title: Systematic review: risk factors for musculoskeletal disorders in musicians.
abstract: BACKGROUND
  Although many musicians suffer from musculoskeletal disorders, aetiological factors are unclear.
  
  
  OBJECTIVE
  To systematically search for and synthesize the best available evidence on risk factors for musculoskeletal disorders in musicians.
  
  
  METHODS
  A database search was performed in PubMed, EMBASE, CINAHL, Pedro, OTseeker and Psychinfo. A manual search was conducted in the journals Medical Problems of Performing Artists and Psychology of Music. Studies with an objective to investigate determinants associated with playing-related musculoskeletal disorders were included. Papers were selected based on adequacy of statistical methods for the purpose of the study. Search, first screening and selection were performed by one author. Two reviewers independently performed the final selection using full-text reports. Methodological quality assessment was performed by two reviewers independently.
  
  
  RESULTS
  One case-control and 14 cross-sectional studies were included. Methodological quality was in general low. Large heterogeneity existed in study design, population, measurement of determinant and outcome and analysis techniques. Data were presented descriptively. Consistent results were found indicating that previous musculoskeletal injury, music performance anxiety, high levels of stress and being a female playing a stringed instrument seemed to be associated with more musculoskeletal disorders. Influence over or support at work, orchestra category/status, exercise behaviour and cigarette smoking seemed to be unrelated with musculoskeletal disorders. No conclusions could be made on causality, as the current data only represent cross-sectional associations.
  
  
  CONCLUSIONS
  Because of lack of prospective studies, no causal relations could be identified in the aetiology of (playing-related) musculoskeletal disorders in instrumental musicians.
authors.affiliation: Department of Rehabilitation Medicine, CAPHRI, Maastricht University, 6200 MD Maastricht, The Netherlands.|Adelante Centre of Expertise in Rehabilitation and Audiology, 6432 CC Hoensbroek, The Netherlands.
authors.forename: V A E
authors.initials: VAE
authors.lastname: Baadjou
authors.affiliation: Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Antwerp, Belgium.|Pain in Motion International Research Group, Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
authors.forename: N A
authors.initials: NA
authors.lastname: Roussel
authors.affiliation: Department of Rehabilitation Medicine, CAPHRI, Maastricht University, 6200 MD Maastricht, The Netherlands.|Adelante Centre of Expertise in Rehabilitation and Audiology, 6432 CC Hoensbroek, The Netherlands.
authors.forename: J A M C F
authors.initials: JAMCF
authors.lastname: Verbunt
authors.affiliation: Department of Rehabilitation Medicine, CAPHRI, Maastricht University, 6200 MD Maastricht, The Netherlands.|Adelante Centre of Expertise in Rehabilitation and Audiology, 6432 CC Hoensbroek, The Netherlands.
authors.forename: R J E M
authors.initials: RJEM
authors.lastname: Smeets
authors.affiliation: Department of Epidemiology, Musculoskeletal Group, CAPHRI, Maastricht University, 6200 MD Maastricht, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: de Bie
keywords: Musculoskeletal disease; WRULD; music; occupational disease; pain; risk factors