Sonia Ranelli

Policy-into-practice for rheumatoid arthritis: Randomized controlled trial and cohort study of E-learning targeting improved physiotherapy management

To examine the effectiveness of a physiotherapy‐specific, web‐based e‐learning platform, “RAP‐el,” in best‐practice management of rheumatoid arthritis (RA) using a single‐blind, randomized controlled trial (RCT) and prospective cohort study.

Playing-related musculoskeletal problems in child instrumentalists: The influence of gender, age and instrument exposure:

Playing-related musculoskeletal problems (PRMP) are common in adult musicians. The limited available evidence suggests PRMP are common in children and adolescents and that risk factors may be similar. The aim of this study was to determine the prevalence of PRMP in children and adolescents and their associations with female gender, age and instrument exposure. The study surveyed 731 children learning musical instruments (460 females) ranging in age from 7—17 years. Lifetime symptoms, monthly symptoms and monthly disorders (the inability to play an instrument as usual) were examined. Logistic regression evaluated the independent association of these potential risk factors with PRMP prevalences. A total of 67% students reported PRM symptoms at some point, 56% reported PRM symptoms within the last month and 30% reported an inability to play as usual within the last month. Female gender was significantly associated with PRMP (OR 1.38—1.56, p = 0.004—0.046), as was age (OR 1.19—0.23, p < 0.001). After adjustment for gender and age, type of instrument (upper and lower strings, woodwind and brass) were significantly associated with all PRMP (p < 0.005) and playing three instruments was protective against monthly symptoms (OR 0.43, p = 0.05). The study concludes that the high prevalence and disabling impact of playing-related musculoskeletal problems is clearly an important issue for child and adolescent health with gender, age and instrument exposure important factors for risk management. Troubles musculo-squelettiques (TMS) associés à la pratique musicale chez les enfants: l’influence du genre, de l’âge et de l’instrument Troubles musculo-squelettiques (TMS) sont communs chez les musiciens adultes. L’evidence limitée disponible suggère que les TMS soient aussi commun chez les enfants et les adolescents et que les facteurs de risque doivent être similaire. Le but de cette étude est de déterminer la prévalence du TMS chez les enfants et les adolescents et leurs associations avec du genre féminin, de l’âge et de l’instrument. L’étude a investigué 731 enfants qui apprenaient un instrument (460 jeune filles) entre l’âge du 7 au 17 ans. Symptômes de longue durée, symptômes de courte durée (mensuelle) et des desordres mensualles (incapacité de jouer un instrument) ont été examinés. Régression logistique a evalué l’association indépendente parmi ces facteurs de risque avec les prévalences de TMS. Parmi les étudiants, 67% ont rapporté des symptômes de TMS pendant le dernier mois et 30 % ont raporté une incapacité de jouer de façon usuelle aussi pendants le dernier mois. Le genre féminin a montré une association significative avec TMS (OR 1,38—1,56, p = 0,004—0,046), ainsi que avec l’âge (OR 1,19—0,23, p < 0,001). Aprés avoir ajustés genre et l’âge, le type d’instrument (cordes, à vent et cuivres) a demonstré une association significative avec TMS (p < 0,005) et jouer trois instruments était protecteur vis-à-vis les symptômes mensuels (OR 0,43, p = 0,05). La haute prévalence et l’impact incapacitant des troubles musculo-squelettiques liès à la pratique musicale sont des sujets importants pour la santé de l’enfant et de l’adolescent en ayant du genre, de l’âge et l’instrument comme des facteurs de risque à gérer. Spielbezogene Probleme des Bewegungsapparats bei