Load and fatigue monitoring in musicians using an online app: A pilot study.

Background/aims: High occupational injury rates are reported in musicians, with a career prevalence of up to 89%. Fatigue and playing (over)load are identified as key risk factors for musicians' injuries. Self-report fatigue management strategies in sport have demonstrated preventive effects. A self-report fatigue management tool for musicians was developed based on a Delphi survey of international experts and hosted in an online app. The aims of this study are to evaluate the content validity and uptake of this new tool, and explore associations between collected performance quality, physical/psychological stress, pain, injury and fatigue data. Methods: University and professional musicians were asked to provide entries into the online app twice per week for 1-6 months. Entries into the app were designed to take 2-3 min to complete and consisted of the following: 6 questions regarding playing load over the previous 72 h; 5 questions regarding current levels in key physical/psychological stress domains (sleep, recovery, overplaying, pain, fitness); one question self-rating of performance quality over the previous day; one question regarding current musculoskeletal symptoms; a reaction time task to evaluate psychomotor fatigue. Results: N = 96 participants provided an average of 2 app entries (range 0-43). Increased playing time, rating of perceived exertion (RPE), and feelings of having to "play too much" were consistently associated with increased self-rated performance quality (p ≤ 0.004; 6.7 <| t |< 2148.5). Increased ratings of feeling fit and recovering well were consistently associated with reduced pain severity (p < 0.001; 3.8 <| t |< 20.4). Pain severity was increased (6.5/10 vs. 2.5/10; p < 0.001) in participants reporting playing-related musculoskeletal disorders (PRMDs; symptoms affecting playing). Conclusion: The prospective value of regular individual self-report playing load, stress, and performance data collection in musicians is clear. However, limited uptake of the online fatigue management app piloted in this study indicates that new approaches to the collection of these data are needed to realize their potential impact.

Flourishing Through Music Creation: A Qualitative Investigation of the Lullaby Project Among Refugee and Incarcerated Communities.

The Lullaby Project is an innovative model developed to support vulnerable groups through community-based music creation. It pairs expectant and new mothers with professional musicians, to create a lullaby for their children. This paper presents an investigation of the project's pilot implementation in the United Kingdom, bringing together musicians from the Royal Philharmonic Orchestra, refugee mothers and inmate fathers from a central London prison. The research aimed to understand how the Lullaby Project was experienced, focusing on the potential areas of perceived change linked with the concept of mental health as flourishing. Participants (N=12) took part in semi-structured interviews and kept daily notes to aid recollection of the sessions in the interviews. Interpretative phenomenological analysis was adopted as the research approach. Participants considered the project to carry significance for them in three key areas: (1) wellbeing, through a strong sense of accomplishment, meaning and connectedness, and the experience of positive emotions; (2) proactivity, promoting initiative, both musical and relational; and (3) reflectiveness, stimulating perspective-taking and positive coping mechanisms. The Lullaby Project offers an effective model towards promotion of flourishing among vulnerable groups, and the results make a strong case for its implementation.

Resounding Meaning: A PERMA Wellbeing Profile of Classical Musicians.

While music has been linked with enhanced wellbeing across a wide variety of contexts, the professional pursuit of a music career is frequently associated with poor psychological health. Most research has focused on assessing negative functioning, and to date, few studies have attempted to profile musicians' wellbeing using a positive framework. This study aimed to generate a profile that represents indicators of optimal functioning among classical musicians. The PERMA model, which reconciles hedonic and eudaimonic wellbeing, was adopted and its five elements assessed with a sample of professional classical musicians: Positive Emotion, Engagement, Relationships, Meaning and Accomplishment. 601 participants (298 women, 303 men) engaged in careers as orchestral (n = 236), solo (n = 158), chamber (n = 112), and choral musicians (n = 36), as well as composers (n = 30) and conductors (n = 29), answered the PERMA-Profiler, a self-report questionnaire built to assess the five components of PERMA. Results point to high scores across all dimensions, with Meaning emerging as the highest rated dimension. Musicians scored significantly higher than general population indicators on Positive Emotion, Relationships and Meaning. When wellbeing is assessed as positive functioning and not the absence of illbeing, musicians show promising profiles. The reconciliation between these findings and the previous body of research pointing to the music profession as highly challenging for healthy psychological functioning is discussed.

