Long-term analysis of health status and preventive behavior in music students across an entire university program

Factors associated with increased risk of playing-related disorders among classical music students within the Risk of Music Students (RISMUS) longitudinal study

Playing-related musculoskeletal disorders (PRMDs) are common among musicians but longitudinal data on risk factors are limited. The aim of the study was to longitudinally identify the factors associated with increased risk of PRMD onset among music students enrolled in different pan-European music institutions. A further goal was to assess the occurrence of PRMDs during a 12-month period. A total of 442 students without PRMDs from 56 European music universities completed a web-based questionnaire on lifestyle and practice habits, health history, physical activity, psychological distress, perfectionism, and fatigue. PRMD onset was assessed prospectively at 6 and 12 months. Logistic regression analysis showed that changes in physical activity level (6-month AOR = 2.343, 12-month AOR = 2.346), increased levels of fatigue (6-month AOR = 1.084, 12-month AOR = 1.081) and socially-prescribed perfectionism (6-month AOR = 1.102) were significantly associated with PRMD onset, which had occurred in 49% of participants during 12 months. Musculoskeletal complaints reported at baseline (6-month AOR = 0.145, 12-month AOR = 0.441) and changes to BMI (12-month AOR = 0.663) limited the onset of PRMDs. The study's novel longitudinal findings were appraised critically within the contexts of potential factors for PRMD onset and evidence-based preventive strategies to minimise the impact of PRMDs.

Identifying physical and psychological risk factors for musculoskeletal pain in student musicians to tailor the curriculum: a cross-sectional study protocol

INTRODUCTION

Insufficient identification and understanding of risk factors make musicians engaging in professional practice particularly vulnerable to musculoskeletal pain. To support positive music learning and good mental, physical, and social health, student musicians need health support tailored to their needs and their instrumental practice. However, these preventive actions must be based on sound scientific approaches that reliably identify the most relevant risk factors. MuSa is a cross-sectional study examining contextual and internal risk variables associated with playing-related musculoskeletal disorders in student musicians.

METHOD AND ANALYSIS

The design is a monocentric cross-sectional study involving student musicians in Bachelor's 1, 2, 3 and Master's 1, 2. Free-form questions will identify students' lifestyle characteristics and work habits, and validated questionnaires will evaluate the interaction between pain due to music practice and psychological and physical risk factors. All data will first be analysed descriptively. Psychological network analysis will be used to explore the overall correlational structure of the dataset. A subgroup comparative analysis will be then applied according to the instrumental subcategories and work postures, including singers.

ETHICS AND DISSEMINATION

The full protocol was approved by the Swiss Ethics Committee 'Commission Cantonale d'Ethique de la Recherche sur l'être humain de Genève' (CCER, no. 2022-02206) on 13 February 2023. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at conferences.

Focal Dystonia and the Stress Network: The Role of Stress Vulnerability and Adverse Childhood Experiences in the Development of Musician's Dystonia

Musician's dystonia is often described as a neurological disorder, resulting from reduced inhibition in the basal ganglia and the cerebellum and dysfunctional cortical plasticity. However, several studies over the last decades support the hypothesis that psychological factors play an important role in the aetiology of dystonia, contradicting its classification as "purely neurological". Especially adverse childhood experiences (ACEs) such as neglect, maltreatment, or household dysfunction may influence the sensorimotor system, additionally to the impact they have on psychological traits. They are known to alter limbic networks, such as the amygdala, the hippocampus, and the stress response via the hypothalamus-pituitary-adrenal (HPA) axis and might also affect the cortico-striatal-thalamo-cortical loop that is vital for correct motor movement learning. Especially a higher activity of the basolateral amygdala could be important by increasing the consolidation of dysfunctional motor memories in stressful situations.Therefore, this chapter explores how musician's dystonia might be a result of dysfunctional stress-coping mechanisms, additionally to the already established neurological alterations.

