Feasibility and impact of an expanded upper extremity musculoskeletal health for musicians (MHM) program on arm and hand pain in musicians.

Abstract

Background: This easibility cohort study follows a prior randomized control pilot trial that examined the feasibility and impact of a formal Musculoskeletal Health for Musicians (MHM) program. In this follow-up study, an expanded program was designed to target hand and arm pain by adding exercises for the wrist, elbow, forearm, and hand intrinsic muscles. The MHM program combines education with exercise instruction to prevent pain and injury in musicians.

Purpose: The aim of this study was to design and implement an expanded MHM program targeted at arm and hand pain and formally assess feasibility and overall adherence and changes in performance-related pain scores. The hypothesis was that the program would be feasible and high adherence to the expanded MHM program would lead to improvements in patient-reported hand and arm pain.

Study design: Feasiblity Cohort Study METHODS: Musicians were administered a questionnaire prior to and after implementation of the expanded MHM program. The questionnaire collected data on practice habits, type of instrument, number of years of playing, and instrument playing level. The validated, Musculoskeletal Pain Interference and Impact Questionnaire for Musicians (MPIIQM) was used to collect data at baseline and ≥1 month after implementation of the MHM. It included categories related to frequency, intensity, duration and location of pain, and impact of pain on playing habits. A customized survey (rated 1-5) captured adherence across five categories. The two-part expanded MHM program included a 30-minute lecture on overuse injuries, musculoskeletal pain conditions, and anatomy related to performance mechanics, with extra focus on the hand and arm anatomy. The second, 70-minute component included a workshop covering five domains: warm up exercises, pacing/breaks, posture/playing positions, "smart" practice habits, and specific pre-performance and exercises plus the hand specific program. The exercise section contained an additional 10-minute module focused on hand exercises.

Results: All 48 subjects recruited for the study participated in the expanded 100-minute MHM program suggesting that attending such a program is feasible. Of these patients only 17 responded to the follow-up survey and were included in the final analysis. The mean age was 24 ± 7 years 71% female, and 29% male. Participants played their instrument for an average of 16 ± 7 years and practiced an average of 14 ± 9.5 h/wk. At baseline, the pain level was 4.5/10 and did not change at follow up (4.5/10). Our preliminary results demonstrated low adherence to the MHM in 3/5 domains (smart practice, posture, pacing) and high adherence in physical warm-up and exercises.

Conclusions: An expanded MHM program targeting the hand and arm is feasible to implement and yielded high participation at multiple higher education music programs. Compared to our pilot study, we had a lower response rate for follow-up and overall adherence, likely due to less follow-up time points, and absence of weekly reminders. High adherence to pacing guidelines, posture recommendations, and smart practice habits were related to pain reduction in our previous study. The low adherence numbers here may reflect the weak outcome.