The preventable burden of musculoskeletal conditions in Australian musicians

Background: The prevalence of musculoskeletal symptoms (MSSs) among musicians is reportedly high, and may have a profound impact upon those affected. Most studies have been conducted on university classical music students and professional orchestral musicians, leaving other sub-groups, such as military band musicians and opera singers, under-investigated. Even for these most commonly researched groups, there have been relatively few studies investigating the impact of MSSs, or their preventability in terms of psychosocial and organisational factors potentially associated with MSS outcomes. The central research question in this thesis was: “is there a preventable burden of musculoskeletal conditions among Australian university music students and professional musicians?”. Methods: Data were obtained from two sources: the National Data Set for Compensation-based Statistics, and a targeted questionnaire survey developed specifically for this project. Questionnaire development was informed by a systematic search and narrative review of the types of outcomes and data collection tools used to assess musicians’ MSS outcomes. The questionnaire was distributed to university music students and professional musicians, as well as a reference group of university science students and non-music university staff. The utility of the questionnaire measures was examined using Rasch analysis. Data were analysed using standard statistical methods. Results: Musculoskeletal disorders accounted for the majority of workers’ compensation claims (WCCs) made by musicians (70%), and the majority of costs (78%). Of the musicians surveyed, 90% reported MSSs in the last 12 months, and 57% reported experiencing MSSs in the last 12 months that impaired musical activities. Musculoskeletal symptoms were most common in the upper limb and spinal regions. There was no significant difference in MSS prevalence overall between musicians and the reference groups, however music students reported a higher prevalence of wrist/hand MSSs specifically. Symptomatic music students also reported higher ratings of the emotional impact of MSSs than did science students. A higher proportion of symptomatic female professional musicians reported moderate-severe pain than their university staff counterparts. The majority (82%) of musculoskeletal WCCs made by musicians were attributed to body stressing. All symptomatic musicians surveyed provided at least one perceived cause (of up to three reported) of their MSSs that was likely modifiable or preventable. The most commonly reported such perceived causes were behavioural factors (94%). Psychological distress was identified as the most important modifiable personal factor to address, as it was associated with most MSS outcomes. The evidence for other factors was less consistent, however social support, musical activity time, sitting time, and perceived work effort were associated with specific MSS outcomes. Conclusion: Evidence from this research indicates that there is a preventable burden of musicians’ musculoskeletal conditions. To reduce this burden, interventions should be developed that are directed at psychological distress. The effectiveness of these interventions should be examined with particular reference to MSSs in the upper limb and spinal regions, and to the consequences of having MSSs. If found to be safe and effective, appropriate interventions could be implemented nationally, to reduce the burden of musicians’ musculoskeletal conditions.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 201

Extended scope physiotherapy roles for orthopedic outpatients: an update systematic review of the literature

Purpose: This systematic review updates one conducted in 2008 into extended scope practice (ESP) in physiotherapy in orthopedics. Methods: A comprehensive open-ended search was conducted using electronic library databases and Google Scholar to identify any primary study design reporting on physiotherapists working in ESP roles within orthopedic settings. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, although only studies in levels I, II, or III_1 were critically appraised using a purpose-built critical appraisal tool. Information was extracted on the country of origin, ESP tasks, relevant training, patient types, health, process, and cost measures. Results: 1071 studies were identified, and twelve were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from II to IV, from which only two diagnostic studies met the criteria for critical appraisal. ESP tasks included injection therapy, removing k-wires, and requesting investigations. The education of ESP physiotherapists varied widely, and included formal and informal training. The positive outcomes of ESP initiatives were reported, in diagnostic ability, reduced costs and waiting times, and improved health outcomes. Conclusion: Despite the positive results, the generally low level of evidence and the range of outcome measures reported, constrained clear conclusions regarding the health, process, and cost implications of ESP physiotherapy roles in orthopedic settings. The need for formalized, widely recognized training was highlighted, to give ESP physiotherapy roles credibility.Jessica Stanhope, Karen Grimmer-Somers, Steve Milanese, Saravana Kumar, Joanne Morri

