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The role of occupational therapy in musicians’ health: A scoping review protocol

Journal: BMJ Open ManuscriptFor ID peerbmjopen-2020-040922 review only Article Type: Protocol

Date Submitted by the 26-May-2020 Author:

Complete List of Authors: Villas, Bethany; University of Alberta, Occupational Therapy Duarte Wisnesky, Uira; University of Alberta, Faculty of Nursing Campbell, Sandra; University of Alberta, University of Alberta Libraries Slavik, Lauren; University of Alberta, Occupational Therapy Mevawala, Amynah; University of Alberta, Faculty of Nursing Guptill, Christine; University of Alberta, Occupational Therapy

OCCUPATIONAL & INDUSTRIAL MEDICINE, REHABILITATION MEDICINE, Keywords: Anxiety disorders < PSYCHIATRY, Depression & mood disorders < PSYCHIATRY

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1 2 3 The role of occupational therapy in musicians’ health: A scoping review protocol 4 5 6 7 Authors: 8 9 Bethany Villas 10 [email protected] 11 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada 12 13 14 Uirá Duarte Wisnesky 15 [email protected] 16 For peer review only 17 Faculty of Nursing, University of Alberta, Edmonton, Canada 18 19 Sandy Campbell 20 [email protected] 21 22 Public Service Librarian, University of Alberta, Edmonton, Canada 23 24 Lauren Slavik 25 26 [email protected] 27 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada 28 29 30 Amynah Mevawala 31 [email protected] 32 Faculty of Nursing, University of Alberta, Edmonton, Canada

33 http://bmjopen.bmj.com/ 34 35 Christine Guptill (corresponding author) 36 [email protected] 37 38 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada 39 8205 114 St NW, Edmonton, AB T6G 2G4 40 (780) 492-9127

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1 2 3 ABSTRACT 4 5 6 Review question/objective: The purpose of this proposed review is two-fold: first, to 7 understand the role of occupational therapy as presented in the musicians’ health 8 9 literature; second, to explore the potential for this role. 10 11 Introduction: The intense movement, awkward postures, concentration, and emotional 12 13 communication required of musicians can place them at increased risk of music-related 14 health conditions, such as musculoskeletal disorders and performance anxiety. The 15 development of music-related health conditions can be emotionally and financially 16 For peer review only 17 devastating. The role of occupational therapists in musicians’ health has been 18 previously discussed; however, no rigorous reviews of the scholarly literature have been 19 published. We will, therefore, undertake a scoping review with the following research 20 questions: 1) what is known about the role of occupational therapy in instrumental 21 22 musicians’ health? 2) what is the potential role of occupational therapy in musicians’ 23 health? Methods and Analysis: A preliminary search of Medline, CINAHL, SCOPUS, 24 and Web of Science was previously undertaken by the first author to determine the 25 26 extent of the research on this topic and to confirm that no other reviews have been 27 conducted or are in progress. Study selection and analysis will follow the Joanna Briggs 28 Institute (JBI) and the PRISMA-ScR guidelines for conducting a scoping review. Ethics 29 30 and Dissemination: Formal ethics approval is not required at our institution for a 31 review of published literature. The results of this review will be shared through peer- 32 reviewed publications, conference presentations and traditional and social media.

33 http://bmjopen.bmj.com/ 34 Trial Registration: We have registered our protocol with the JBI Systematic Review 35 register. 36 37 38 Strengths and limitations of this study 39  This scoping review protocol follows the Joanna Briggs Institute and PRISMA-ScR 40 guidelines for conducting scoping reviews.

41 on September 28, 2021 by guest. Protected copyright. 42  This is a novel scoping review that will provide a comprehensive review of what is 43 known about the current and potential role of occupational therapy in the care of 44 instrumental musicians’ playing-related health conditions, adding to the potential care 45 46 available for this vulnerable population. 47  Papers of English and non-English language will be considered in selection to reduce 48 language-bias. 49 50  This review is limited to evidence from peer-reviewed, published papers, which may 51 result in publication bias. 52 53 54 Keywords: Musicians’ health; Music-related injury; Occupational therapy; Rehabilitation 55 Word Count: 1266 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 11 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 ACKNOWLEDGMENTS 4 5 6 Thank you to the support of Dr. Christine Guptill, Dr. Uira Wisnesky, Amynah Mevawala, 7 and Sandy Campbell for providing guidance and expertise in this process. 8 9 10 AUTHOR STATEMENT 11 12 13 CG is the corresponding author. BV developed the research question and conducted a 14 preliminary review to determine the feasibility of the research questions. BV, LS, UW 15 and CG participated in the development of the draft data extraction form. CG, SC, UW 16 For peer review only 17 and AM provided methodological and content experience. All authors read and provided 18 feedback on the final manuscript. 19 20 FUNDING STATEMENT 21 22 23 The authors declare no specific grant for this review from any funding agency in the 24 public, commercial or not-for-profit sectors. 25 26 27 PATIENT AND PUBLIC INVOLVEMENT 28 29 30 No patient or public involvement was sought for this scoping review protocol. 31 32 COMPETING INTERESTS

33 http://bmjopen.bmj.com/ 34 35 None declared. 36 37 38 39 40

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1 2 3 INTRODUCTION 4 5 6 Instrumental musicians are recognized for their skill and dedication to their 7 occupation. In the fields of occupational therapy and occupational science, occupations 8 are defined as activities and tasks in which people engage that are given value or 9 10 meaning by the person or culture[1]. For musicians, this can include practicing, playing, 11 learning, and performing. However, the intense movement, awkward postures, 12 concentration, and emotional communication required of musicians can place them at 13 14 increased risk of music-related health conditions, such as repetitive strain disorders and 15 performance anxiety[2]. Because musicians’ identities are often closely tied to their 16 occupation[3], theFor development peer of music-related review health onlyconditions can be emotionally 17 18 devastating. In addition, many musicians are self-employed, have very low incomes, 19 and lack access to workers’ compensation and employer-paid health insurance 20 schemes[4,5]. As a result, a holistic approach to healthcare that considers a wide range 21 22 of contextual factors (e.g. social insurance schemes; relations with colleagues) and 23 overlapping roles (e.g. worker, teacher, musician) has been recommended for this 24 vulnerable population[6]. 25 26 The role of occupational therapists in musicians’ health has been previously 27 discussed by Guptill[7] and Goodman and Staz[8]; however, to our knowledge, no peer- 28 reviewed, rigorous reviews exist on this topic. This review will help musicians and health 29 30 practitioners understand the potential benefits of occupational therapy to enable 31 meaningful occupation for those with music-related health conditions. 32

