Occupational Risk Factors for Musculoskeletal Disorders in Musicians: A Systematic Review

Abstract

Objective: This study aimed to systematically evaluate the available evidence on risk factors for professional instrumentalists' developing musculoskeletal (MSK) disorders. Methods: Relevant studies were identified by a search of MEDLINE, CINAHL, EMBASE, a manual search of Medical Problems of Performing Artists, and a search of the Performing Arts Medicine Association's online bibliography. Two independent reviewers assessed the methodologic quality of the selected publications using a standardized checklist. The studies' sample characteristics, findings, and quality scores were presented in an evidence table. Results: Two case-control studies and 6 cross-sectional survey designs were included in this review. The median method-score was 61%. Potential risk factors associated with developing MSK complaints included gender, years of playing experience, type of instrument played, playing-related physical (long hours, over-practicing) and psychological stressors (self-pressure/academic), lack of preventive wellness behaviours (taking breaks), and previous trauma. The high degree of methodological (including sample profile) heterogeneity among the studies impeded statistical pooling of relative effect sizes such as odds ratios. Conclusion: The etiology of MSK conditions in instrumental musicians is multifactorial; however, because the majority of research designs were of a cross-sectional survey nature, a temporal relationship between risk factors and the onset of MSK complaints could not be established. Additional case-control studies should be conducted to reveal the most relevant confounding factors, such as exposure to physical stressors during leisure time, the psychosocial environment, and musical work load. Longer-term studies should then focus on more accurately quantifying the degree of risk associated with these risk factors.