Are Factors of Posture and Balance Integrated in Research Studies on Upper Extremity Musculoskeletal Pain in Instrumental Musicians?: A Scoping Review.

It is widely believed that posture and balance stressors are factors in playing-related pain for musicians using hand-held musical instruments. This purpose of this scoping review was to assess the available literature relative to the effects of posture and balance in musicians with neuromusculoskeletal injuries. A search of Medline, Web of Science, and SportDiscus seeking articles combining posture and balance considerations with pain in performing artists was performed. From 1,403 articles initially identified by the search parameters, the further abstract/title review for relevance and inclusiveness of pain and posture/balance variables in performing artists resulted in the retention of 29 articles for this full-text scoping review. The full-text analysis assessed publication type, study design, participant population, methodology, statistical methods, main results, and whether the study evaluated the relationship between posture/balance and pain in musicians. Overall, most of the studies including musicians were observational or descriptive. Although, in recent years, there has been an increase in the number of interventional studies regarding posture, balance and pain in musicians, there is still minimal evidence about the contribution of posture and balance characteristics to pain in musician performers. To reliably establish a predictable relationship with injury symptomatology experienced by musicians, it is essential to integrate standardized, validated measurements of posture and balance in the evaluation of all musicians who report to a health professional with neuromusculoskeletal pain. This will not only allow researchers to determine the effect of postural righting dysfunction on neuromusculoskeletal injuries in musicians, but also may provide a foundation for clinicians to develop effective interventions.

Patient and Citizen Innovation Council in family practice.

PROBLEM ADDRESSED: Patient engagement is integral to the Patient's Medical Home model. Patient-centred care is more than what happens in the examination room. Decisions around clinic processes, work flow, and initiative prioritization also warrant a patient perspective. OBJECTIVE OF PROGRAM: The Academic Family Medicine Clinic at the South Health Campus in Calgary, Alta, identified a need for patient and community advisory expertise regarding clinic initiatives and quality improvement. A council was proposed to engage patients and citizens in exploring meaningful ways to drive innovation and improve the care experience. PROGRAM DESCRIPTION: The Academic Family Medicine Clinic partnered with the South Health Campus Patient and Family Centred Care staff in developing a dedicated family medicine patient and community council. The resulting committee of 6 volunteers and 3 staff members has delivered presentations to incoming family medicine residents and staff on the role of a patient advisory council; advised on methodology to collect and represent broad patient perspectives; provided patient-perspective input to operations management and quality improvement committees; developed a pilot patient satisfaction and experience survey; and brought additional perspective, based on learnings from other industries and professions with experience in "customer service," on how to enhance the quality of the patient experience. CONCLUSION: A patient advisory council has the potential to reach beyond simple patient engagement toward functional involvement in decision making about clinic operations.