Summary Tables: 2018 Essex County, Virginia Shoreline Inventory Report

The Shoreline Inventory Summary Tables quantify observed conditions based on river systems, such as the combined length of linear features (e.g. shoreline miles surveyed, miles of bulkhead and revetment), the total number of point features (e.g. docks, boathouses, boat ramps) & total acres of polygon features (tidal marshes)

Prince George County and the City of Hopewell, Virginia Shoreline Inventory Report Methods and Guidelines

The 2016 Inventory for Prince George County and the City of Hopewell was generated using on-screen, digitizing techniques in ArcGIS® - ArcMap v10.2.2 while viewing conditions observed in Bing high resolution oblique imagery, Google Earth, and 2013 imagery from the Virginia Base Mapping Program (VBMP). Four GIS shapefiles are developed. The first describes land use and bank conditions (PrinceGeorge_Hopewell _lubc_2016). The second portrays the presence of beaches (PrinceGeorge_Hopewell_beaches_2016). The third reports shoreline structures that are described as arcs or lines (e.g riprap) (PrinceGeorge_Hopewell _sstru_2016). The final shapefile includes all structures that are represented as points (e.g. piers) (PrinceGeorge_Hopewell_astru_2016). The metadata file accompanies the shapefiles and defines attribute accuracy, data development, and any use restrictions that pertain to data

City of Chesapeake, Virginia Shoreline Inventory Report Methods and Guidelines

The 2016 Inventory for City of Chesapeake was generated using on-screen, digitizing techniques in ArcGIS® - ArcMap v10.2.2 while viewing conditions observed in Bing high resolution oblique imagery, Google Earth, and 2013 imagery from the Virginia Base Mapping Program (VBMP). Four GIS shapefiles are developed. The first describes land use and bank conditions (Chesapeake_lubc_2016). The second portrays the presence of beaches (Chesapeake_beaches_2016). The third reports shoreline structures that are described as arcs or lines (e.g. riprap) (Chesapeake_sstru_2016). The final shapefile includes all structures that are represented as points (e.g. piers) (Chesapeake_astru_2016). The metadata file accompanies the shapefiles and defines attribute accuracy, data development, and any use restrictions that pertain to data

Summary Tables: Surry County, Virginia Shoreline Inventory Report

The Shoreline Inventory Summary Tables quantify observed conditions based on river systems, such as the combined length of linear features (e.g. shoreline miles surveyed, miles of bulkhead and revetment), the total number of point features (e.g. docks, boathouses, boat ramps) & total acres of polygon features (tidal marshes)

The County of Isle of Wight, Virginia Shoreline Inventory Report: Summary Tables

The Shoreline Inventory Summary Tables quantify observed conditions based on river systems, such as the combined length of linear features (e.g. shoreline miles surveyed, miles of bulkhead and revetment), the total number of point features (e.g. docks, boathouses, boat ramps) & total acres of polygon features (tidal marshes)

Isle of Wight County, Virginia - Shoreline Inventory Report: Methods and Guidelines

The 2017 Inventory for the Isle of Wight County was generated using on-screen, digitizing techniques in ArcGIS® -ArcMap v10.4.1while viewing conditions observed in Bing high resolution oblique imagery, Google Earth, and2013imagery from the Virginia Base Mapping Program (VBMP). Four GIS shapefiles are developed. The first describes land use and bank conditions (IsleofWight_lubc_2017). The second portrays the presence of beaches (IsleofWight_beaches_2017). The third reports shoreline structures that are described as arcs or lines(e.g. riprap)(IsleofWight_sstru_2017). The final shapefile includes all structures that are represented as points(e.g. piers)(IsleofWight_astru_2017).The metadata file accompanies the shapefiles and defines attribute accuracy, data development, and any use restrictions that pertain to data