Successful collaboration between disciplines might be particularly beneficial as the domain of music performance is rife with psychological, physical, and systemic challenges for which appropriate support structures are often lacking. Accordingly, this article aims to contribute to effective interdisciplinary communication by reviewing a selection of common sociocultural and systemic issues in music performance that might broaden practitioners’ contextual knowledge of musicians. Although this article is not meant to be a comprehensive review of all available research, we have included ample references to direct readers toward relevant material on the topics being discussed. In addition, we propose that practitioners who are interested in working with musicians apply a positive, culturally sensitive, evidence-based, and holistic approach when translating and communicating psychology principles to musicians. We provide suggestions as to how this might be achieved and also emphasize the importance of exploring a range of methods, prioritizing practicality, and introducing performance enhancement training accurately. In doing so, we suggest that practitioners avoid focusing solely on performer wellbeing, theoretical delivery formats or limited psychological skills strategies.
28 citations
Dissertation•
01 Jul 2018
TL;DR: The water needs of this region have changed in recent years from being primarily for agricultural purposes to domestic and industrial uses currently and in the future also for residential and industrial purposes.
Abstract: .............................................................................................................. vi Table of contents................................................................................................. viii Addenda............................................................................................................. List of Figures...................................................................................................... xvi
26 citations
Cites background from "Evidence-informed physical therapy ..."
...Psychosocial risk factors for the development of PRMDs include depression, anxiety, internal or external pressures on the individual, personal and professional stress, social phobia and personality characteristics, such as perfectionism and somatisation (Chan & Ackermann 2014:3)....
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References
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TL;DR: Physical inactivity is a primary cause of most chronic diseases as discussed by the authors, and the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life.
Abstract: Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause vs. treatment; physical activity and inactivity mechanisms differ; gene-environment interaction [including aerobic training adaptations, personalized medicine, and co-twin physical activity]; and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [Accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, non-alcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, preeclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.
1,753 citations
"Evidence-informed physical therapy ..." refers background in this paper
...There are many physical and psychological benefits associated with appropriate levels of regular physical activity, such as significant increases in cardiovascular fitness, skeletal muscle endurance, reaction time, and decreased incidence of osteoarthritis, depression and anxiety (Booth et al., 2012)....
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...…are many physical and psychological benefits associated with appropriate levels of regular physical activity, such as significant increases in cardiovascular fitness, skeletal muscle endurance, reaction time, and decreased incidence of osteoarthritis, depression and anxiety (Booth et al., 2012)....
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TL;DR: Risk factors with at least reasonable evidence of a causal relationship for the development of work-related musculoskeletal disorders include: heavy physical work, smoking, high body mass index, high psychosocial work demands, and the presence of co-morbidities.
Abstract: Objective This systematic review was designed and conducted in an effort to evaluate the evidence currently available for the many suggested risk factors for work-related musculoskeletal disorders. Methods To identify pertinent literature we searched four electronic databases (Cinahl, Embase, Medline, and The Cochrane Library). The search strategies combined terms for musculoskeletal disorders, work, and risk factors. Only case–control or cohort studies were included. Results A total of 1,761 non-duplicated articles were identified and screened, and 63 studies were reviewed and integrated in this article. The risk factors identified for the development of work-related musculoskeletal disorders were divided and organized according to the affected body part, type of risk factor (biomechanical, psychosocial, or individual) and level of evidence (strong, reasonable, or insufficient evidence). Conclusions Risk factors with at least reasonable evidence of a causal relationship for the development of work-related musculoskeletal disorders include: heavy physical work, smoking, high body mass index, high psychosocial work demands, and the presence of co-morbidities. The most commonly reported biomechanical risk factors with at least reasonable evidence for causing WMSD include excessive repetition, awkward postures, and heavy lifting. Additional high methodological quality studies are needed to further understand and provide stronger evidence of the causal relationship between risk factors and work-related musculoskeletal disorders. The information provided in this article may be useful to healthcare providers, researchers, and ergonomists interested on risk identification and design of interventions to reduce the rates of work-related musculoskeletal disorders. Am. J. Ind. Med. 2009. 2009 Wiley-Liss, Inc.
1,135 citations
"Evidence-informed physical therapy ..." refers background in this paper
...…long rehearsals and performances that involve extremely repetitive activities, it is only sensible to educate them about potential risks to which they may be exposed; since these could lead to them sustaining a work-related injury (Pascarelli and Hsu, 2001; Baldwin, 2004; da Costa and Viera, 2010)....
