Evaluation of a trial of an e-health promotion course aimed at Australian tertiary music students

87 Pages·2014·1.52 MB·English

by  Michael Ingle

Copyright and use of this thesis
This thesis must be used in accordance with the
provisions of the Copyright Act 1968.
Reproduction of material protected by copyright
may be an infringement of copyright and
copyright owners may be entitled to take
legal action against persons who infringe their
copyright.
Section 51 (2) of the Copyright Act permits
an authorized officer of a university library or
archives to provide a copy (by communication
or otherwise) of an unpublished thesis kept in
the library or archives, to a person who satisfies
the authorized officer that he or she requires
the reproduction for the purposes of research
or study.
The Copyright Act grants the creator of a work
a number of moral rights, specifically the right of
attribution, the right against false attribution and
the right of integrity.
You may infringe the author’s moral rights if you:
- fail to acknowledge the author of this thesis if
you quote sections from the work
- attribute this thesis to another author
- subject this thesis to derogatory treatment
which may prejudice the author’s reputation
For further information contact the University’s
Director of Copyright Services
sydney.edu.au/copyright
Evaluation of a trial of an e-health promotion course aimed at Australian
tertiary music students

Michael William Kennedy Ingle, BSc (Phty)

A thesis submitted in partial fulfilment of
requirements for the degree of
Master of Music (Performance)
Sydney Conservatorium of Music
University of Sydney
2013
STATEMENT OF ORIGNIALITY

I, Michael Ingle, declare that the research presented here is my own original work and
has not been submitted to any other institution for the award of a degree.

In addition, ethical approval from the University of Sydney Human Ethics Committee
was granted for this study. Participants were required to read a participant information
form and informed consent was gained prior to data collection.

Signed: ______________________________________________Date: ___________

ii
ABSTRACT

Playing a musical instrument is an inherently risky occupation. Student musicians
face high levels of competition and must practice long hours each day to constantly
refine their technique and musical expression. This puts them at high risk of physical
and psychological strain. Despite this, student musicians are essentially left to their
own devices to manage their health. A review of the literature pertaining to student
musicians shows high levels of playing-related injury and poor psychological health.
The Australian Learning and Teaching Council has awarded a $220 000 grant to
address occupational risk factors for performance-related health shortfalls in
Australian musicians. This has been used to develop a web-based health promotion
course aimed at tertiary music students, written by experts in the field of performing
arts medicine.

The aim of this thesis was to evaluate the effectiveness of this course in a group of
elite student musicians at the Australian National Academy of Music (ANAM). This
was done through the use of 2 questionnaires to evaluate Playing-Related
Musculoskeletal Disorders (PRMDs) and psychological health. Qualitative feedback
was also sought from participants. 25 students completed the questionnaires initially.
88% of the participants reported a current PRMD. A significant number of
participants also reported moderately or higher levels of depression, anxiety and stress
symptoms. Students reported to be in strong favour of institutionalising a health
promotion course related to their music performance.

Participation in the web course was very low, with only 4 students completing the
course. Organisational, timing and accessibility issues were cited as contributing to
this. However, it was postulated that these issues relate to a culture of neglect with
regard to performance-related physical and mental health. This study has added to the
growing body of literature that has identified the need for music institutions to take a
proactive and holistic approach to preventing performance related injuries and
preparing students physically and mentally for peak musical performance.
iii
ACKNOWLEDGMENTS

Writing this thesis over the last few years has taken many hours of time and I
acknowledge the significant contribution of the following people who have helped me
along the way:

Dr Bronwen Ackermann – for supervising this work. Your leadership and knowledge
in the field of performing arts medicine is groundbreaking and truly inspiring.

Mr Scott Kinmont – for your assistance with proofreading as well as my development
as a musician.

A/Prof Suzanne Wijsman – for your assistance with the background to this thesis and
running of the Sound Performers trial.