kindlichen Instrumentalisten: der Einfluss von Geschlecht, Alter und instrumentaler Belastung Spielbezogene Erkrankungen des Bewegungsapparats (SEB) sind bei erwachsenen Musikern bekannt. Die begrenzt zugänglichen Erfahrungen legen nahe, dass SEB auch bei Kindern und Jugendlichen vorkommen und dass die Risikofaktoren ähnlich sind. Ziel der Untersuchung war es daher, die Verbreitung von SEB bei Kindern und Jugendlichen nachzuweisen und deren Verbindung mit dem weiblichen Geschlecht, mit Alter und instrumentaler Belastung zu bestimmen. Die Studie begutachtete 731 Kinder, die ein Instrument erlernen (460 weibliche Personen) im Alter von 7 bis 17 Jahren. Langzeit Symptome, monatliche Symptome und monatliche Erkrankungen (die Unfähigkeit, das Instrument wie üblich zu spielen) wurden untersucht. Logistische Regressionsanalyse bewertete die unabhängige Verbindung dieser potentiellen Risikofaktoren mit der Verbreitung von SEB. Ergebnisse: 67% berichteten über gelegentliche SEB Symptome, 56% nannten Symptome innerhalb des letzten Monats, und 30% konnten ihr Instrument im letzten Monat nicht wie sonst spielen. Weibliches Geschlecht stand signifikant mit SEB in Verbindung (OR 1.38—1.56, p = 0.004—0.046) wie ebenso das Alter (OR 1.19—0.23, p < 0.001). Nach der Eichung für Geschlecht und Alter zeigte auch die Instrumentengruppe (obere und tiefere Streicher, Holzund Blechbläser) signifikante Zusammenhänge mit SEB (p < 0.005), während das Spielen von drei Instrumenten die Spieler vor monatlichen Symptomen bewahrte (OR 0.43, p = 0.05). Die große Verbreitung und Beeinträchtigung des Instrumentalspiels durch SEB ist eindeutig ein wichtiger Punkt für die Gesundheit von Kindern und Jugendlichen, wobei Geschlecht, Alter und instrumentale Belastung wichtige Faktoren bei der Risikobehandlung darstellen. Trastornos Músculo-esqueléticos Relacionados con la Interpretación en Niños Instrumentistas: Influencias del Género, Edad y Contacto con el Instrumento Los trastornos músculo-esqueléticos relacionados con la interpretación (TMRI) son comunes entre los músicos adultos. Las evidencias limitadas de que disponemos sugieren que los TMRI son también comunes entre niños y adolescentes y los factores de riesgo pueden ser similares a los de los adultos. El propósito de este estudio fue determinar el predominio de los TMRI en niños y adolescentes y su relación con el género femenino, la edad, y el contacto con el instrumento. El trabajo encuestó a 271 niños y 460 niñas (n = 731) de entre 7 y 17 años aprendiendo a tocar un instrumento musical. Se estudiaron síntomas crónicos, síntomas mensuales y trastornos también mensuales (es decir, la incapacidad para tocar normalmente un instrumento). Mediante regresión logística se valoraron las asociaciones independientes de estos factores de riesgo potenciales con el predominio de los TMRI. Resultados: Un 67% del alumnado dijo tener algún síntoma MRI en mayor o menor medida, un 56% dijo haber padecido algún síntoma en el último mes y un 30% informó de la imposibilidad de tocar normalmente durante el último mes. El género femenino estuvo significativamente asociado con TMRI (OR 1’38—1’56, p = 0’004—0’046), así como la edad (OR 1’19—0’23, p < 0’001). Tras realizar ajustes por género y edad, el tipo de instrumento (cuerdas superiores e inferiores, viento madera y metal) se asociaba significativamente con todos los TMRI (p < 0’005). Se encontró además que tocar tres instrumentos protegía contra los síntomas mensuales (OR 0’43, p = 0’05). El alto predominio de los trastornos músculo-esqueléticos relacionados con la interpretación musical y su impacto incapacitante es claramente una cuestión importante para la salud de los niños y los adolescentes en donde el género, la edad y el contacto con el instrumento son factores importantes que influyen en la gestión del riesgo.

