Musculoskeletal Health among Music Students: Risk Factors Study

1. Occurrence of (Musculoskeletal) Health Complaints and associated Risk Factors in Music Students and Non-music Students – Interim Results from an ongoing Cohort Study Nikolaus Ballenberger, PHD, Msc, PT Dirk, Möller, Dipl. Sportwiss., PT Christine Guptill, PhD, OT, BSc, BMus, MS(OT) Julius Bruder, BSs, PT Christoff Zalpour, MD

2. Who is a musician?

3. Who is a musician? • Who haspain/complaintswhenplaying at themoment?

4. Who is a musician? • Who haspain/complaintswhenplaying at themoment? • Last year?

5. Who is a musician? • Who haspain/complaintswhenplaying at themoment? • Last year? • Ever?

6. Background • Systematic review of occurrence of musculoskeletal complaints in professional musicians (Kok, 2016) • point prevalences : 9 to 68 % • 12-month prevalences : 41 to 93 % • lifetime prevalences : 62 to 93 % • At beginning of studies: 79% of music students reported playing-related pain (Brandfonbrener, 2009) • Classification of Playing-related health complaints among musicians: • Physical : musculoskeletal health complaints (MHC) (Kok, 2013) • Psychological : stress, performance anxiety (Lockwood, 1988; Barthel and Thomson, 1994)

7. Problem • Sport physiotherapy/medicineisestablished • In Germany threetimesmore professionell musiciansthanathletes • Master degrees in Sport PT BUTnoacademiccoursein musicphysiotherapy • muchmoreinstitutes in sportsmedicinethanmusicmedicine

8. Background Overall goal: specificintervention/prevention Requirements for specific Therapy/Prevention: • Identification of etiological mechanisms (risk factors) for playing-related complaints and understanding of interaction necessary

9. Background Requirements for specific Therapy/Prevention: • Identification of etiological mechanisms (risk factors) for playing-related complaints and understanding of interaction necessary BUT : not sufficiently investigated due to inappropriate study designs  mainly cross sectional (Baadjou, 2016) • no incidences prospectively recorded, only prevalences • no causality due to lack of temporal relationship • hence, no (proper) Risk Factors identified (Longitudinal) Cohort Study at University ofappliedscienceofOsnabrueck

10. Cross sectionalvs longitudinal • E.g: oneaimstoevaluatewhetherdepressioncausespain

11. Cross sectionalvs longitudinal Cross-sectional No Depression Depression Hen egg problem!! NoPain Pain Time t0

12. Cross sectionalvs longitudinal longitudinal No Depression NoPain Depression causespain!! Depression Pain Time t0 t1

13. Goal Cohort Study: • Ocurrences(IncidenceandPrevalance) ofmusculoskeletal health complaints (MHC)among music students (University of Osnabrück and other study sites e.g. Alberta Canada) • Assessthedifference in physicalandpsychologicalhealthbetweenmusicstudentsandstudentsofotherdisciplines at baselineandcourseover time • Identification of risk factors  health complaintsbased on health related variables at baseline • Prediction modelhealth complaints

14. Difference in health between music students and students of other disciplines at baseline (cross-sectional) Recruitment

15. Occurrences (Incidence and Prevalence) of MHC over time

16. Identification of risk factors based on health related variables at baseline and prediction of MHC

17. Assessments • Questionnaireabouthistoryofpain, localisationofpain, habits, practicing , sports…. • Corestability planks and Biering-Sørensen-test (Biering-Sorensen 1984; McGill et al. 1999)   • Hypermobility Beighton-Score (Beighton et al. 1973) • CROM (Cervical Range of Motion) • Mechanosensitivity(Grossi et al. 2011; Persson et al. 2004) • Health related QuoL SF12 (Ware, JR und Sherbourne 1992) • Stress- und Coping Inventar(Satow, 2012) • Performance anxiety K-MPAI (Kenny, 2004)

18. Comparison of music students to control students at baseline (cross-sectional, adjusted) N=219

19. Differencesbetweenmusicstudentsandcontrolstudents (cross-sectional)

21. Distribution of MHC within 1 year (longitudinal) Control student Music student 4.6% 4.9% Head/face Neck/schoulder 22.4% 14.6% 11.2% Th.sp/chest 4.6% Up.ex. 10.3% 0.4% 0.5% 4.6% Lower back Low. ex. 4.9% 3.8%

22. Predictorsofmonthlyepisodeof MHC (longitudinal)

23. Things (riskfactors) youshould NOT have/bewhenstartingyourmusiccareerifyouwanttobepainfree….

24. Discussion/Summary • Cross-sectional (at baseline): • Bodily pain, N° stress symptoms, Physical health, Mental health, Physical activity, Planks, General mechanosensitivity, CROM • results are comparable to other research (Kok, 2013; Roach, 2013; Steinmetz, 2012; Voltmer,2012) • Risk factors based on longitudinal data (complete sample): • Music student, Bodily pain, Complaints (seven days), N° stress symptoms, Physical health, Mental health, Complaints (ever), Complaints (12 months), Smoking (years) • results are comparable to other research (Brandfonbrener,2009; Rosset-Llobet, 2000; Steinmetz, 2012; Baadjou, 2016;Kaufman-Cohen,2012)

25. Discussion/Summary • Of interest: mainly pain related variables and generic assessment are more relevant • Even though different between musicians and control not necessarily predictors for MHC  planks, general mechanosensitivity • Need for standardized definition of MHC and its assessment • use MPIIQM (Berque, 2014) in order to make data about MHC comparable across cultures • MPIIQM validated into German (Möller, 2018)

26. Discussion/Limitations Strengths: • Consistency of results  validity • Prospective design  causal relationship (risk factors) , incidences, reduced recall bias (see discrepancy to retrospective) • Detailed information about health Limitations: • compliance • monthly records do not allow to distinguish between recurrence (new episode) and lasting episode • heterogeneity of sample (age, gender)

27. Future • Expandourstudysites • Occurrences, risk factors and prediction model specific for body region and instrumentlow back, neck , upper extremity etc. • Developspecificintervention/prevention

28. Thank you! Questions?

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