Table of Contents

SEPTEMBER 2026, Vol 41, No 3

ARTICLES

Prevalence and Associated Factors of Temporomandibular Symptom Reporting in Portuguese Professional Orchestral Musicians: A Cross-Sectional Study. [Open Access]
Daniela Abrantes Pinho, Sofia Rocha Lopes, Paula Clara Santos, Roberto Meroni, Cristina Carvalho Mesquita

BACKGROUND: Temporomandibular disorders (TMDs) comprise a heterogeneous group of conditions affecting the temporomandibular joints, masticatory muscles, and related structures, and may influence both quality of life and professional performance. Professional musicians represent an occupational group exposed to combined physical and psychosocial demands that may increase vulnerability to temporomandibular symptoms. OBJEC­TIVE: To determine the prevalence of temporomandibu­lar symptom reporting and its association with socio-demographic and occupational factors, as well as health-related quality of life, among Portuguese profes­sional orchestral musicians. METHODS: A cross-sectional study was conducted involving 271 professional musi­cians from Portuguese orchestras. Data were collected using a self-administered questionnaire incorporating the Fonseca Anamnestic Index (FAI) and the SF-12v2 Health Survey, alongside sociodemographic and occupa­tional variables. Descriptive statistics, chi-square tests, Student’s t-tests, Mann–Whitney U tests, and multiple logistic regression analyses were performed with a sig­nificance level of p < 0.05. RESULTS: Temporomandibu­lar symptoms were identified in 61.6% of participants. Female musicians showed a significantly higher preva­lence than males (77.4% vs 48.3%, p < 0.001). Younger musicians (18–29 years) presented the highest preva­lence, whereas those aged over 50 years showed the lowest frequency. Part-time employment was associated with increased odds of symptom reporting (OR = 2.15, 95% CI: 1.07–4.31). No significant associations were observed with education level, instrument category, or weekly practice time. Musicians reporting temporo­mandibular symptoms demonstrated significantly lower physical and mental health scores on the SF-12v2 (p < 0.01). CONCLUSION: Temporomandibular symptoms are highly prevalent among professional orchestral musi­cians and are associated with demographic and occupational factors, as well as reduced health-related quality of life. These findings highlight the importance of preventive and multidisciplinary approaches addressing the occupational demands of orchestral performance.
[Open Access: Licensed under CC-BY-4.0 Int.]

The Right Fit Matters: A 12-Millimeter Narrower Keyboard per Octave Reduces Muscle Fatigue in Pianists with Smaller Hands
Robin Mailly, Craig Turner, Justine Pelletier, Luis-Angel Rivera, Fabien Dal Maso, Felipe Verdugo

Muscle fatigue and smaller hand spans are considered important risk factors of injuries for pianists. The objective of the present study was to assess the effect of keyboard size and hand anthropometry on perceived exertion and the evolution of upper-limb muscle fatigue in 20 expert pianists performing a repetitive piano task, while controlling for performance parameters. Muscle fatigue was assessed using surface electromyography (EMG), including a high-density EMG grid placed on the right posterior forearm and wireless EMG sensors on the right upper-limb muscles. The myoelectric manifestation of fatigue was quantified using variations in the median EMG frequency at different time intervals throughout the task. All upper-limb muscles exhibited fatigue. Smaller hand size was found to be a contributing factor to increased perceived exertion and muscle fatigue in finger/wrist extensor muscles. When pianists with smaller hands played on a smaller keyboard (DS6.0 keyboard), perceived exertion decreased, the radial area of finger/wrist extensors showed fewer signs of fatigue, and play­ing speed (tempo) was faster toward the end of the task. The DS6.0 keyboard can help reduce muscle fatigue in pianists with smaller hands. However, as hand-size and keyboard-size effects were localized in different areas of the posterior forearm, the DS6.0 keyboard might reduce but not fully mitigate hand-size disparities between pianists.

Cross-Cultural Validation of the Mazzarolo Music Performance Anxiety Scale—Brazilian Version (M-MPAS-Br)
Frederico Barreto Kochem, Débora Cristina Lima da Silva, Isabella Mazzarolo, Renato Santos de Almeida

BACKGROUND: Music performance anxiety (MPA) is common among musicians, affecting performance qual­ity, well-being, and career continuity. Reliable and culturally adapted tools are essential for its assessment. The Mazzarolo Music Performance Anxiety Scale (M-MPAS) is a brief five-item measure of the intensity, frequency, and avoidance of performance-related anxiety, but no validated Brazilian version has been available. OBJECTIVE: To conduct a cross-cultural validation of the M-MPAS among professional and student musicians in the Brazilian context and evaluate the construct validity and reliability of the Brazilian version (M-MPAS-Br). METHODS: A cross-sectional methodological study was conducted with 243 musicians from orchestras, conservatories, and university programs in Rio de Janeiro. The adaptation followed international and COSMIN guidelines. The measurement properties evaluated were structural validity (exploratory and confirmatory factor analyses), internal consistency, test–retest reliability, and hypotheses testing for construct validity through correlations with the Kenny Music Performance Anxiety Inventory (K-MPAI) and the Short-Form 8 (SF-8). RESULTS: The M-MPAS-Br showed semantic and conceptual equivalence. A one-factor solution explained 74.9% of variance (CFI = 0.989, TLI = 0.978, RMSEA = 0.098, SRMR = 0.015). Internal consistency was α = 0.929 (95% CI [0.917–0.940]) and test–retest reliability ICC = 0.948 (95% CI [0.929–0.962]). Convergent validity with the K-MPAI (24 anxiety-related items) was ρ = 0.967, 95% CI [0.957–0.974], p < 0.001. Divergent validity showed weak correlations with the Physical Component Summary (PCS-T) (ρ = –0.211, p < 0.001) and moderate with the Mental Component Summary (MCS-T) (ρ = –0.462, p < 0.001). CONCLUSIONS: The M-MPAS-Br demonstrated excellent reliability, validity, and cultural adequacy, providing a brief and psychometrically robust tool for assessing MPA among Brazilian musicians. Its brevity supports its use as a screening instrument for the early identification of performance anxiety in clinical, educational, and large-scale research settings.