Promoting well-being through group drumming with mental health service users and their carers.

PURPOSE: Music has been linked with well-being across clinical and community settings. Yet, research has focused on assessment of single dimensions of well-being and on the typical receiver of support services. Acknowledging the burden that a caring role encompasses and integrating recent proposals for a multifaceted definition of well-being, we explore the extent to which group drumming interventions translate into multidimensional well-being change for both mental health service users and carers. METHOD: Thirty-nine participants engaged in one of a series of community drumming programmes were assessed via semi-structured interviews (n = 11) and focus groups (n = 28) at the end of each programme. Data were analysed using IPA. RESULTS AND CONCLUSION: Emotional, psychological and social dimensions of well-being emerged for both patients and carers, accounted for through six themes: (1) hedonia: positive affect and pleasant physical effects of drumming; (2) agency: initiative and sense of control; (3) accomplishment: non-specific and in relation to musical goals; (4) engagement, through focus and flow; (5) a redefinition of self, through self-awareness, construction of a positive identity, self-prospection and incorporation of a musical identity; and (6) social well-being, through connectedness and positive relationships. The potential of such interventions for clinical contexts is discussed.

Making music for mental health: how group drumming mediates recovery.

BACKGROUND: While music-making interventions are increasingly recognised as enhancing mental health, little is known of why music may engender such benefit. The objective of this article is to elucidate the features of a programme of group drumming known to enable mental health recovery. METHODS: Qualitative research was conducted with 39 mental health patients and carers who had demonstrated recovery following engagement with a programme of group djembe drumming in the UK. Data were collected through semi-structured individual interviews and focus group interviews designed to understand the connection between drumming and recovery and analysed using Interpretative Phenomenological Analysis (IPA). RESULTS: Results revealed three overarching features of the drumming intervention: (1) the specific features of drumming, including drumming as a form of non-verbal communication, as a connection with life through rhythm, and as a grounding experience that both generates and liberates energy; (2) the specific features of the group, including the group as a space of connection in and through the rhythmic features of the drumming, as well as facilitating feelings of belonging, acceptance, safety and care, and new social interactions; (3) the specific features of the learning, including learning as an inclusive activity in which the concept of mistakes is dissolved and in which there is musical freedom, supported by an embodied learning process expedited by the musical facilitator. CONCLUSION: The findings provide support for the conceptual notion of 'creative practice as mutual recovery', demonstrating that group drumming provides a creative and mutual learning space in which mental health recovery can take place.

Effects of Group Drumming Interventions on Anxiety, Depression, Social Resilience and Inflammatory Immune Response among Mental Health Service Users.

UNLABELLED: Growing numbers of mental health organizations are developing community music-making interventions for service users; however, to date there has been little research into their efficacy or mechanisms of effect. This study was an exploratory examination of whether 10 weeks of group drumming could improve depression, anxiety and social resilience among service users compared with a non-music control group (with participants allocated to group by geographical location.) Significant improvements were found in the drumming group but not the control group: by week 6 there were decreases in depression (-2.14 SE 0.50 CI -3.16 to -1.11) and increases in social resilience (7.69 SE 2.00 CI 3.60 to 11.78), and by week 10 these had further improved (depression: -3.41 SE 0.62 CI -4.68 to -2.15; social resilience: 10.59 SE 1.78 CI 6.94 to 14.24) alongside significant improvements in anxiety (-2.21 SE 0.50 CI -3.24 to -1.19) and mental wellbeing (6.14 SE 0.92 CI 4.25 to 8.04). All significant changes were maintained at 3 months follow-up. Furthermore, it is now recognised that many mental health conditions are characterised by underlying inflammatory immune responses. Consequently, participants in the drumming group also provided saliva samples to test for cortisol and the cytokines interleukin (IL) 4, IL6, IL17, tumour necrosis factor alpha (TNFα), and monocyte chemoattractant protein (MCP) 1. Across the 10 weeks there was a shift away from a pro-inflammatory towards an anti-inflammatory immune profile. Consequently, this study demonstrates the psychological benefits of group drumming and also suggests underlying biological effects, supporting its therapeutic potential for mental health. TRIAL REGISTRATION: ClinicalTrials.gov NCT01906892.