33 http://bmjopen.bmj.com/ 34 METHODS 35 36 Study Design 37 To guide the review and synthesis process, Arksey and O’Malley’s[9] framework, 38 39 as adapted by Levac, Colquhoun, and O’Brien[10], will be followed. The review will 40 proceed as follows: 1) identify the research question 2) identify the relevant studies 3)

41 study selection 4) charting the data and 5) collating, summarizing, and reporting results. on September 28, 2021 by guest. Protected copyright. 42 43 We will not engage in the optional stage 6 - consultation with the community - in this 44 current study, although such consultation may form a part of future knowledge 45 translation. The study will follow the Joanna Briggs Institute (JBI) and the PRISMA-ScR 46 47 guidelines for conducting a scoping review[11, 12]. This protocol has been registered 48 with the Joanna Briggs Institute (JBI) Systematic Review Register. 49 50 51 Step 1: Identify the Research Question 52 1) What is known about the role of occupational therapy in instrumental musicians’ 53 health? 54 55 2) What is the potential role of occupational therapy in musicians’ health? 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 6 of 11 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 Step 2: Search Strategy 4 5 A preliminary search of Medline, CINAHL, SCOPUS, and Web of Science was 6 undertaken to determine the extent of the research on this topic and to confirm that no 7 other reviews have been conducted or are in progress. Studies published since the 8 9 inception year of each database will be considered for inclusion. A search strategy 10 including both text words and controlled vocabulary (e.g.: MeSH, EMTREE, etc.) for the 11 concepts “musicians” and “occupational therapy” will be conducted in the following 12 13 databases: Prospero, Wiley Cochrane Library, Ovid Embase, Ovid Medline, Ovid 14 PsycInfo, EBSCO CINAHL, EBSCO RILM, and SCOPUS. The Medline search strategy 15 (Appendix I) will be adapted for each database by the third author, a health sciences 16 For peer review only 17 librarian. In addition, the reference list of key identified papers will be hand-searched to 18 ensure the review is comprehensive. 19 20 Step 3: Study Selection 21 22 23 Selection process 24 Screening of abstracts will be conducted independently by four reviewers for 25 26 assessment against the inclusion criteria. Two of the reviewers are occupational 27 therapists, and one of these two will review each abstract. Each abstract will be 28 screened in duplicate. Reviewers will screen each potentially useful abstract identified in 29 30 the literature search by i) reading the title and abstract and applying the 31 inclusion/exclusion criteria from the screening form to ii) determine whether to include 32 the study in the review. Every decision, with the reasons for inclusion/exclusion, will be

33 http://bmjopen.bmj.com/ 34 recorded in the study screening spreadsheet. Once each reviewer has completed their 35 screening process, the group will compare their results. Abstracts that are determined to 36 be not relevant to the study will be excluded from the full-text review. 37 38 Full texts of remaining studies will be retrieved and independently assessed 39 against the inclusion criteria by the four reviewers, and the process described for 40 abstracts will be repeated. The results of the search, screening, and selection will be

41 on September 28, 2021 by guest. Protected copyright. 42 reported in full, in the final report, and presented in a PRISMA flow diagram[13]. During 43 the abstract and full-text screening, any disagreements that arise between the reviewers 44 will be resolved through discussion or with input from a third reviewer as a tiebreaker 45 46 when needed. 47 48 Eligibility criteria 49 50 The proposed review is designed to map what is known about the role of 51 occupational therapy in the current literature on musicians’ health and to explore future 52 areas of occupational therapy practice for musicians’ health. Therefore, all studies that 53 54 focus, evaluate, comment on, or explore the role of occupational therapists in enabling 55 instrumental musicians to engage in musical occupations, will be considered. Papers 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 7 of 11 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 that deal with vocal musicians, or other performers, will be excluded. Participants of 4 5 interest are instrumental musicians, who received or were recommended to receive, 6 services from occupational therapists. Occupational therapists work within a broad 7 range of contexts including health and social care settings, community agencies, and 8 9 schools. This scoping review will consider all settings in any geographic area/country. 10 No date or language limit will be applied, enabling us to capture the full range of 11 relevant studies for this review. We will include primary research studies, including 12 13 quantitative, qualitative and mixed-method study designs, and secondary research 14 studies, including all forms of literature reviews. Grey literature will not be included in 15 this review. 16 For peer review only 17 18 Step 4: Data Collection 19 Data will be extracted from the included studies using a proposed structured data 20 extraction form, based on the research questions (Appendix II). Information pertinent to 21 22 the review questions will be recorded in the data extraction form. An iterative thematic 23 analysis process and the Canadian Model of Occupational Performance and 24 Engagement[14] will be applied to each document so that themes related to the 25 26 research question and to the scope of practice of occupational therapy emerge. 27 Charting the results will also be iterative, such that the extraction form may be calibrated 28 to reflect new information and decisions by the reviewers[9,10]. 29 30 31 Study appraisal 32 The review team will trial the data extraction form with five studies to ensure

33 http://bmjopen.bmj.com/ 34 consistency, to gain familiarity with the search results, and to ensure that all relevant 35 results are extracted. If modifications occur, they will be detailed in the final report. 36 Authors of papers will be contacted to request missing or additional data, where 37 38 required. 39 40 Data items

41 on September 28, 2021 by guest. Protected copyright. 42 The variables currently identified for data collection are publication type, health- 43 related content, participant type, health care providers involved, and whether the article 44 focuses on music therapy (as an exclusion data item). 45 46 47 Outcomes and prioritization 48 The outcomes of interest will be the current and potential role of occupational 49 50 therapists in instrumental musicians’ health. 51 52 Data management 53 54 All results from the database and hand searches will be imported into RefWorks 55 (ProQuest LLC, 2020). Duplicates and publications that do not directly relate to the 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 8 of 11 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 research question will be eliminated. The remaining citations will be imported into a 4 5 spreadsheet for screening. Data will be extracted from the included studies using a 6 structured data extraction form based on the research questions (Appendix II). 7 8 9 Step 5: Data Synthesis 10 The extracted data will be presented as a summary of the retrieved data in 11 tabular form, categorized as follows: i) authors and year of publication, ii) professional 12 13 designation, iii) study purpose, iv) musician population, v) type of study/methods, vi) 14 treatment provided, vii) key points, and viii) suggested occupational therapy role and 15 scopes. Finally, the results will be presented in a narrative description that aligns with 16 For peer review only 17 the objectives of this scoping review, which are to explore what is known about the 18 current and potential role of occupational therapy in instrumental musicians’ health. 19 20 21 22 23 24 25 26 27 28 29 30 31 32