Physiotherapy co-management of rheumatoid arthritis: Identification of red flags, significance to clinical practice and management pathways

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease. Physiotherapy interventions for people with RA are predominantly targeted at ameliorating disability resulting from articular and peri-articular manifestations of the disease and providing advice and education to improve functional capacity and quality of life. To ensure safe and effective care, it is critical that physiotherapists are able to identify potentially serious articular and peri-articular manifestations of RA, such as instability of the cervical spine. Additionally, as primary contact professionals, it is essential that physiotherapists are aware of the potentially serious extra-articular manifestations of RA. This paper provides an overview of the practice-relevant manifestations associated with RA that might warrant further investigation by a medical practitioner (red flags), their relevance to physiotherapy practice, and recommended management pathways.

Soreness during non-music activities is associated with playing-related musculoskeletal problems: an observational study of 731 child and adolescent instrumentalists

QUESTION Is exposure to non-music-related activities associated with playing-related musculoskeletal problems in young instrumentalists? Is non-music-activity-related soreness associated with playing-related musculoskeletal problems in this group of instrumentalists? DESIGN Observational study using a questionnaire and physical measures. PARTICIPANTS 859 instrumentalists aged 7 to 17 years from the School of Instrumental Music program. RESULTS Of the 731 respondents who completed the questionnaire adequately, 412 (56%) experienced instrument-playing problems; 219 (30%) had symptoms severe enough to interfere with normal playing. Children commonly reported moderate exposure to non-music-related activities, such as watching television (61%), vigorous physical activity (57%), writing (51%) and computer use (45%). Greater exposure to any non-music activity was not associated with playing problems, with odds ratios ranging from 1.01 (95% CI 0.7 to 1.5) for watching television to 2.08 (95% CI 0.5 to 3.3) for intensive hand activities. Four hundred and seventy eight (65%) children reported soreness related to non-music activities, such as vigorous physical activity (52%), writing (40%), computer use (28%), intensive hand activities (22%), electronic game use (17%) and watching television (15%). Non-music-activity-related soreness was significantly associated with instrument playing problems, adjusting for gender and age, with odds ratios ranging from 2.6 (95% CI 1.7 to 3.9) for soreness whilst watching television, to 4.3 (95% CI 2.6 to 7.1) for soreness during intensive hand activities. CONCLUSION Non-music-activity-related soreness co-occurs significantly with playing problems in young instrumentalists. The finding of significant co-occurrence of music and non-music-related soreness in respondents in this study suggests that intervention targets for young instrumentalists could include risk factors previously identified in the general child and adolescent population, as well as music-specific risk factors. This is an important consideration for the assessment and management of the musculoskeletal health of young musicians.

Selected Physical Characteristics and Playing-Related Musculoskeletal Problems in Adolescent String Instrumentalists

PURPOSE Music research has investigated the prevalence of playing-related musculoskeletal problems in adults and children, but the prevalence in adolescents has not been established. String instrumentalists report high problem rates, though it is unclear whether rates vary between upper and lower strings in adolescent instrumentalists. Further, there is limited evidence for the association between physical characteristics and playing problems in this group of musicians. METHODS Seventy-six adolescent string musicians from the West Australian Youth Orchestras were surveyed. Their experience of playing problems, both symptoms (PRMS) and disorders (PRMD), within the last month and measurements of body mass index, hand span, and joint mobility (Beighton scale) were obtained. Prevalence rates were calculated and compared between upper and lower string instrumentalists using a chi-squared test. Logistic regression examined the association of physical measures with playing problems, adjusting for confounding factors. RESULTS Within the last month, 73.5% participants reported experiencing a PRMS and 26.5percnt; reported experiencing a PRMD. There was no significant difference between the problem rates in upper and lower string instrumentalists. After adjusting for potential confounders, an increasing count of hypermobile joints remained significantly associated with problems (OR 1.76, CI 1.02 to 3.04, p=0.042). CONCLUSIONS This study found playing problems are common in adolescent string instrumentalists, though rates did not differ between upper and lower string players. Joint hypermobility was associated with playing-related problems in adolescent musicians. Early identification of problems in this group of maturing musicians may help prevent disabling disorders and maximize performance.

The association of music experience, pattern of practice and performance anxiety with playing-related musculoskeletal problems (PRMP) in children learning instrumental music

There is evidence supporting the social and cognitive benefits of music education. However aspects of music practice, such as an increase in frequency and intensity of practice, are associated with playing-related musculoskeletal problems in adult musicians, though with limited evidence in children. The aim of this study was to describe the music practice of child instrumentalists and determine their associations with playing-related musculoskeletal problems (PRMP), accounting for gender and age. A total of 731 children learning musical instruments (460 females) ranging in age from 7 – 17 years were surveyed; music experience, music practice and intrinsic factors (e.g. the experience of butterflies in stomach before a concert/exam) were investigated. Logistic regression evaluated the independent association of these potential correlates with PRMP. Music experience (number of years playing main instrument) was significantly negatively associated with PRMP (OR 0.88, p = .003). Pattern of playing was significantly associated with PRMP, specifically playing less than usual (OR 2.1, p = .002) and playing more than usual for longer and more often (OR 2.7, p < .001), compared to playing about usual. The experience of butterflies in the stomach during exams/competitions most times (OR 2.1, p = .029) and always (OR 2.4, p = .027) compared to never, was significantly associated with PRMP. Music inexperience, changed pattern of practice and performance anxiety are associated with playing-related problems in child instrumentalists and are therefore important issues for music education. Evidence-based guidelines may be recommended to help prevent problems and optimize music performance and music education development.