Playing-related musculoskeletal problems in children learning instrumental music: prevalence and associated potential risk factors

731 child instrumentalists were surveyed to establish the 1) prevalence and location of PRMP, and 2) independent association of potential risk factors with PRMP. 67% reported lifetime prevalence of PRMP, 56% monthly PRMP and 30% were unable to play the instrument as usual. The hands and neck were the most commonly reported PRMP locations. Individual factors and music-related factors were significantly associated with PRMP. Understanding potential risk factors will guide intervention initiatives for young instrumentalists

Playing-related Musculoskeletal Problems in Children Learning Instrumental Music: The Association Between Problem Location and Gender, Age, and Music Exposure Factors

Purpose: Playing-related musculoskeletal problems (PRMP) are common in adult musicians, and risk factors include gender, music exposure, and particularly instrument type. Emerging evidence suggests PRMP are common in children and adolescents and that risk factors may be similar. The aim of this study was to determine the prevalence of PRMP, both symptoms and disorders, and PRMP location in children and adolescents as well as the associations with gender, age, and music exposure factors such as type and number of instruments and playing time. Methods: This study surveyed 731 children (460 females), aged 7 to 17 years, studying instrumental music in government schools in Perth, Australia. Lifetime and monthly symptoms, monthly disorders (inability to play an instrument as usual), and PRMP location were examined. Chi-squared analyses were used to evaluate associations between gender, age, music exposure, and PRMP outcomes. Logistic regression evaluated the independent association of these potential risk factors with PRMP prevalence and location.Results: Sixty-seven percent of students reported PRMP symptoms at some point, 56% reported them within the last month, and 30% reported an inability to play as usual within the last month. After adjustment for gender and age, the type of instrument played (upper and lower strings, woodwind, and brass) was significantly associated with all PRMP (p<0.005) and playing three instruments was protective against monthly symptoms (OR 0.43, p=0.05). The right (24%) and left (23%) hand/elbow and neck (16%) were the most commonly reported PRMP locations, with females affected significantly more than males Prevalence of PRMP increased with age for neck (p<0.001), mid-back (p=0.007), low back (p<0.001), right hand/elbow (p=0.008), and mouth (p=0.011). PRMP prevalence for the left hand/elbow and right and left shoulders demonstrated high rates across all childhood ages. Odds ratios for the risk of PRMP in different locations varied by instrument played. Conclusions: The high prevalence and location of PRMP are important issues for child and adolescent instrumentalists. Gender, age, and music exposure are associated with PRMP risk and need to be addressed to ensure musicians' personal well-being and musical longevity

Soreness during non-music activities is associated with playing-related musculoskeletal problems: an observational study of 731 child and adolescent intrumentalists

Question: Is exposure to non-music-related activities associated with playing-related musculoskeletal problems in young instrumentalists? Is non-music-activity-related soreness associated with playing-related musculoskeletal problems in this group of instrumentalists? Design: Observational study using a questionnaire and physical measures. Participants: 859 instrumentalists aged 7 to 17 years from the School of Instrumental Music program. Results: Of the 731 respondents who completed the questionnaire adequately, 412 (56%) experienced instrument-playing problems; 219 (30%) had symptoms severe enough to interfere with normal playing. Children commonly reported moderate exposure to non-music-related activities, such as watching television (61%), vigorous physical activity (57%), writing (51%) and computer use (45%). Greater exposure to any non-music activity was not associated with playing problems, with odds ratios ranging from 1.01 (95% CI 0.7 to 1.5) for watching television to 2.08 (95% CI 0.5 to 3.3) for intensive hand activities. Four hundred and seventy eight (65%) children reported soreness related to non-music activities, such as vigorous physical activity (52%), writing (40%), computer use (28%), intensive hand activities (22%), electronic game use (17%) and watching television (15%). Non-music-activity-related soreness was significantly associated with instrument playing problems, adjusting for gender and age, with odds ratios ranging from 2.6 (95% CI 1.7 to 3.9) for soreness whilst watching television, to 4.3 (95% CI 2.6 to 7.1) for soreness during intensive hand activities.Conclusion: Non-music-activity-related soreness co-occurs significantly with playing problems in young instrumentalists. The finding of significant co-occurrence of music and non-music-related soreness in respondents in this study suggests that intervention targets for young instrumentalists could include risk factors previously identified in the general child and adolescent population, as well as music-specific risk factors. This is an important consideration for the assessment and management of the musculoskeletal health of young musicians

Physiotherapy co-management of rheumatoid arthritis: Identification of red flags, significance to clinical practice and management pathways

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease. Physiotherapy interventions for people with RA are predominantly targeted at ameliorating disability resulting from articular and periarticular manifestations of the disease and providing advice and education to improve functional capacity and quality of life. To ensure safe and effective care, it is critical that physiotherapists are able to identify potentially serious articular and peri-articular manifestations of RA, such as instability of the cervical spine. Additionally, as primary contact professionals, it is essential that physiotherapists area ware of the potentially serious extra-articular manifestations of RA. This paper provides an overview of the practice-relevant manifestations associated with RA that might warrant further investigation by a medical practitioner (red flags), their relevance to physiotherapy practice, and recommended management pathways