33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40

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1 2 3 REFERENCES 4 5 6 1. Townsend E. Enabling Occupation: An Occupational Therapy Perspective. Ottawa, 7 ON: CAOT Publications ACE 2002. 8 9 2. Hagglund KL, Jacobs K. Physical and mental practices of music students as they 10 relate to the occurrence of music-related injuries. Work 1996;6:11-24. 11 3. Guptill C. The lived experience of professional musicians with playing-related 12 injuries: a phenomenological inquiry. Med Probl Perform Art 2011;26:84-95. 13 14 https://doi.org/10.21091/mppa.2011.2013 15 4. Statistics Canada. Labour Force Survey 2019. Available: 16 http://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=3701&lang=For peer review only 17 fr&db=imdb&adm=8&dis=2 (accessed 24 May 2020). 18 19 5. Hill Strategies Research Inc. Situation of Artists 2019. Available: 20 https://hillstrategies.com/wp-content/uploads/2019/07/arm_vol18_no3.pdf (accessed 21 24 May 2020). 22 23 6. Guptill CA. Survivors on the edge: The lived-experience of professional musicians 24 with playing-related injuries (Doctoral dissertation) 2010. Available: 25 https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=7033&context=digitizedtheses 26 27 (accessed 24 May 2020). 28 7. Guptill C. Musicians’ health: a developing role for occupational therapists. 29 Occupational Therapy Now 2014;16:29-31. Available: 30 31 https://www.caot.ca/document/3979/nov_AE_NOV_2014.pdf (accessed 24 May 32 2020).

33 8. Goodman G, Staz S. Occupational therapy for musicians with upper extremity http://bmjopen.bmj.com/ 34 35 overuse syndrome: patient perceptions regarding effectiveness of treatment. Med 36 Probl Perform Art 1989;4:9-14. 37 9. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J 38 Soc Res Methodol 2005;8:19-32. https://doi.org/10.1080/1364557032000119616 39 40 10.Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology.

41 Implement Sci 2010;5:69. https://doi.org/10.1186/1748-5908-5-69 on September 28, 2021 by guest. Protected copyright. 42 11.Aromataris E, Munn Z. Joanna Briggs Institute Reviewer's Manual. The Joanna 43 44 Briggs Institute, 2017. Available: https://reviewersmanual.joannabriggs.org/ 45 (accessed 24 May 2020). 46 12.Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA- 47 ScR): Checklist and explanation. Annals of Internal Medicine 2018;169:467-473. 48 https://doi.org/10.7326/M18-0850 49 13.Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic 50 reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:332-336. 51 52 https://doi.org/10.1371/journal.pmed.1000097 53 14. Townsend EA., Polatajko HJ. Enabling Occupation II: Advancing an Occupational 54 Therapy Vision for Health, Well-being, & Justice through Occupation (2nd Ed.). 55 Ottawa, ON: CAOT Publications ACE 2013. 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 10 of 11 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 Appendix I. Search Strategy 4 5 Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations 6 and Daily <1946 to July 12, 2019> Results =12 7 8 # Search Statement Results 9 10 11 (((music or musical or harp or harps or recorder or recorders or synthesi?er* or tuba or 12 tubas) adj3 (performer* or artist* or player* or student* or teacher* or instructor*)).mp. or 13 ((Musician* or instrumentalist* or accordionist* or bagpiper* or bassist* or bassoonist or 14 cellist* or conguera* or conguero* or drummer* or fiddler* or Flautist* or flutist or harpist* or 15 guitarist* or keyboardist* or keytarist* or organist or organists or percussionist* or pipers or 16 saxaphonist* or trumpeterFor orpeer trumpeters or review tubaist or tubist or vibraphonist*only or vibraharpist* 17 or violinist* or (Accordion* or alphorn* or alpenhorn* or alpine horn* or Bagpipe* or 18 Balalaika or (Bandura* not (Bandura* adj4 (self efficacy or theor*))) or Banjo* or Bariton* or 19 Bass guitar* or Bassoon* or Berimbau or Bongo or Bongos or Boom whacker* or 20 boomwhacker* or Bouzouki* or Bugle* or Cello or Cellos or Chapman Stick* or Cimbalom 21 or Clarinet* or Clavichord or Concertina* or (Conga not glycemi*) or Contrabass* or Cor 22 anglais* or Cornet* or Cymbal or Cymbals or Didgeridoo* or Djembe or Double bass* or 23 Drum or Drums or Dulcimer* or Euphoni* or Fiddle or Fiddles or Fifes or Flute or Flutes or 24 Flugelhorn* or French horn* or Fujara or Glockenspiel* or (Guira not cuckoo*) or Guitar or 25 1 Guitars or Hand Bell* or Harmonica* or Harmonium* or Harpsichord* or Hurdy gurd* or 14694 26 Jew's harp* or Kalimba* or Lute or Lutes or Lyre* or Mandolin* or Maraca or Maracas or 27 Marimba* or Melodica* or Melodion or Oboe or Oboes or Ocarina* or Octobass* or ((organ 28 or organs) adj2 (pipe or pipes or reed or pump)) or ((Pan or Parlour or Uilleann) adj2 Pipe*) 29 or Pennywhistle* or Piano or Pianos or Piccolo* or Pungi* or Saxophone* or Sitars or 30 Sousaphone* or Spinet or Svirel or Tabla or Tambourine* or Thoramin or Thoramins or 31 Timbale* or Timpani* or Tin Whistle* or Tinwhistle* or Trombon* or Trumpet* or Theremin* 32 or Tubas or Tubular Bells or Tumbadora or Ukulele* or Vibraphone or ((Viola or Violas) not

33 http://bmjopen.bmj.com/ (oil or oils or oderata or violet*)) or (Violin* not plot*) or Whamola* or Woodwind* or Wood 34 35 wind or Wood Winds or Xylophone* or Zeusaphone or Zither*)).mp. or (exp Music/ and 36 (performer* or artist* or player* or student* or teacher* or instructor*).mp.))) not (fish* or 37 poultry or chicken* or bird or birds or laboratory animals).mp. [mp=title, abstract, original 38 title, name of substance word, subject heading word, floating sub-heading word, keyword 39 heading word, organism supplementary concept word, protocol supplementary concept 40 word, rare disease supplementary concept word, unique identifier, synonyms]

41 on September 28, 2021 by guest. Protected copyright. 42 2 Occupational Therapy.mp. or exp Occupational Therapy/ 16697 43 44 3 Occupational therapist*.mp. 5386 45 46 4 2 or 3 18814 47 48 49 5 1 and 4 17 50 51 (Alzheimer* or "nursing home*" or "music* therap*").mp. [mp=title, abstract, original title, 52 name of substance word, subject heading word, floating sub-heading word, keyword 6 194983 53 heading word, organism supplementary concept word, protocol supplementary concept 54 word, rare disease supplementary concept word, unique identifier, synonyms] 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 11 of 11 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 7 5 not 6 12 4 5 6 7 8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40

