title: A systematic review of prevalence and risk factors associated with playing-related musculoskeletal disorders in pianists.
abstract: BACKGROUND
  Playing-related musculoskeletal disorders (PRMDs) are a recognized problem amongst instrumental musicians. Although pianists are prominent in data regarding prevalence of PRMDs, there is poor understanding of piano-specific risk factors associated with PRMDs.
  
  
  OBJECTIVE
  To synthesize published literature on the prevalence of and risk factors associated with PRMDs in pianists.
  
  
  METHODS
  Thirty-eight databases were searched. Eligible studies were those investigating prevalence of or risk factors associated with PRMDs in pianists, using an appropriate methodology according to a hierarchy of evidence. Information regarding study population, operational definition of PRMD, risk factors investigated, statistical tests used and outcomes was extracted and narratively synthesized for all eligible papers above an arbitrarily chosen quality score.
  
  
  RESULTS
  The literature search identified 482 citations. Fifty-two papers were ranked in a hierarchy of evidence; 12 were eligible for evaluation using a quality assessment tool. Common methodological limitations included sampling/measurement biases, inadequate reporting of reliability/validity of outcome measures, lack of operational definition of PRMD and no statistical significance testing. Prevalence rates for PRMDs in pianists varied widely (26-93%). Four authors demonstrated statistically significant risk factors; however, no authors combined a clear operational definition of PRMD with statistically established risk factors. There was no consensus between authors regarding risk factors.
  
  
  CONCLUSIONS
  Current evidence does not provide sufficient information regarding prevalence of and risk factors associated with PRMDs in pianists. Future studies should provide an operational definition of PRMD, use valid, reliable measurement tools, utilize a prospective cohort study design and perform appropriate statistical tests.
authors.affiliation: School of Physiotherapy, University of Melbourne, 200 Berkeley Street, Parkville, Victoria 3010, Australia. pbragge@unimelb.edu.au
authors.forename: Peter
authors.initials: P
authors.lastname: Bragge
authors.forename: Andrea
authors.initials: A
authors.lastname: Bialocerkowski
authors.forename: Joan
authors.initials: J
authors.lastname: McMeeken
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000209:etiology; D009146:Music; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors