Job-Related Stressors of Classical Instrumental Musicians: A Systematic Qualitative Review

Development and Initial Validation of the First Questionnaire to Evaluate Performance-related Pain Among Musicians with Different Backgrounds: Performance-related Pain Among Musicians Questionnaire (PPAM)

AIM

To develop and perform the expert's content validation and pretesting of the first questionnaire specifically designed to evaluate performance-related pain among musicians with different backgrounds.

METHODS

The development of the Performance-related Pain Among Musicians Questionnaire (PPAM) was carried out in 4 phases: (1) item generation, (2) experts' panel evaluation and content validation (3) pretesting, and (4) conceptualization of the final version. For item generation we conducted two systematic reviews to identify the existing tools evaluating similar constructs and the predictive factors of performance-related pain. Four expert panel meetings and three pilot tests were performed, with a total of 94 musicians.

RESULTS

From the 1154 articles initially found in the literature search, 153 were included (65 related to pain tools and 88 related to predictive factors) and a pool of 115 items were created. After expert panel evaluation and pretesting, a final self-report questionnaire was defined, comprising 33 core items to evaluate 3 constructs (pain intensity, pain interference in general activities and pain interference in performance), as well as 32 additional items (optional module - predictive factors).

CONCLUSIONS

The PPAM Questionnaire is specifically designed and validated for musicians and can be applied for all types of musicians (professional, amateur and music students), allowing the development of comparative studies between musicians. It is a new enriched tool, easy to respond and disseminate to large, multicentre, and international samples. PPAM is suitable for research and clinical practice purposes and will allow the improved assessment and monitoring of pain in this occupational context.

It's not a virus! Reconceptualizing and de-pathologizing music performance anxiety

Music Performance Anxiety (MPA) is one of the most widespread and debilitating challenges facing musicians, affecting significant numbers of performers in terms of both their personal and professional functioning. Although numerous interventions exist to target MPA, its prevalence remains unchanged since the first large-scale studies of the 1980s, indicating that available interventions are having limited impact. This review synthesizes and critiques existing literature in order to investigate possible reasons for the limited efficacy of current approaches to managing MPA. Key concepts discussed include conceptual and methodological challenges surrounding defining MPA, theoretical perspectives on MPA's etiology and manifestation, and the coping strategies and interventions used to manage MPA. MPA has predominantly been investigated pathologically and defined as a negative construct manifesting in unwanted symptoms. Based on this conceptualization, interventions largely seek to manage MPA through ameliorating symptoms. This review discusses possible reasons why this approach has broadly not proved successful, including the issue of relaxation being both unrealistic and counterproductive for peak performance, issues associated with intentionally changing one's state creating resistance thus exacerbating anxiety, and focusing on the presence of, rather than response to, symptoms. Despite 50 years of research, MPA remains an unsolved enigma and continues to adversely impact musicians both on and off the stage. Reconceptualizing MPA as a normal and adaptive response to the pressures of performance may offer a new perspective on it, in terms of its definition, assessment and management, with practical as well as theoretical implications.

Determining factors for compensatory movements of the left arm and shoulder in violin playing

Introduction

Despite a large number of available ergonomic aids and recommendations regarding instrument positioning, violin players at any proficiency level still display a worrying incidence of task-specific complaints of incompletely understood etiology. Compensatory movement patterns of the left upper extremity form an integral part of violin playing. They are highly variable between players but remain understudied despite their relevance for task-specific health problems.

Methods

This study investigated individual position effects of the instrument and pre-existing biomechanical factors likely determining the degree of typical compensatory movements in the left upper extremity: (1) left elbow/upper arm adduction ("Reference Angle α", deviation from the vertical axis), (2) shoulder elevation ("Coord x", in mm), and (3) shoulder protraction ("Coord y", in mm). In a group of healthy music students (N = 30, 15 m, 15 f, mean age = 22.5, SD = 2.6), "Reference Angle α" was measured by 3D motion capture analysis. "Coord x" and "Coord y" were assessed and ranked by a synchronized 2D HD video monitoring while performing a pre-defined 16-s tune under laboratory conditions. These three primary outcome variables were compared between four typical, standardized violin positions varying by their sideward orientation ("LatAx-CSP") and/or inclination ("LoAx-HP") by 30°, as well as the players' usual playing position. Selected biomechanical hand parameter data were analyzed as co-factors according to Wagner's Biomechanical Hand Measurement (BHM).

Results

Mean "Reference Angle α" decreased significantly from 24.84 ± 2.67 to 18.61 ± 3.12° (p < 0.001), "Coord x" from 22.54 ± 7.417 to 4.75 ± 3.488 mm (p < 0.001), and "Coord y" from 5.66 ± 3.287 to 1.94 ± 1.901) mm (p < 0.001) when increasing LatAx-CSP and LoAx-HP by 30°. Concerning the biomechanical co-factors, "Reference Angle α", "Coord y", but not "Coord x", were found to be significantly increased overall, with decreasing passive supination range (r = -0.307, p = <0.001 for "Passive Supination 250 g/16Ncm", and r = -0.194, p = <0.001 for "Coord y"). Compensatory movements were larger during tune sections requiring high positioning of the left hand and when using the small finger.