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1 2 3 Appendix II. Proposed data extraction tool 4 5 6 Study ID: Date form completed: 7 First author: Year of study: Reviewer: 8 9 1. General Information 10 Publication type: Journal Article  Abstract  Other (specify e.g. book chapter)______11 12 Country of study: 13 14 2. Study Eligibility 15 Study Characteristics 16 For peer review only 17 Type of study Is the study health related? Yes  No  Exclude Unclear  18 Details: 19 20 Participants Are participants defined as Yes  No  Exclude Unclear  21 instrumental musicians? Details: 22 23 24 Health care Do occupational therapists have Yes  No  Exclude Unclear  25 provider explicit involvement? Details: 26 27 28 Is there potential for occupational Yes  No  Exclude Unclear  29 therapist involvement? Details: 30 31 Music Therapy Does it explicitly include music No  Yes  Exclude Unclear  32 therapy Details:

33 http://bmjopen.bmj.com/ 34 35 36 37 SUMMARY OF ASSESSMENT FOR INCLUSION 38 Include in review  Exclude from review  39 40 Independently assessed, and then compared? Differences resolved Yes  No  Yes  No  41 on September 28, 2021 by guest. Protected copyright. 42 Request further details? Yes  No  Contact details of authors: 43 44 Notes: 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

The role of occupational therapy in musicians’ health: A scoping review protocol

Journal: BMJ Open ManuscriptFor ID peerbmjopen-2020-040922.R1 review only Article Type: Protocol

Date Submitted by the 28-Sep-2020 Author:

Primary Subject Rehabilitation medicine Heading:

Secondary Subject Heading: Occupational and environmental medicine

OCCUPATIONAL & INDUSTRIAL MEDICINE, Anxiety disorders < Keywords: PSYCHIATRY, Depression & mood disorders < PSYCHIATRY,

REHABILITATION MEDICINE http://bmjopen.bmj.com/

on September 28, 2021 by guest. Protected copyright.

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1 2 3 The role of occupational therapy in musicians’ health: A scoping review protocol 4 5 6 7 Authors: 8 9 Bethany Villas 10 [email protected] 11 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada 12 13 14 Uirá Duarte Wisnesky 15 [email protected] 16 For peer review only 17 Faculty of Nursing, University of Alberta, Edmonton, Canada 18 19 Sandy Campbell 20 [email protected] 21 22 Public Service Librarian, University of Alberta, Edmonton, Canada 23 24 Lauren Slavik 25 26 [email protected] 27 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada 28 29 30 Amynah S. Mevawala 31 [email protected] 32 Faculty of Nursing, University of Alberta, Edmonton, Canada

41 on September 28, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 12 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 ABSTRACT 4 5 6 Review question/objective: The purpose of this proposed review is two-fold: first, to 7 understand the role of occupational therapy presented in the musicians’ health 8 9 literature; and second, to explore the potential for this role. 10 11 Introduction: The intense movement, awkward postures, concentration, and emotional 12 13 communication required of musicians can place them at increased risk of music-related 14 health conditions, such as musculoskeletal disorders and performance anxiety. The 15 development of music-related health conditions can be emotionally and financially 16 For peer review only 17 devastating. The role of occupational therapists in musicians’ health has been 18 previously discussed; however, no rigorous reviews of the scholarly literature have been 19 published. We will, therefore, undertake a scoping review with the following research 20 questions: 1) what is known about the role of occupational therapy in instrumental 21 22 musicians’ health? 2) what is the potential role of occupational therapy in musicians’ 23 health? Methods and Analysis: A preliminary search of Medline, CINAHL, SCOPUS, 24 and Web of Science was previously undertaken by the first author to determine the 25 26 extent of the research on this topic and to confirm that no other reviews have been 27 conducted or are in progress. Study selection and analysis will follow the Joanna Briggs 28 Institute (JBI) and the PRISMA-ScR guidelines for conducting a scoping review. Ethics 29 30 and Dissemination: Formal ethics approval is not required at our institution for a 31 review of published literature. The results of this review will be shared through peer- 32 reviewed publications, conference presentations and traditional and social media.

41 on September 28, 2021 by guest. Protected copyright. 42  This is a novel scoping review that will provide a comprehensive review of what is 43 known about the current and potential role of occupational therapy in the care of 44 instrumental musicians’ playing-related health conditions, adding to the potential care 45 46 available for this vulnerable population. 47  Papers of English and non-English language will be considered in selection to reduce 48 language-bias. 49 50  This review is limited to evidence from peer-reviewed, published papers, which may 51 result in publication bias. 52 53 54 Keywords: Musicians’ health; Music-related injury; Occupational therapy; Rehabilitation 55 Word Count: 1551 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 12 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 ACKNOWLEDGMENTS 4 5 6 Thank you to the support of Dr. Christine Guptill, Dr. Uira Duarte Wisnesky, Dr. Amynah 7 S. Mevawala, and Sandy Campbell for providing guidance and expertise in this process. 8 9 10 AUTHOR STATEMENT 11 12 13 CG is the corresponding author. BV developed the research question and conducted a 14 preliminary review to determine the feasibility of the research questions. BV, LS, UW 15 and CG participated in the development of the draft data extraction form. CG, SC, UW 16 For peer review only 17 and AM provided methodological and content experience. All authors read and provided 18 feedback on the final manuscript. 19 20 FUNDING STATEMENT 21 22 23 The authors declare no specific grant for this review from any funding agency in the 24 public, commercial or not-for-profit sectors. 25 26 27 PATIENT AND PUBLIC INVOLVEMENT 28 29 30 No patient or public involvement was sought for this scoping review protocol. 31 32 COMPETING INTERESTS

33 http://bmjopen.bmj.com/ 34 35 None declared. 36 37 38 39 40

41 on September 28, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 12 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 INTRODUCTION 4 5 6 Instrumental musicians are recognized for their skill and dedication to their 7 occupation. In the fields of occupational therapy and occupational science, occupations 8 are defined as activities and tasks in which people engage that are given value or 9 10 meaning by the person or culture[1]. For musicians, this can include practising, playing, 11 learning, and performing. However, the intense movement, awkward postures, 12 concentration, and emotional communication required of musicians can place them at 13 14 increased risk of music-related health conditions, including musculoskeletal disorders 15 such as repetitive strain disorders and mental health concerns such as performance 16 anxiety[2]. BecauseFor musicians’ peer identities review are often closely only tied to their occupation[3], the 17 18 development of music-related health conditions can be emotionally devastating. In 19 addition, many musicians are self-employed, have very low incomes, and lack access to 20 workers’ compensation and employer-paid health insurance schemes[4,5]. As a result, 21 22 a holistic approach to healthcare that considers a wide range of contextual factors (e.g. 23 social insurance schemes; relations with colleagues) and overlapping roles (e.g. worker, 24 teacher, musician) has been recommended for this vulnerable population[6]. 25 26 The role of occupational therapists in musicians’ health has been previously 27 discussed by Guptill[7] and Goodman and Staz[8]; however, to our knowledge, no peer- 28 reviewed, rigorous reviews exist on this topic. Two questions are put forward in this 29 30 scoping review: 1) What is known about the role of occupational therapy in instrumental 31 musicians’ health 2) What is the potential role of occupational therapy in musicians’ 32 health? This scoping review will help musicians and health practitioners understand the

