title: The Influence of a Sudden Increase in Playing Time on Playing-Related Musculoskeletal Complaints in High-Level Amateur Musicians in a Longitudinal Cohort Study.
abstract: BACKGROUND
  Several studies in the domain of professional musicians describe the relation between playing time and the occurrence of musculoskeletal complaints in professional musicians. To date, no longitudinal cohort study into this relationship has been performed and no amateur musicians were studied. Therefore, the aim of this study is to examine the causal relationship between a sudden increase in playing time among amateur musicians on the occurrence of musculoskeletal complaints in a prospective cohort study.
  
  
  METHODS
  All members of two national Dutch Students Orchestras were asked to participate in the study. These project-based orchestras, consisting of high-level amateurs, followed a nine-hour rehearsing schedule for ten consecutive days. On the first day (t0) and after one week (t1) the subjects were asked to complete a paper-based questionnaire including sociodemographic characteristics, music-related questions, questions regarding playing-related musculoskeletal complaints and the music module of the disabilities of arm, shoulder and hand questionnaire.
  
  
  RESULTS
  The NSO consisted of 85 and the NESKO of 41 members during the study period. 59 subjects completed the questionnaire at both timepoints (response rate 47%). 9 subjects were excluded for being a music academy student, leaving 50 subjects (mean age 22.1, 72% female) suitable for analysis. During the rehearsal week, the prevalence of at least one playing-related musculoskeletal complaint increased from 28% to 80%. The most frequently affected areas were the neck, upper and lower back, hand/and or wrists and shoulders. The DASH music module score increased from 14 at t0 to 23 at t1.
  
  
  CONCLUSIONS
  A point prevalence of 28% at the start of the study that increased remarkably to 80% within a one-week period. Future research should evaluate other risk factors for musculoskeletal complaints in amateur musicians. These risk factors should be the base for the development of preventive measures.
authors.affiliation: Department of Orthopedics, NoordWest Ziekenhuis Groep, Alkmaar, The Netherlands.|Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Laura M
authors.identifier: http://orcid.org/0000-0002-2821-9309
authors.initials: LM
authors.lastname: Kok
authors.affiliation: Medical Center for Dancers and Musicians, Medisch Centrum Haaglanden, The Hague, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: Haitjema
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Karlijn A
authors.initials: KA
authors.lastname: Groenewegen
authors.affiliation: Medical Center for Dancers and Musicians, Medisch Centrum Haaglanden, The Hague, The Netherlands.
authors.forename: A Boni M
authors.initials: AB
authors.lastname: Rietveld