Injury Prevalence and Risk Factors in Professional and Amateur Breakdancers in China: A Cross-Sectional Study
Bo Wang, HuiYe Jia, XiYang Zhang, Lu Bai

OBJECTIVES: This cross-sectional survey aimed to compare the 24-month injury prevalence between amateur and professional male breakdancers (also known as breakers or B-boys) in China and identify key injury characteristics associated with skill level. This study hypothesized that Chinese professional B-boys have a higher injury prevalence than amateurs and the injury characteristics differ in their association with technical movements and training condition. METHODS: A self-developed 27-item questionnaire covering three domains—basic information, training history, and injury characteristics—was distributed online to male breakers. Participants were classified into amateur (n=468) and professional (n=178) groups using a composite criterion combining self-assessed skill rank and cumulative train­ing hours. Continuous variables were compared using Mann-Whitney U tests, and categorical variables using chi-square tests with Bonferroni correction for post-hoc pairwise comparisons. Generalized estimating equations (GEE) were applied to analyze injury factors while accounting for within-dancer clustering of multiple injuries. RESULTS: Among the 646 dancers, 584 (90.4%) reported at least one injury, with no significant difference in injury prevalence between the amateur and professional groups (89.3% vs 93.3%, P=0.445). A total of 1,000 injury cases were documented. The most frequently injured sites were the wrist, knee, shoulder, and waist, with shoulder injuries significantly more common in professional dancers (21.3% vs 14.6%, P=0.031). Self-reported contributing factors included insufficient warm-up, fatigue, and perceived deficiencies in basic skills. Over 80% of dancers lacked professional medical support. Exploratory chi-square tests revealed that shoulder, knee, and wrist injuries were related with tech­nical movements; however, these patterns were unad­justed for exposure time and therefore reflect only injury distribution, not movement-specific risk. CONCLUSIONS: Injury prevalence was similarly high in amateur and professional B-boys, with no significant between-group differences. Commonly injured sites and self-reported contributing factors, together with the lack of medical support, highlight the priorities for prevention. The movement–injury patterns warrant further investigation in future prospective studies.

Patient-Reported Outcome Measures and Self-Management Strategies to Promote Health in Higher-Education Classical Music Performance Students: A Delphi Study [Open Access]
François Tharin, Clara E. James, Anne-Violette Bruyneel

OBJECTIVES: Students in classical music performance in higher education frequently report playing-related musculoskeletal disorders (PRMDs) and psychological distress. Observational studies based on self-reported data suggest an association between these two health problems. This observation supports early multidimensional prevention. However, access to musician-specific health support remains limited. The aim of this study was to develop a consensus among experts, informed by input from music students and teachers (stakeholders), on the relevance/usefulness of Patient-Reported Outcome Measures (PROMs) and self-management strategies for music students, structured across four target domains: physical, psychocognitive, behavioral, and professional. A secondary aim was to identify relevant health-knowledge content and pedagogical modalities for prevention within the music curriculum. METHODS: A Delphi study was conducted according to the Guidance on Conducting and Reporting Delphi Studies (CREDES) guidelines. The Delphi survey items were derived from a previous scoping review, which identified 42 PROMs and 97 self-management strategies for pre­professional and professional musicians, and from relevance/usefulness ratings provided by music students and teachers. In Round 1, experts rated each item’s relevance/usefulness on 5-point Likert scales. In Round 2, retained items and refined additional proposals were re-rated; consensus was defined as ≥50% of experts rank­ing an item among the top 50% most relevant/useful within their individual set of rated items. RESULTS: Fourteen experts participated in Round 1 (4 clinicians, 2 researchers, 8 clinician-researchers) and 12 in Round 2. After two rounds, experts reached consensus on 10 PROMs, 30 self-management strategies (e.g., advice on physical exercise, individual work organization, and balance/postural control exercises), and 7 health-knowledge topics, spanning physical, psychocognitive, behavioral, and professional domains. Experts supported structured, curriculum-embedded delivery and formal academic credit at both Bachelor’s and Master’s levels. CONCLUSION: Numerous self-management strategies are considered relevant for improving health management in the daily lives of music students. The results highlight strong consensus in favor of incorporating PROMs-based health monitoring, health knowledge, and self-management strategies into higher-education music curricula to support music students’ health management in daily life across physical, psychocognitive, behavioral, and professional domains.
[Open Access: Licensed under CC-BY 4.0 Int.]