33 http://bmjopen.bmj.com/ 34 potential benefits of occupational therapy to enable meaningful occupation for those 35 with music-related health conditions. 36 37 38 METHODS 39 40 Study Design

41 To answer the research questions, a scoping review will be used. Scoping on September 28, 2021 by guest. Protected copyright. 42 43 reviews are used to understand broad questions by collecting available literature related 44 to a question[9]. A scoping review was chosen to understand the role of occupational 45 therapy in the current literature on the musicians’ health and to explore future areas 46 47 where an occupational therapist may be beneficial. 48 To guide the review and synthesis process, Arksey and O’Malley’s[10] scoping 49 review framework, as adapted by Levac, Colquhoun, and O’Brien[9], will be followed. 50 51 The review will proceed as follows: 1) identify the research question 2) identify the 52 relevant studies 3) study selection 4) charting the data and 5) collating, summarizing, 53 and reporting results. We will not engage in the optional stage 6 – consultation with the 54 55 community - in this current study, although such consultation may form a part of future 56 knowledge translation. The study will follow the Joanna Briggs Institute (JBI) and the 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 6 of 12 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 PRISMA extension for scoping reviews (PRISMA-ScR) [11]. This protocol has been 4 5 registered with the Joanna Briggs Institute (JBI) Systematic Review Register. 6 7 Step 1: Identify the Research Question 8 9 The research questions, as stated above, were identified to understand the role 10 occupational therapists have in musicians’ health. 11 12 13 Step 2: Search Strategy 14 The search strategy was developed with the collaboration of a librarian/expert 15 searcher and then reviewed by a second librarian/expert searcher. A preliminary search 16 For peer review only 17 of Medline, CINAHL, SCOPUS, and Web of Science was undertaken to determine the 18 extent of the research on this topic and to confirm that no other reviews have been 19 conducted or are in progress. A search strategy including both text words and controlled 20 vocabulary (e.g.: MeSH, EMTREE, etc.) for the concepts “musicians” and “occupational 21 22 therapy” will be conducted in the following databases: PROSPERO, Wiley Cochrane 23 Library, Ovid Embase, Ovid Medline, Ovid PsycINFO, EBSCO Cumulative Index to 24 Nursing and Allied Health (CINAHL), EBSCO Répertoire International de Littérature 25 26 Musicale (RILM), Web of Science, and SCOPUS. PROSPERO was searched to ensure 27 duplicate research is not already being conducted and to identify any other research 28 groups currently working in the same area. Studies published since the inception year of 29 30 each database will be considered for inclusion. The Medline search strategy (Appendix 31 I) will be adapted for each database by the third author, a health sciences librarian. In 32 addition, the reference list of papers selected for full review will be searched to ensure

33 http://bmjopen.bmj.com/ 34 the review is comprehensive. Results from the searches will then be imported into 35 RefWorks (ProQuest LLC, 2020) for management and selection. 36 37 38 Step 3: Study Selection 39 40 Selection process

41 on September 28, 2021 by guest. Protected copyright. 42 Screening of abstracts will be conducted independently by four reviewers for 43 assessment against the inclusion criteria. Two of the reviewers are occupational 44 therapists, and one of these two will review each abstract. Each abstract will be 45 46 screened in duplicate. Reviewers will screen each potentially useful abstract identified in 47 the literature search by reading the title and abstract and applying the 48 inclusion/exclusion criteria as reported below and then determining whether to include 49 50 the study in the review. Every decision, with the reasons for inclusion/exclusion, will be 51 recorded in the study screening spreadsheet. Once each reviewer has completed their 52 screening process, the group will compare their results. Abstracts that are determined to 53 54 be not relevant to the study will be excluded from the full-text review. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 7 of 12 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 Full texts of remaining studies will be retrieved and independently assessed 4 5 against the inclusion criteria by the four reviewers, and the process described for 6 abstracts will be repeated. The results of the search, screening, and selection will be 7 reported in full, and presented in a PRISMA flow diagram in the final report as guided by 8 9 Levac, Colquhoun, and O’Brien scoping review framework[12,9]. During the abstract 10 and full-text screening, any disagreements that arise between the reviewers will be 11 resolved through discussion or with input from a third reviewer. 12 13 14 Eligibility criteria 15 Selection of the literature will be based on the following inclusion and exclusion 16 For peer review only 17 criteria. 18 Inclusion criteria: 19 All studies that focus, evaluate, comment on, or explore the following will be included: 20 21  Occupational therapy/therapist explicit involvement 22  Instrumental musician population 23  Health-related 24 25 Exclusion criteria: 26  Papers focusing solely on vocal musicians and/or non-instrumental musician 27 performers 28 29  Interventions solely based on music therapy and not occupational therapy 30 This scoping review will consider all settings in any geographic area/country. No date or 31 language limit will be applied, enabling us to capture the full range of relevant studies 32 for this review. No publication format limitations have been set; thus database results 33 http://bmjopen.bmj.com/ 34 may include different formats of publication to be considered (e.g. abstracts). We will 35 include primary research studies, including quantitative, qualitative and mixed-method 36 37 study designs, and secondary research studies, including all forms of literature reviews. 38 Grey literature will not be included in this review as the focus of this study is on 39 published, peer-reviewed literature, which would guide and be the basis of education 40 and clinical reasoning as occupational therapists. 41 on September 28, 2021 by guest. Protected copyright. 42 43 Data management 44 45 All results from the database and hand searches will be imported into RefWorks 46 (ProQuest LLC, 2020). Duplicates and publications that do not directly relate to the 47 research question will be eliminated. The remaining citations will be imported into a 48 49 spreadsheet for screening. Data will be extracted from the included studies using a 50 structured data extraction form based on the research questions (Appendix II). 51 52 53 Step 4: Data Collection 54 Data will be extracted from the included studies using a proposed structured data 55 collection form, based on the research questions (Appendix II). Information pertinent to 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 8 of 12 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 the review questions will be recorded in the data extraction form. An iterative thematic 4 5 analysis process and the Canadian Model of Occupational Performance and 6 Engagement[13] will be applied to each document so that themes related to the 7 research question and the scope of practice of occupational therapy emerge. Charting 8 9 the results will also be iterative, such that the data collection form may be calibrated to 10 reflect new information and decisions by the reviewers[9,10]. 11 12 13 Study selection 14 The review team will trial the data collection form with five studies to ensure 15 consistency, to gain familiarity with the search results, and to ensure that all relevant 16 For peer review only 17 results are extracted. If modifications occur, they will be detailed in the final report. 18 Authors of papers will be contacted to request missing or additional data, where 19 required. 20 21 22 Data items 23 The variables currently identified for data collection are publication type, health- 24 related content, participant type, health care providers involved, and whether the article 25 26 focuses on music therapy (as an exclusion data item). 27 28 Outcomes and prioritization 29 30 The outcomes of interest will be the current and potential role of occupational 31 therapists in instrumental musicians’ health. 32