Discussion

Results may enable to adapt individually suitable instrument positions to minimize strenuous and potentially unhealthy compensation movements of the left upper extremity.

Typologies of Adolescent Musicians and Experiences of Performance Anxiety Among Instrumental Learners

Literature suggests that music performance anxiety (MPA) is prevalent in adolescence, a developmental period with increased likelihood of experiencing anxiety under evaluative conditions. Evidence also indicate that individuals may respond to evaluative situations in distinct ways. Factors contributing to the individuality of responses in evaluative situations (such as test taking and musical performance) are not yet fully understood. This study investigated student typologies in adolescent instrumental learners. Participants included 410 learners who completed the Young Musicians’ Performance Questionnaire. K-Means cluster analysis revealed three typologies: Cluster 1 – moderately anxious students evidencing lower levels of motivation and feeling ineffective but guarding their self-esteem; Cluster 2 – highly anxious students evidencing negative self-perceptions and being susceptible to experiencing maladaptive MPA; Cluster 3 – low anxious students evidencing high levels of motivation and confidence and inclined toward experiencing adaptive MPA. The 3-cluster solution effectiveness was validated with discriminant analysis. Significant associations between examination achievement and cluster membership revealed variations between clusters. Thematic analysis of qualitative data facilitated further understanding of their characteristics. This study adds to the body of MPA literature by exploring the different ways with which adolescent musicians interpret and respond to anxiety inducing situations. Findings have implications for clinical and educational practice.

The Experiences of Mid-career and Seasoned Orchestral Musicians in the UK During the First COVID-19 Lockdown

The introduction of social distancing, as part of efforts to try and curb the spread of the COVID-19 pandemic, has brought about drastic disruption to the world of the performing arts. In the UK the majority of professional orchestral musicians are freelance and therefore self-employed. These players, previously engaged in enjoyable, busy, successful, portfolio careers, are currently unable to earn a living carrying out their everyday work of performing music, and their future working lives are surrounded by great uncertainty. The aim of the present study was to examine how established professional musicians are experiencing this period, and to look for similarities and differences between the experiences of musicians in the middle of their performing careers (aged 35-45), with those of older players (aged 53 and over). Single semi-structured interviews were carried out over Zoom with 24 freelance, self-employed orchestral musicians; 12 mid-career musicians aged 35-45, and 12 seasoned musicians aged 53 and over. Thematic analysis identified themes common to both groups: the loss of a much-loved performing career, missing music making and colleagues, and anxiety about the future of the music profession. It also identified differences between the two groups: challenges to their identity as a musician, the extent of their anxiety about finances, the extent of their emotional distress, attitudes toward practicing and engaging in collaborative music making, and confusion over future career plans. Findings are discussed with reference to lifespan models of musicians' career development, the PERMA model of wellbeing, and the concept of resilience.

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

PURPOSE

Musicians' practice and performance routines reportedly lead to musculoskeletal complaints and disorders (MCD) that impact their wellbeing and performance abilities. This systematic review aims to assess the prevalence, risk factors, prevention and effectiveness of treatments for MCD in professional musicians and consider the methodological quality of the included studies.

METHODS

A systematic literature search was performed in December 2017 using electronic databases and supplemented by a hand search. Case-control studies, cohort studies, cross-sectional studies, interventional studies and case reports investigating the prevalence, risk factors, prevention or treatment effects of MCD in professional musicians or music students (age ≥ 16 years) were included. Quality assessments of the included studies were performed using an adapted version of the "Study Quality Assessment Tools" from the National Heart, Lung, and Blood Institute.

RESULTS

One case-control study, 6 cohort studies, 62 cross-sectional studies, 12 interventional studies and 28 case reports were included and assessed for methodological quality. The study designs, terminology, and outcomes were heterogeneous, as the analyses mostly did not control for major confounders, and the definition of exposure was often vague. Therefore, evidence that being a professional musician is a risk factor for MCD as well as the causal relationship between these factors remains low despite the fact that a large number of studies have been performed.

CONCLUSIONS

Studies with high internal and external validity regarding the prevalence, risk factors and effectiveness of the prevention or treatment of MCD in professional musicians are still missing. Further high-quality observational and interventional studies are required.

