The usefulness of on-site physical therapy-led triage services for professional orchestral musicians – a national cohort study

Abstract

BackgroundAustralian professional orchestral musicians reported a lifetime prevalence of musculoskeletal injuries that had interfered with playing at 84%. Physical therapy-led triage clinics may be a practical method to manage the impact of high performance-related musculoskeletal disorders (PRMDs) in professional orchestral musicians. This study aimed to: a) collect information on presenting injuries, b) determine the participant’s provisional diagnosis, c) evaluate uptake of an on-site triage service, d) measure participant satisfaction, and e) identify factors influencing attendance.MethodsEight triage sessions were run on a fortnightly basis during a designated lunch break between rehearsal calls in seven premier symphony orchestras in Australia; a total population of 483 musicians. The participants received one or a combination of: a) education and advice relating to their provisional diagnosis, b) basic acute management and/or c) a referral to a suitable medical practitioner or allied health professional for further consultation or treatment. A three-month follow-up questionnaire was completed and a qualitative narrative themes-based analysis was undertaken to summarise participant and physical therapist feedback. Uptake, participant satisfaction and factors influencing attendance were measured.Results99 initial consultations (83 individuals) were conducted with more females (61%) utilizing the service than males (49%). The most common injury complaints were in the shoulder (22%), neck (18%), upper back (18%), and hand (8%). 66% of these were diagnosed as PRMDs. Of these injuries, 94% were considered preventable, 93% continued to affect playing, 68% were severe requiring a referral for further management, and 46% were recurrent. The advice at the triage service was rated as helpful or very helpful by 79% of the musicians, whilst 68% responded they were likely or very likely to continue to use the service if it was offered in the future. Of the participants that followed through with the referral advice, 67% reported that the referral advice was helpful or very helpful. Musicians’ and physical therapists’ written feedback indicated their acknowledgement for the need of this service. The main suggestions for improving attendance were increasing the music-specific physical therapy knowledge of therapists and overcoming competing time demands.ConclusionOn-site health services for musicians may facilitate better injury management by providing immediate and specific health advice.Trial registrationACTRN12612000220864

Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians

“…This was found to be the case in our studies with professional orchestral musicians (Chan et al, 2013b,c). All stakeholders including researchers, expert clinicians, orchestral management and musician employee representatives should contribute.…”

Musculoskeletal disorders and complaints in professional musicians: a systematic review of prevalence, risk factors, and clinical treatment effects

“…The term "PRMD" as "performance-related musculoskeletal disorders" was used in seven publications (Ackermann et al 2002b(Ackermann et al , 2011Chan et al 2013;Chan et al 2014;Khalsa and Cope 2006;Khalsa et al 2009). Among these, two intervention studies defined performance-related musculoskeletal disorders according to Zaza and Farewell as "any pain, weakness, numbness, tingling or any other symptoms that interfere with your ability to play your instrument at the level you are accustomed to.…”

“…This definition does not include transient aches or pains" (Ackermann et al 2002b;Chan et al 2014;Zaza and Farewell 1997). One study defined the same term as "a musculoskeletal disorder was considered performancerelated if the injury occurred during or immediately after playing and the musician specified that playing the instrument was the main contributor to their injury" (Chan et al 2013). The term "PRMD" as "performance-related musculoskeletal pain disorders" was applied in three other publications (Kenny and Ackermann 2015;Ackermann et al 2012;Kenny et al 2016) that used the definition based on Zaza and Farewell (Zaza and Farewell 1997), as mentioned above.…”

“…MCDs in the cross-sectional studies were measured with different instruments and used different definitions and questionnaires that to our knowledge, were often not validated (Abréu-Ramos and Micheo 2007;Ackermann et al 2011;Arnason et al 2014;Blackie et al 1999;Chan et al 2013;Crnivec 2004;Davies and Mangion 2002;De Smet et al 1998;Fishbein et al 1988;Fry 1986;Heredia et al 2014;Hodapp et al 2009;Kim et al 2012;Kok et al 2013;Kovero and Könönen 1995;Marques et al 2003;Schäcke et al 1986;Middlestadt and Fishbein 1989;Molsberger 1991;Papandreou and Vervainioti 2010; Raymond et al Moderate degree of disability and pain in all the groups, more disability and pain in the cellists, slightly lower in the violinists and the lowest in the pianists, pain stat. sign.…”

Have musicians’ musculoskeletal symptoms been thoroughly addressed? A systematic mapping review

“…Overall, the comparison between musicians and non-musicians remains under-investigated. Most primary extent studies investigated prevalence of MSS outcomes, with only 5 studies reporting the incidence [68,89,90,117,174]. These, however, appeared to investigate episodic incidence, rather than true incidence.…”