33 http://bmjopen.bmj.com/ 34 Step 5: Data Synthesis 35 The extracted data will be presented as a summary of the retrieved data in 36 tabular form, categorized as follows: i) authors and year of publication, ii) professional 37 38 designation, iii) study purpose, iv) musician population, v) type of study/methods, vi) 39 treatment provided, vii) key points, and viii) suggested occupational therapy roles and 40 scopes. Finally, the results will be presented in a narrative description that aligns with

41 on September 28, 2021 by guest. Protected copyright. 42 the research questions of this scoping review, which are to explore what is known about 43 the current and potential role of occupational therapy in instrumental musicians’ health. 44 45 46 LIMITATIONS 47 48 A limitation of this scoping review is that the databases we will be searching do 49 50 not search the full text of articles in the databases. As such, studies relevant to our 51 review may be missed. To decrease this limitation, the reference lists of, and citations 52 in, the selected studies will be screened for relevance to our study. 53 54 55 CONCLUSION 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 9 of 12 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 4 5 A preliminary search conducted by the first author showed a promising number of 6 studies and breadth of data. We anticipate that this study can contribute to improved 7 services for musicians experiencing health challenges. Through understanding their role 8 9 in musicians’ health, occupational therapists can better provide holistic, informed 10 services to musicians. 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40

41 on September 28, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 10 of 12 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

33 8. Goodman G, Staz S. Occupational therapy for musicians with upper extremity http://bmjopen.bmj.com/ 34 35 overuse syndrome: patient perceptions regarding effectiveness of treatment. Med 36 Probl Perform Art 1989;4:9-14. 37 9. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. 38 Implement Sci 2010;5:69. https://doi.org/10.1186/1748-5908-5-69 39 40 10.Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J

41 Soc Res Methodol 2005;8:19-32. https://doi.org/10.1080/1364557032000119616 on September 28, 2021 by guest. Protected copyright. 42 11.Aromataris E, Munn Z. Joanna Briggs Institute Reviewer's Manual. The Joanna 43 44 Briggs Institute, 2017. Available: https://reviewersmanual.joannabriggs.org/ 45 (accessed 24 May 2020). 46 12.Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA- 47 ScR): Checklist and explanation. Annals of Internal Medicine 2018;169:467-473. 48 https://doi.org/10.7326/M18-0850 49 13.Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic 50 reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:332-336. 51 52 https://doi.org/10.1371/journal.pmed.1000097 53 14. Townsend EA., Polatajko HJ. Enabling Occupation II: Advancing an Occupational 54 Therapy Vision for Health, Well-being, & Justice through Occupation (2nd Ed.). 55 Ottawa, ON: CAOT Publications ACE 2013. 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 11 of 12 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 Appendix I. Search Strategy 4 5 Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations 6 7 and Daily <1946 to July 12, 2019> Results =12 8 9 # Search Statement Results 10 11 (((music or musical or harp or harps or recorder or recorders or synthesi?er* or tuba or 12 tubas) adj3 (performer* or artist* or player* or student* or teacher* or instructor*)).mp. or 13 ((Musician* or instrumentalist* or accordionist* or bagpiper* or bassist* or bassoonist or 14 cellist* or conguera* or conguero* or drummer* or fiddler* or Flautist* or flutist or harpist* or 15 guitarist* or keyboardist* or keytarist* or organist or organists or percussionist* or pipers or 16 saxaphonist* or trumpeterFor or peer trumpeters or review tubaist or tubist or vibraphonist*only or vibraharpist* 17 or violinist* or (Accordion* or alphorn* or alpenhorn* or alpine horn* or Bagpipe* or 18 Balalaika or (Bandura* not (Bandura* adj4 (self efficacy or theor*))) or Banjo* or Bariton* or 19 Bass guitar* or Bassoon* or Berimbau or Bongo or Bongos or Boom whacker* or 20 boomwhacker* or Bouzouki* or Bugle* or Cello or Cellos or Chapman Stick* or Cimbalom 21 or Clarinet* or Clavichord or Concertina* or (Conga not glycemi*) or Contrabass* or Cor 22 anglais* or Cornet* or Cymbal or Cymbals or Didgeridoo* or Djembe or Double bass* or 23 Drum or Drums or Dulcimer* or Euphoni* or Fiddle or Fiddles or Fifes or Flute or Flutes or 24 Flugelhorn* or French horn* or Fujara or Glockenspiel* or (Guira not cuckoo*) or Guitar or 25 1 Guitars or Hand Bell* or Harmonica* or Harmonium* or Harpsichord* or Hurdy gurd* or 14694 26 Jew's harp* or Kalimba* or Lute or Lutes or Lyre* or Mandolin* or Maraca or Maracas or 27 Marimba* or Melodica* or Melodion or Oboe or Oboes or Ocarina* or Octobass* or ((organ 28 29 or organs) adj2 (pipe or pipes or reed or pump)) or ((Pan or Parlour or Uilleann) adj2 Pipe*) 30 or Pennywhistle* or Piano or Pianos or Piccolo* or Pungi* or Saxophone* or Sitars or 31 Sousaphone* or Spinet or Svirel or Tabla or Tambourine* or Thoramin or Thoramins or 32 Timbale* or Timpani* or Tin Whistle* or Tinwhistle* or Trombon* or Trumpet* or Theremin* or Tubas or Tubular Bells or Tumbadora or Ukulele* or Vibraphone or ((Viola or Violas) not 33 http://bmjopen.bmj.com/ 34 (oil or oils or oderata or violet*)) or (Violin* not plot*) or Whamola* or Woodwind* or Wood 35 wind or Wood Winds or Xylophone* or Zeusaphone or Zither*)).mp. or (exp Music/ and 36 (performer* or artist* or player* or student* or teacher* or instructor*).mp.))) not (fish* or 37 poultry or chicken* or bird or birds or laboratory animals).mp. [mp=title, abstract, original 38 title, name of substance word, subject heading word, floating sub-heading word, keyword 39 heading word, organism supplementary concept word, protocol supplementary concept 40 word, rare disease supplementary concept word, unique identifier, synonyms]