The Relationship Between Occupational Demands and Well-Being of Performing Artists: A Systematic Review

Background: Performing artists are exposed to a range of occupational demands from organisational, interpersonal and intrapersonal sources, which may impact their well-being. The aim of this systematic review was to evaluate and synthesise the literature where researchers have considered the relationship between occupational demands and well-being in performing artists. Methods: A mixed-methods systematic review was conducted including professional and student performing artists. Quantitative, qualitative and mixed-methods study designs were eligible for inclusion in the review. A total of 14 databases were searched from their inception through to October 2017, including MEDLINE, EMBASE, and Scopus. Critical appraisal was conducted using the Mixed-Methods Appraisal Tool and results presented as a narrative synthesis. Results: A total of 20 studies were included in the review, comprising of quantitative (n = 7), qualitative (n = 9) and mixed-methods (n = 4) study designs. Several frameworks of occupational stress and well-being were explored in relation to the results. Organisational, social and emotional demands were associated with lower well-being. Conversely, music-making, performance activities and social support were reported to be resources and were related to higher well-being. Conclusion: This systematic review highlights the need for researchers in this field to adopt methodologically robust study designs, which are informed by appropriate theoretical frameworks. The paucity of high quality and theoretically informed research in this area is a hindrance to the development of evidence-based interventions for this population.

Influence of ergonomic layout of musician chairs on posture and seat pressure in musicians of different playing levels

INTRODUCTION

Musicians often perform in forced postures over a long period of time, which in the worst case may lead to playing-related musculoskeletal disorders. In this context, the ergonomics of the musician's chair (construction and surface quality) can be an influencing factor, with impact on the seating position of the upper body and the pressure distribution of the bottom. Therefore, the relationship between different musician chairs and musicians of different playing levels (professional, amateur or student) was analyzed in order to gain useful insights whether playing experience, playing level, playing style (symmetrical or asymmetrical) or gender have an impact.

METHOD

The total dataset of 47 musicians (3 playing levels: professional, amateur, student) were analysed on six musician chairs with different ergonomic layout. Sitting on each chair without instrument (condition 1) and with instrument (condition 2), the upper body posture (videorasterstereography) and the seat pressure (load distribution) were recorded.as Also, a subjective assessment concerning constitutional data, sitting behaviour, prevailing pain in the musculoskeletal system, sport activity and chair comfort rating, was completed using a questionnaire.

RESULTS

There were significant differences shown in 6 of 17 variables, where all between and within factors were accounted for with a MANOVA. Two measurements of the upper body posture (scapular distance and scapular height) differentiated between playing level. Four of the pressure measurements (pressure under the sit bone and the thigh for the left and the right side) differentiated between chairs and the two conditions (with and without instrument). Chairs with soft cushioning had a mean pressure reduction of about 30%. The pressure was increased by about 10% while playing an instrument. Subjective rating was correlated to age for some of the chairs.

DISCUSSION

Differences between chairs are mainly associated with the pressure distribution under the sitting surface. Playing with an instrument puts an additional force onto the surface of the chair that is more than the weight of the instrument. No relationship between pressure data and upper body posture data could be found. Therefore, it can be speculated that the intersubject variability is larger than systematic differences introduced by the chair or instrument.

Improved Self-Esteem in Artists After Participating in the "Building Confidence and Self-Esteem Toolbox Workshop"

Performing and creative artists have unique occupational and lifestyle stresses and challenges that can negatively affect self-esteem. Low self-esteem not only has serious implications for their psychological and physical health, it can also affect their performance, and creativity. There is a need to establish effective interventions to deal with this issue. To the best of our knowledge, there are no reported studies specific to workshops or interventions on enhancing self-esteem for artists. The Al and Malka Green Artists' Health Centre at the Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada, is a unique multidisciplinary, and integrative clinic serving the special needs of the artist population. We developed a workshop entitled “Building Confidence and Self Esteem Toolbox Workshop” to address this need. We then designed a single-blind, randomized, prospective, pilot study to evaluate the effectiveness of the workshop on enhancing self-esteem in artists, and to evaluate the long-term effectiveness of using the recommended tools in maintaining a healthy self-esteem, as well as maintaining physical and emotional health. Both quantitative and qualitative data were collected. A validated “Self-Esteem Checkup” questionnaire was administered pre- and immediately post workshop, as well as at 2, 6, and 12 months post workshop. Open-ended questions were posed to study participants via email at 2 and 12 months following the workshop, and at 6 months in in-person interviews. Thirty-five professional artists consented to participate in the study, with 26 completing all study visits. Mean scores for all time points, and the individual questionnaire statement mean scores for the five timepoints increased significantly post-workshop and remained statistically significantly improved by the 3rd follow-up 12 months later (p < 0.001). The mean self-esteem rating score increased significantly post-workshop and remained statistically significantly improved by the 3rd follow-up 12 months later (p < 0.01). Qualitative data showed positive feedback on the utilization of the tools learned in the workshop that helped maintain this improvement over a 1-year period. This workshop may be an effective means of addressing the issue of self-esteem in artists. Further controlled studies of larger sample size and longer duration are needed to confirm these findings.