Bronwen Jane Ackermann

Music students are at high risk of sustaining music performance health issues (MPHIs) during their training and thereafter but are not necessarily prepared adequately for the physical and psychological demands of performance careers. MPHIs can be managed comparatively easily if early warning signs are recognised but students are often unaware of both risk factors and their indicators. In consultation with stakeholders, we aimed to develop and implement a simple triage or health advisory pathway (HAP) model in the form of a poster to help students and teachers identify appropriate courses of action for a range of common MPHIs. We used formative and process evaluation methods and modified the model, informed by practice and research, based on constructive feedback. Participants were 10 music (instrumental/vocal) teachers and eight non-music teachers (academic/support staff) at a tertiary-level music conservatoire. Most engaged with the evaluation process and strongly endorsed the final version of the model and its display and use. Those who were least likely to engage fully were workplace health and safety staff and administrative support personnel; it will be crucial to overcome this challenge in future, for the sake of the music profession and all those who benefit from it.

Widespread research over four decades has shown that musicians suffer physical and psychological injuries that can begin during childhood and early adulthood. A survey of 268 Australian tertiary music students revealed their perceptions of the importance of health education as part of their education. While students rated health knowledge as highly important, they considered its inclusion in their education to be less significant. Thirty-six percent reported current physical pain or injury, and 41% reported current psychological health issues. Significant correlations emerged between students’ reported injury history and prioritisation of health education and particular health topics. This has implications for tertiary music education providers regarding policies for the integration of health education into the curriculum.

A new continuing education course from Performing Arts Medicine Association and American College of Sports Medicine enables sports medical health professionals to better care for performing artists. High occupational injury rates have been reported in performing artists, yet the quality of preventive and clinical care remains highly variable. Through the Athletes and the Arts collaboration, The Performing Arts Medicine Association, and the American College of Sports Medicine identified that health care practitioners’ existing expertise should be enhanced to address the complex psychophysical needs of performing artists. In response, a 2-d continuing education course, “The Essentials of Performing Arts Medicine” (EOPAM), was developed and has been delivered at least annually since 2016. This course has been well-received by 149 physicians and 240 allied health professionals to date (average ratings, ≥3.5/5 from 2018 to present), with course quality significantly improved by a transition to online delivery in 2020 (average ratings ≥4.5/5; P < 0.01). Accordingly, EOPAM demonstrates that a brief continuing education course can enhance health professionals’ understanding of the unique needs and demands of performing artists, addressing a key barrier to improved care.

Training in the performing arts exposes individuals to often extreme physical and psychological demands, which are linked to high occupational injury rates. The intense demands of performing artists have been likened to those of sport athletes. However, distinct differences in these demands necessitate specialized approaches to the health care of performing artists. Through the Athletes and the Arts collaboration, the American College of Sports Medicine and Performing Arts Medicine Association identified that the creation of a specialized preparticipation screening tool for performing artists would likely enhance health care for performing artists significantly. Based on a thorough review of established assessments and an extensive consultation process with domain experts, a consensus best-practice screening tool was developed: the Dancer, Instrumentalist, Vocalist, Actor (DIVA) Preparticipation Screening. This screening tool is modeled on the athletic preparticipation examination (PPE) in its structure and 30-min target duration. However, DIVA diverges considerably from the PPE in its content to address the specific risks and needs of performing artists. In particular, screening questions and physical examination procedures focus strongly on musculoskeletal injuries and mental health conditions, in response to the preponderance and interactions of these conditions appearing in performing artists. The DIVA tool presented is intended as a “living tool,” which can be modified in the future to include new effective assessment techniques as appropriate. Training in the DIVA preparticipation physical examination is included as a core component of the essentials of performing arts medicine continuing education course described in detail in a companion manuscript in this issue.

This issue of MPPA raises awareness once more of the highly specific needs of performing artists, and the specialised kind of support or assessment that will be required to optimally manage their health care needs. As reported in this issue, Kawano et al. concluded that highly expressive task-specific movements are often a normal part of the technical requirements for a dance routine, and analysing whether dancers are safe to perform these manoeuvres requires a highly trained eye and experience. Not only that, but their beliefs on how such movements affect their risk of injury may be influenced by perspectives within the dance culture (Hendry et al.). To be able to assess dancers and their injury risk requires health professionals to have substantial experience, as general health assessment measures are unlikely to be adequate to meet their highly complex performance demands (Clarke et al.). Similar experience is required in understanding the complex demands of the wide spectrum of musical performance, acting, and other artistic pursuits, including understanding strategies to help performing artists manage their workloads. Problems are highlighted with the impact of fatigue on circus (Decker et al.) and dance activities (Jarvis et al.), with work and training loads playing a role in affecting movement patterns and health status. Further research may clarify other factors contributing to fatigue in performing artists, as many issues such as travel, diet, and mood will contribute to feelings of fatigue.

Medical Problems of Performing Artists has addressed the needs of clinicians for many decades, providing evidence and opinion pieces on performing artists' healthcare regarding a wide range of health issues that may either affect or cause problems when performing. Traditionally, two major challenges facing the best approaches to managing the health of performing artists has been (i) limited scientific research evidence supporting preventative approaches, specific assessments and treatment methods for the vast array of conditions seen, and (ii) a lack of training programs specifically targeting performing artists' healthcare. Not only are there many important differences between general healthcare and managing the health of performing artists, but there are variations between individuals performing on the same instrument, and a vast array of styles and genres of performing arts that create very different demands on performers. In relation to the first point, a previous lack of available scientific literature has hindered evidence-informed performing arts medicine practice; however, high-quality research has recently progressed rapidly. This edition of MPPA also highlights the incredible breadth of information emerging, recognising the complex and multiple health demands facing diverse performing arts domains.

In recent years, the role of health literacy in determining appropriate attitudes and behaviours to health has received extensive attention. According to the World Health Organisation, health literacy refers to the ability of individuals to access, understand, and use information in ways which promote and maintain good health for themselves, their families, and their communities. It has been increasingly recognised that this information should be tailored to the specific needs of the community (e.g., performing artists) to empower them to take an active role in improving their own health outcomes. One concern recognised for well over a decade now has been the challenge for non-health-trained individuals to recognise what is reliable when searching through the highly variable sources of “health information” published on the internet.