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TL;DR: This review examines the current knowledge of water intake as it pertains to human health, including overall patterns of intake and some factors linked with intake, the complex mechanisms behind water homeostasis, and the effects of variation in water intake on health and energy intake, weight, and human performance and functioning.
Abstract: This review examines the current knowledge of water intake as it pertains to human health, including overall patterns of intake and some factors linked with intake, the complex mechanisms behind water homeostasis, and the effects of variation in water intake on health and energy intake, weight, and human performance and functioning. Water represents a critical nutrient, the absence of which will be lethal within days. Water's importance for the prevention of nutrition-related noncommunicable diseases has received more attention recently because of the shift toward consumption of large proportions of fluids as caloric beverages. Despite this focus, there are major gaps in knowledge related to the measurement of total fluid intake and hydration status at the population level; there are also few longer-term systematic interventions and no published randomized, controlled longer-term trials. This review provides suggestions for ways to examine water requirements and encourages more dialogue on this important topic.
748 citations
"Evidence-informed physical therapy ..." refers background in this paper
...Even a small degree of dehydration can affect cognitive and physical function (Shirreffs, 2009; Popkin et al., 2010), and as such musicians needing to perform at their peak and reduce the likelihood of injury should be aware of their water intake....
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...…is water intake, with these needs varying from approximately 2 l of water per day for a sedentary adult male under normal environmental conditions up to approximately 3 l with the addition of modest physical activity (Kenefick and Sawka, 2007; Jéquier and Constant, 2010; Popkin et al., 2010)....
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TL;DR: This review focuses on four factors that have been shown to enhance the learning of motor skills: observational practice; the learner’s focus of attention; feedback, and self‐controlled practice.
Abstract: Objectives Findings from the contemporary psychological and movement science literature that appear to have implications for medical training are reviewed. Specifically, the review focuses on four factors that have been shown to enhance the learning of motor skills: observational practice; the learner’s focus of attention; feedback, and self-controlled practice.
Observational Practice Observation of others, particularly when it is combined with physical practice, can make important contributions to learning. This includes dyad practice (i.e. practice in pairs), which is not only cost-effective, but can also enhance learning.
Focus of Attention Studies examining the role of the performer’s focus of attention have consistently demonstrated that instructions inducing an external focus (directed at the movement effect) are more effective than those promoting an internal focus (directed at the performer’s body movements). An external focus facilitates automaticity in motor control and promotes movement efficiency.
Feedback Feedback not only has an informational function, but also has motivational properties that have an important influence on learning. For example, feedback after successful trials and social-comparative (normative) feedback indicating better than average performance have been shown to have a beneficial effect on learning.
Self-Controlled Practice Self-controlled practice, including feedback and model demonstrations controlled by the learner, has been found to be more effective than externally controlled practice conditions.
Conclusions All factors reviewed in this article appear to have both informational and motivational influences on learning. The findings seem to reflect general learning principles and are assumed to have relatively broad applicability. Therefore, the consideration of these factors in designing procedures for medical training has the potential to enhance the effectiveness and efficiency of training.
Medical Education 2010: 44: 75–84
729 citations
TL;DR: Structural brain changes after only 15 months of musical training in early childhood are demonstrated, which were correlated with improvements in musically relevant motor and auditory skills and suggest that structural brain differences in adult experts (whether musicians or experts in other areas) are likely due to training-induced brain plasticity.
Abstract: The human brain has the remarkable capacity to alter in response to environmental demands. Training-induced structural brain changes have been demonstrated in the healthy adult human brain. However, no study has yet directly related structural brain changes to behavioral changes in the developing brain, addressing the question of whether structural brain differences seen in adults (comparing experts with matched controls) are a product of “nature” (via biological brain predispositions) or “nurture” (via early training). Long-term instrumental music training is an intense, multisensory, and motor experience and offers an ideal opportunity to study structural brain plasticity in the developing brain in correlation with behavioral changes induced by training. Here we demonstrate structural brain changes after only 15 months of musical training in early childhood, which were correlated with improvements in musically relevant motor and auditory skills. These findings shed light on brain plasticity and suggest that structural brain differences in adult experts (whether musicians or experts in other areas) are likely due to training-induced brain plasticity.
727 citations
"Evidence-informed physical therapy ..." refers background in this paper
...These are honed by long daily hours of practicing highly complex movements over many years of intensive training (Watson, 2006; Hyde et al., 2009; Krause et al., 2010; Hoenig et al., 2011)....
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