A Longitudinal Study of Physical and Mental Health and Health-Related Attitudes Among Music Students: Potentials and Challenges for University Health Promotion Programs

Objective

Well-being of music students has been an increasing matter of concern since studies show that up to 50% of beginners suffer from playing-related pain or anxiety. The aim of this longitudinal study was to examine health status, health-related attitudes, behaviors, knowledge, skills, and coping strategies of students at the beginning of their education at a music university and at the end of their second semester.

Methods

Based on a longitudinal online survey conducted among students at a German music university since 2017, we investigated mental and physical health status, health-related attitudes, knowledge, skills, behaviors, and coping strategies of music students at the beginning of their first year (n = 205). We analyzed differences between performance and music education majors and between students playing different main instruments. In a subsample (n = 62), we additionally analyzed changes between the beginning of the music students’ first and the end of their second semester, also depending on whether they attended courses on musicians’ health.

Results

Music students are already in demand when they enter a music university, practicing on average almost 3 h daily. Compared to other body regions, pain in shoulders/back is most prevalent in first-year students, especially in those playing string instruments. Performance majors reported better knowledge about health risks and protective measures for musicians, better coping abilities, and practiced more than music education majors. First-year students assessed their overall and mental health status at the beginning of their first semester mainly as good, but we found a decrease in mental health status at the end of the second semester. After two semesters, students attending courses on musicians’ health showed increased knowledge and skills regarding different aspects of musicians’ health.

Conclusion

The health status of music students when they first enter a music university is still a concern. Information and practical courses enabling students to prevent overuse and cope with performing anxiety and other stressors are important components of a comprehensive study program. Knowledge about music students’ needs can help conservatories better respond to the requirements and develop courses and measures supporting students from the beginning of their education.

Exploring the Impact of the Somatic Method 'Timani' on Performance Quality, Performance-Related Pain and Injury, and Self-Efficacy in Music Students in Norway: An Intervention Study

The importance of including performance-related body mechanics into music education to improve performance quality and prevent performance-related injuries has been stressed by many researchers recently. However, it is unclear how this information could be delivered most effectively. The somatic method ‘Timani’ provides a practical solution by combining expertise in music performance and functional body mechanics with the goal of achieving a more efficient playing technique. Since no in-depth study has been conducted to assess the method before, we explored the impact of this method on young musicians’ performance through an online, 4-week-long Timani intervention with a mixed-methodology design. 17 students (mean age = 19.17 years) were recruited from the Norwegian Academy of Music. They participated in two group workshops at the beginning and the end of the project and received four individual Timani sessions administered by certified teachers. We collected survey data at the workshops about performance-related pain and self-efficacy, and qualitative feedback after each session. In addition, all sessions were observed by the researcher and semi-structured interviews were conducted with the teachers about the perceived outcomes and their experiences with teaching the method online. Our findings show that the intervention had a positive impact on a physical, professional, and to some extent, psychological and behavioral level. The improvements included better posture when playing, enhanced control and dexterity in the upper extremities, and improved breathing mechanisms. The seven students who had performance-related pain pre-intervention reported a reduction in the discomfort. The positive results were achieved by the dual expertise of the teachers in music performance and functional body mechanics, the structure of the sessions, the communication, and the pedagogical tools used. Both students and teachers felt that administering the sessions online was satisfactory and produced good results. Timani is a promising method to establish healthy playing and singing habits thus improving performance quality and preventing performance-related problems and has great potential in reducing pre-existing injuries and pain. Also, it can be effectively taught online which has further implications for the logistics of delivery.