41 on September 28, 2021 by guest. Protected copyright. 42 2 Occupational Therapy.mp. or exp Occupational Therapy/ 16697 43 44 45 3 Occupational therapist*.mp. 5386 46 47 4 2 or 3 18814 48 49 5 1 and 4 17 50 51 52 (Alzheimer* or "nursing home*" or "music* therap*").mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword 53 6 194983 54 heading word, organism supplementary concept word, protocol supplementary concept 55 word, rare disease supplementary concept word, unique identifier, synonyms] 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 12 of 12 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 4 7 5 not 6 12 5 6 7

8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40

41 on September 28, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 13 of 12 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 Appendix II. Proposed data extraction tool 4 5 6 Study ID: Date form completed: 7 First author: Year of study: Reviewer: 8 9 1. General Information 10 Publication type: Journal Article  Abstract  Other (specify e.g. book chapter)______11 12 Country of study: 13 14 2. Study Eligibility 15 16 Study CharacteristicsFor peer review only 17 Type of study Is the study health related? Yes  No  �Exclude Unclear  18 Details: 19 20 Participants Are participants defined as Yes  No  �Exclude Unclear  21 instrumental musicians? Details: 22 23 24 Health care Do occupational therapists have Yes  No  �Exclude Unclear  25 provider explicit involvement? Details: 26 27 28 Is there potential for occupational Yes  No  �Exclude Unclear  29 therapist involvement? Details: 30

31 Does it explicitly include music No  Yes  � Unclear  32 Music Therapy Exclude therapy Details: 33 http://bmjopen.bmj.com/ 34 35 36 37 SUMMARY OF ASSESSMENT FOR INCLUSION 38 Include in review  Exclude from review  39 40 Independently assessed, and then compared? Differences resolved Yes  No 

41 Yes  No  on September 28, 2021 by guest. Protected copyright. 42 Request further details? Yes  No  Contact details of authors: 43 44 Notes: 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

The role of occupational therapy in musicians’ health: A scoping review protocol

Journal: BMJ Open ManuscriptFor ID peerbmjopen-2020-040922.R2 review only Article Type: Protocol

Date Submitted by the 25-Nov-2020 Author:

Complete List of Authors: Villas, Bethany; University of Alberta, Occupational Therapy Duarte Wisnesky, Uira; University of Alberta, Faculty of Nursing Campbell, Sandra; University of Alberta, University of Alberta Libraries Slavik, Lauren; University of Alberta, Occupational Therapy Mevawala, Amynah; University of Alberta, Faculty of Nursing Handl, Melisa; University of Ottawa, Faculty of Law Guptill, Christine; University of Alberta, Occupational Therapy

Primary Subject Rehabilitation medicine Heading:

Secondary Subject Heading: Occupational and environmental medicine

OCCUPATIONAL & INDUSTRIAL MEDICINE, Anxiety disorders <

Keywords: PSYCHIATRY, Depression & mood disorders < PSYCHIATRY, http://bmjopen.bmj.com/ REHABILITATION MEDICINE

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 13 BMJ Open

1 2

37 http://bmjopen.bmj.com/ 38 39 40 41 42 43 44

45 on September 28, 2021 by guest. Protected copyright. 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 13 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 The role of occupational therapy in musicians’ health: A scoping review protocol 4 5 6 Authors: 7 Bethany Villas 8 9 [email protected] 10 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada 11 12 13 Uirá Duarte Wisnesky 14 [email protected] 15 Faculty of Nursing, University of Alberta, Edmonton, Canada 16 For peer review only 17 18 Sandra Campbell 19 [email protected] 20 Public Service Librarian, University of Alberta, Edmonton, Canada 21 22 23 Lauren Slavik 24 [email protected] 25 26 Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada 27 28 Amynah S. Mevawala 29 30 [email protected] 31 Faculty of Nursing, University of Alberta, Edmonton, Canada 32

33 http://bmjopen.bmj.com/ 34 Melisa N. Handl 35 [email protected] 36 Faculty of Law, University of Ottawa, Ottawa, Canada 37 38 39 Christine Guptill (corresponding author) 40 [email protected]

41 on September 28, 2021 by guest. Protected copyright. 42 School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada 43 Guindon Hall 44 451 Smyth Road, Room 3071 45 46 Ottawa, ON K1H 8M5 47 (613) 562-5800 ext. 8393 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

41 on September 28, 2021 by guest. Protected copyright. 42  This is a novel scoping review that will provide a comprehensive review of what is 43 known about the current and potential role of occupational therapy in the care of 44 instrumental musicians’ playing-related health conditions, adding to the potential care 45 46 available for this vulnerable population. 47  Papers of English and non-English language will be considered in selection to reduce 48 language-bias. 49 50  This review is limited to evidence from peer-reviewed, published papers, which may 51 result in publication bias. 52 53 54 Keywords: Musicians’ health; Music-related injury; Occupational therapy; Rehabilitation 55 Word Count: 1551 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 13 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40

41 on September 28, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 5 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 INTRODUCTION 4 5 6 Instrumental musicians are recognized for their skill and dedication to their 7 occupation. In the fields of occupational therapy and occupational science, occupations 8 are defined as activities and tasks in which people engage that are given value or 9 10 meaning by the person or culture[1]. For musicians, this can include practising, playing, 11 learning, and performing. However, the intense movement, awkward postures, 12 concentration, and emotional communication required of musicians can place them at 13 14 increased risk of music-related health conditions, including musculoskeletal disorders 15 such as repetitive strain disorders and mental health concerns such as performance 16 anxiety[2]. BecauseFor musicians’ peer identities review are often closely only tied to their occupation[3], the 17 18 development of music-related health conditions can be emotionally devastating. In 19 addition, many musicians are self-employed, have very low incomes, and lack access to 20 workers’ compensation and employer-paid health insurance schemes[4,5]. As a result, 21 22 a holistic approach to healthcare that considers a wide range of contextual factors (e.g. 23 social insurance schemes; relations with colleagues) and overlapping roles (e.g. worker, 24 teacher, musician) has been recommended for this vulnerable population[6]. 25 26 The role of occupational therapists in musicians’ health has been previously 27 discussed by Guptill[7] and Goodman and Staz[8]; however, to our knowledge, no peer- 28 reviewed, rigorous reviews exist on this topic. Two research questions will direct this 29 30 scoping review: 1) What is known about the role of occupational therapy in instrumental 31 musicians’ health 2) What is the potential role of occupational therapy in musicians’ 32 health? This scoping review will help musicians and health practitioners understand the