My parents, Martha and Ian Ingle – for your help with proofreading, but mainly all
your love and support and for always being there when I’ve needed you.
iii
TABLE OF CONTENTS
STATEMENT OF ORIGINALITY………………………………………………….. i
ABSTRACT .................................................................................................................. ii
ACKNOWLEDGMENTS ........................................................................................... III
LIST OF TABLES ....................................................................................................... Vi
LIST OF FIGURES .................................................................................................... vii
GLOSSARY……………………………………………………………………….. viii
BACKGROUND - THE AUSTRALIAN LEARNING AND TEACHING
COUNCIL (ALTC) PROJECT: ..................................................................................... 1
INTRODUCTION AND STUDY AIMS ...................................................................... 4
THEORTETICAL AND PRACTICAL BACKGROUND TO THE STRUCTURE
OF THE E-HEALTH COURSE…………………………………………………...9-31
Characteristics of, and risk factors for, Playing-Related Musculoskeletal Disorders
(PRMDs) in musicians ................................................................................................... 9
Perception of risk factors among health experts and musicians ................................ 9
Posture................................................................................................................... 10
Long practice hours ................................................................................................ 12
Sudden increases in playing time and insufficient rest breaks.... Error! Bookmark not
defined.
Technique flaws ..................................................... Error! Bookmark not defined.
ROLE OF MUSIC TEACHERS IN INJURY MANAGEMENT ............................... 14
CONSIDERING PAIN AND INJURIES FROM A BIOPSYCHOSOCIAL
PERSPECTIVE............................................................................................................ 15
PSYCHOLOGICAL ASPECTS OF PERFORMANCE ............................................. 17
Performance anxiety ................................................................................................ 17
STUDENT MUSICIANS AND THEIR HEALTH-RELATED BEHAVIOURS…...20
PRINCIPALS OF OCCUPATIONAL MEDICINE –
APPLICATIONS TO MUSICIAN’S HEALTH. ........................................................ 22
Sports medicine literature ........................................................................................ 22
Work-Related Musculoskeletal Disorders literature ................................................ 25
Other relevant forms of injury prevention measures ............................................... 27
Case Study: The Australian Ballet ........................................................................... 28
IMPLEMENTATION OF HEALTH PROMOTION COURSES IN MUSIC
STUDENTS TO DATE ............................................................................................... 30
iv
LITERATURE REVIEW OF STUDIES EVALUATING HEALTH PROMOTION
COURSES FOR MUSIC STUDENTS………………………………………………32
METHOD .................................................................................................................... 37
Study design ............................................................................................................. 37
Recruitment of participants ...................................................................................... 39
Participant description ............................................................................................. 39
Procedures ................................................................................................................ 39
Web course module.................................................................................................. 40
RESULTS ................................................. ERROR! BOOKMARK NOT DEFINED.
Participant characteristics ........................................................................................ 42
Questionnaire 1 – Depression, Anxiety and Stress Scale -21 (DASS-21) ............... 43
Questionnaire 2 - Physical characteristics/health attitudes among participants ...... 45
Qualitative feedback from participants .................................................................... 49
DISCUSSION .............................................................................................................. 50
Study limitations ...................................................................................................... 56
FURTHER DIRECTIONS FOR RESEARCH RELATED TO THIS FIELD ............ 57
Quantitative evaluation of the Sound Performers course on reducing PRMDs....... 57
Educating school-aged children about the risks of instrumental playing ................ 57
Training of instrumental music teachers .................................................................. 58
CONCLUSION ............................................................................................................ 59
REFERENCES ............................................................................................................ 60
APPENDIX A: QUESTIONNAIRE 1 - DASS-21………………………………......72
APPENDIX B: QUESTIONNAIRE 2……………………………………………….73

v
LIST OF TABLES

Table 1 Perception of Risk Factors Contributing to Playing-Related
Musculoskeletal Disorders …………………………………….……...9
Table 2 Abridged table of frequencies and percentages of selection,
and items ranked 1 from 21 causes of performance anxiety
in music and dance students……..…………………………………...18
Table 3 Predisposing factors to injury in the sporting population…………....22
Table 4 Summary of hazards identified in the WRMD literature and
their application to musicians………………………………………...26
Table 5 Participants’ age categories..................................................................42
Table 6 Number of participants in each instrumental group………………….42
Table 7 Physical pain and injury characteristics of participants at baseline.....46
Table 8 Participants’ reported physical location of pain/injury site(s)……….47
Table 9 Participants’ perceived level of knowledge in regard
to course topics……………………………………………………….48

vi
LIST OF FIGURES

Figure 1 A common negative cycle of events of a student
with a playing-related injury…………………………………………21
Figure 2 Study design……………………………………………………….....38
Figure 3 DASS-21 result from data compared to normal,
mild, moderate, severe and extremely severe stress, anxiety
and depression subscales……………………………………………..43
Figure 4 Proportion of sample in moderate or higher category
of depression subscale of DASS-21………………………………….44
Figure 5 Proportion of sample in moderate or higher category
of anxiety subscale of DASS-21……………………………………..44
Figure 6 Proportion of sample in moderate or higher category
of stress subscale of DASS-21…………………………………….....45
Figure 7 Rating of Perceived Exertion Scale (RPE)…………………………...48
vii
GLOSSARY

ALTC Australian Learning and Teaching Council

ANAM Australian National Academy of Music

AIS Australian Institute of Sport

ASPAH Australian Society of Performing Arts Healthcare

DASS Depression, Anxiety and Stress Scale

ICSOM International Conference of Symphony and Opera
Musicians

MPPA Medical Problems of Performing Artists

PAMA Performing Arts Medicine Association

PRMD Playing-Related Musculoskeletal Disorder

RPE Rating of Perceived Exhaustion

Sound Performers The e-health curriculum used in this study

WRMD Work-Related Musculoskeletal Disorder
viii