Leveraging implementation science to prevent and reduce musculoskeletal overuse injury in musicians: A proposal for the study of a conceptual framework

BACKGROUND

Musician health and wellness, a fundamental requirement for safe, effective and optimal musical performance, is not guaranteed. Performance related musculoskeletal disorders (PRMD) affect between 60% and 90% of all musicians, and have serious consequences on musculoskeletal health, performance ability and the overall healthcare burden of musculoskeletal injury. The high prevalence of PRMD in musicians can be prevented and reduced via health-education programs designed to address risk factors and practice habits. Multiple studies demonstrate the efficacy of education and instructional exercises in reducing PRMD symptoms in musicians. Despite the awareness of risk and the substantial consequence of non-adherence, implementation of health-education programs is complex and challenging and is rarely offered in music institutions. For successful adoption of musculoskeletal health programs, it is important to identify system level barriers and facilitators and it is important to develop and pilot effective strategies to guide successful implementation of musculoskeletal health programs for musicians.

PURPOSE

This paper proposes a conceptual framework using implementation science methodology to study the factors that influence adoption of musician health education programs to prevent performance related injury. The overall goal of this methodology is to identify determinants of implementation by engaging key stakeholders, developing strategies for adoption of injury prevention programs and generate hypotheses for future studies.

METHODS

The research plan is designed to accomplish the specific aims of this study. Through a mixed-method study we will use qualitative and quantitative methods to address potential barriers, and design and test implementation feasibility of health-education programs for musicians.

RESULTS/CONCLUSIONS

Our findings will inform the development of a large-scale participant randomized hybrid trial to assess effectiveness and implementation outcomes of health education programs and ultimately reduce injury and promote musculoskeletal longevity and performance in musicians.

Prevalence and associated factors of playing-related musculoskeletal disorders among music students in Europe. Baseline findings from the Risk of Music Students (RISMUS) longitudinal multicentre study

Musculoskeletal (MSK) conditions among professional musicians and music students are frequent and may have significant physical and psychosocial consequences on their lives and/or on their playing abilities. The Risk of Music Students (RISMUS) research project was set up in 2018 to longitudinally identify factors associated with increased risk of playing-related musculoskeletal disorders (PRMDs) in a large sample of music students enrolled in pan-European institutions. The aim of this cross-sectional study was to describe the prevalence of playing-related musculoskeletal disorders (PRMDs) in this novel population at baseline of the RISMUS project. A further goal was to begin to identify variables that might be associated with the self-reported presence of PRMDs among music students. Eight hundred and fifty students from fifty-six conservatories and music universities in Europe completed a web-based questionnaire on lifestyle and physical activity participation levels, musical practice habits, health history and PRMDs, psychological distress, perfectionism and fatigue. A total of 560 (65%) out of 850 participants self-reported a positive history of painful MSK conditions in the last 12 months, 408 (48%) of whom self-reported PRMDs. Results showed that coming from West Europe, being a first- or a second-year Masters student, having more years of experience and higher rates of perceived exertion after 45 minutes of practice without breaks were factors significantly associated with self-reported presence of PRMDs. According to the authors’ knowledge, a large-scale multicentre study investigating prevalence and associated factors for PRMDs among music students at different stages of their education (from Pre-college to Masters levels) has not been conducted before. The high prevalence of PRMDs among music students, especially those studying at university-level, has been confirmed in this study and associated factors have been identified, highlighting the need for relevant targeted interventions as well as effective prevention and treatment strategies.

Educating Australian musicians: are we playing it safe?

The effectiveness of health promotion through arts engagement, and the health benefits and social importance of music in particular, are becoming increasingly recognized. However, like sport, music-making is an athletic endeavour, one that often involves high physiological and psychological loadings on the bodies and minds of musicians. Research over the past 30 years has revealed alarming rates of injury among musicians, and has identified health risk factors associated with music performance faced by professional and student musicians. Australia lacks consistent provision of essential health education for musicians, and research shows an unacceptably high prevalence of performance-related health problems among musicians of all ages. This article advocates for effective health promotion to be embraced in the policies and practices of Australian music performance organizations and educational bodies. It argues that a cultural shift is required, recognizing that a settings-based approach to health literacy is as fundamentally important for musicians as it is for any other occupation or athletic activity. Embedding health education into the delivery of music education will not only help to prevent injury over the lifespan of Australian musicians, it will support and sustain their capacity to contribute towards societal wellbeing and public health outcomes.