Participatory design of an infographic to help support the care of people living with complex regional pain syndrome

Background Complex regional pain syndrome (CRPS) can be a debilitating pain condition with enduring physical, psychological and social impacts. CRPS is often poorly understood by healthcare professionals and management needs to be tailored to each individual’s presentation. People with lived experience express difficulty in accessing reliable and meaningful information about the condition. This study aimed to co-create a trustworthy infographic to share information about the lived experience of CRPS. Methods We adopted a seven-phase, iterative, participatory methodology to co-create the infographic. Potential infographic content was obtained from qualitative work investigating the lived experience of CRPS. Online consumer engagement (people with doctor diagnosed CRPS/their family, n=20) was used to prioritise content to be included in the infographic and then potential designs were sourced. The research team narrowed the selections down to two designs which were presented to consumers online for final selection ( n=25) and refinement ( n=34). Results An infographic for understanding the lived experience of CRPS was completed using participatory design, providing a resource aligned to the needs of people with this condition. Using the Patient Education Materials Assessment Tool, the final infographic rated highly for understandability (92%) and participants indicated significant willingness to share this infographic with others (93%). Conclusion A process of participatory design was an effective and efficient process for translation of evidence gathered from qualitative research into a trustworthy resource for people with CRPS and their support people

Selected Physical Characteristics and Playing-Related Musculoskeletal Problems in Adolescent String Instrumentalists

PURPOSE: Music research has investigated the prevalence of playing-related musculoskeletal problems in adults and children, but the prevalence in adolescents has not been established. String instrumentalists report high problem rates, though it is unclear whether rates vary between upper and lower strings in adolescent instrumentalists. Further, there is limited evidence for the association between physical characteristics and playing problems in this group of musicians. METHODS: Seventy-six adolescent string musicians from the West Australian Youth Orchestras were surveyed. Their experience of playing problems, both symptoms (PRMS) and disorders (PRMD), within the last month and measurements of body mass index, hand span, and joint mobility (Beighton scale) were obtained. Prevalence rates were calculated and compared between upper and lower string instrumentalists using a chi-squared test. Logistic regression examined the association of physical measures with playing problems, adjusting for confounding factors. RESULTS: Within the last month, 73.5% participants reported experiencing a PRMS and 26.5% reported experiencing a PRMD. There was no significant difference between the problem rates in upper and lower string instrumentalists. After adjusting for potential confounders, an increasing count of hypermobile joints remained significantly associated with problems (OR 1.76, CI 1.02 to 3.04, p=0.042). CONCLUSIONS: This study found playing problems are common in adolescent string instrumentalists, though rates did not differ between upper and lower string players. Joint hypermobility was associated with playing-related problems in adolescent musicians. Early identification of problems in this group of maturing musicians may help prevent disabling disorders and maximize performance

Prevalence of Playing-related Musculoskeletal Symptoms and Disorders in Children Learning Instrumental Music

A cross-sectional questionnaire study gathered data from 731 children enrolled in the instrumental music programs of government primary and secondary schools in Perth, Western Australia. This study, the first in a series investigating risk factors, established the prevalence of playing-related musculoskeletal problems, both symptoms (PRMS) and disorders (PRMD), and the association with gender and age. In this group, 67% of children reported ever experiencing PRMS, with 56% reporting symptoms at least monthly. Females were more likely (odds ratio [OR] 1.5, p = 0.03) to experience symptoms and older children were more likely to have ever experienced symptoms (p < 0.001). Thirty percent reported the experience of a PRMD, being unable to play their instrument as usual. Females (OR 1.5, p = 0.035) and older children (p = 0.001) again were more likely to report the experience of a disorder. For children having reported the experience of a PRMS within the last month, 5% took medication to relieve the problem and 4% visited a health professional to seek advice for the problem

Perspectives on hand function in girls and women with Rett syndrome

Objective: Rett syndrome is a rare neurodevelopmental disorder that is usually associated with a mutation on the X-linked MECP2 gene. Hand function is particularly affected and we discuss theoretical and practical perspectives for optimising hand function in Rett syndrome. Methods: We reviewed the literature pertaining to hand function and stereotypies in Rett syndrome and developed a toolkit for their assessment and treatment. Results: There is little published information on management of hand function in Rett syndrome. We suggest assessment and treatment strategies based on available literature, clinical experience and grounded in theories of motor control and motor learning. Conclusion: Additional studies are needed to determine the best treatments for hand function in Rett syndrome. Meanwhile, clinical needs can be addressed by supplementing the evidence base with an understanding of the complexities of Rett syndrome, clinical experience, environmental enrichment animal studies and theories of motor control and motor learning