33 http://bmjopen.bmj.com/ 34 potential benefits of occupational therapy to enable meaningful occupation for those 35 with music-related health conditions. 36 37 38 METHODS 39 40 Study Design

41 To answer the research questions, a scoping review will be used. Scoping on September 28, 2021 by guest. Protected copyright. 42 43 reviews are used to understand broad questions by collecting available literature related 44 to a question[9]. A scoping review was chosen to understand the role of occupational 45 therapy in the current literature on the musicians’ health and to explore future areas 46 47 where an occupational therapist may be beneficial. 48 To guide the review and synthesis process, Arksey and O’Malley’s[10] scoping 49 review framework, as adapted by Levac, Colquhoun, and O’Brien[9], will be followed. 50 51 The review will proceed as follows: 1) identify the research question 2) identify the 52 relevant studies 3) study selection 4) charting the data and 5) collating, summarizing, 53 and reporting results. We will not engage in the optional stage 6 – consultation with the 54 55 community – in this current study, although such consultation may form a part of future 56 knowledge translation. The study will follow the Joanna Briggs Institute (JBI) and the 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 6 of 13 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 PRISMA extension for scoping reviews (PRISMA-ScR) [11,12]. This protocol has been 4 5 registered with the Joanna Briggs Institute (JBI) Systematic Review Register. 6 7 Step 1: Identify the Research Question 8 9 Two research questions, identified above, will direct our review, with the goal of 10 understanding the role occupational therapists have in musicians’ health. 11 12 13 Step 2: Search Strategy 14 The search strategy was developed with the collaboration of a librarian/expert 15 searcher and then reviewed by a second librarian/expert searcher. A preliminary search 16 For peer review only 17 of Medline, CINAHL, SCOPUS, and Web of Science was undertaken to determine the 18 extent of the research on this topic and to confirm that no other reviews have been 19 conducted or are in progress. A search strategy including both text words and controlled 20 vocabulary (e.g.: MeSH, EMTREE, etc.) for the concepts “musicians” and “occupational 21 22 therapy” will be conducted in the following databases: PROSPERO, Wiley Cochrane 23 Library, Ovid Embase, Ovid Medline, Ovid PsycINFO, EBSCO Cumulative Index to 24 Nursing and Allied Health (CINAHL), EBSCO Répertoire International de Littérature 25 26 Musicale (RILM), Web of Science, and SCOPUS. PROSPERO was searched to ensure 27 duplicate research is not already being conducted and to identify any other research 28 groups currently working in the same area. Studies published since the inception year of 29 30 each database will be considered for inclusion. The Medline search strategy (Appendix 31 I) will be adapted for each database by the third author, a health sciences librarian. In 32 addition, the reference list of papers selected for full review will be searched to ensure

41 on September 28, 2021 by guest. Protected copyright. 42 Screening of abstracts will be conducted independently by four reviewers for 43 assessment against the inclusion criteria. Two of the reviewers are occupational 44 therapists, and one of these two will review each abstract. Each abstract will be 45 46 screened in duplicate. Reviewers will screen each potentially useful abstract identified in 47 the literature search by reading the title and abstract and applying the 48 inclusion/exclusion criteria as reported below and then determining whether to include 49 50 the study in the review. Every decision, with the reasons for inclusion/exclusion, will be 51 recorded in the study screening spreadsheet. Once each reviewer has completed their 52 screening process, the group will compare their results. Abstracts that are determined to 53 54 be not relevant to the study will be excluded from the full-text review. 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 7 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 Full texts of remaining studies will be retrieved and independently assessed 4 5 against the inclusion criteria by the four reviewers, and the process described for 6 abstracts will be repeated. The results of the search, screening, and selection will be 7 reported in full, and presented in a PRISMA flow diagram in the final report as guided by 8 9 Levac, Colquhoun, and O’Brien scoping review framework[13,9]. During the abstract 10 and full-text screening, any disagreements that arise between the reviewers will be 11 resolved through discussion or with input from a third reviewer. 12 13 14 Eligibility criteria 15 Selection of the literature will be based on the following inclusion and exclusion 16 For peer review only 17 criteria. 18 Inclusion criteria: 19 All studies that focus, evaluate, comment on, or explore the following will be included: 20 21  Occupational therapy/therapist explicit involvement 22  Instrumental musician population 23  Health-related 24 25 Exclusion criteria: 26  Papers focusing solely on vocal musicians and/or non-instrumental musician 27 performers 28 29  Interventions solely based on music therapy and not occupational therapy 30 This scoping review will consider all settings in any geographic area/country. No date or 31 language limit will be applied, enabling us to capture the full range of relevant studies 32 for this review. No publication format limitations have been set; thus database results 33 http://bmjopen.bmj.com/ 34 may include different formats of publication to be considered (e.g. abstracts). We will 35 include primary research studies, including quantitative, qualitative and mixed-method 36 37 study designs, and secondary research studies, including all forms of literature reviews. 38 Grey literature will not be included in this review as the focus of this study is on 39 published, peer-reviewed literature, which would guide and be the basis of education 40 and clinical reasoning as occupational therapists. 41 on September 28, 2021 by guest. Protected copyright. 42 43 Data management 44 45 All results from the database and hand searches will be imported into RefWorks 46 (ProQuest LLC, 2020). Duplicates and publications that do not directly relate to the 47 research question will be excluded. The remaining citations will be imported into a 48 49 spreadsheet for screening. Data will be extracted from the included studies using a 50 structured data extraction form based on the research questions (Appendix II). 51 52 53 Step 4: Data Collection 54 Data will be extracted from the included studies using a proposed structured data 55 collection form, based on the research questions (Appendix II). Information pertinent to 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 8 of 13 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 the review questions will be recorded in the data extraction form. An iterative thematic 4 5 analysis process and the Canadian Model of Occupational Performance and 6 Engagement[14] will be applied to each document so that themes related to the 7 research question and the scope of practice of occupational therapy emerge. Charting 8 9 the results will also be iterative, such that the data collection form may be calibrated to 10 reflect new information and decisions by the reviewers[9,10]. 11 12 13 Study selection 14 The review team will trial the data collection form with five studies to ensure 15 consistency, to gain familiarity with the search results, and to ensure that all relevant 16 For peer review only 17 results are extracted. If modifications occur, they will be detailed in the final report. 18 Authors of papers will be contacted to request missing or additional data, where 19 required. 20 21 22 Data items 23 The variables currently identified for data collection are publication type, health- 24 related content, participant type, health care providers involved, and whether the article 25 26 focuses on music therapy (as an exclusion data item). 27 28 Outcomes and prioritization 29 30 The outcomes of interest will be the current and potential role of occupational 31 therapists in instrumental musicians’ health. 32

41 on September 28, 2021 by guest. Protected copyright. 42 the research questions of this scoping review, which are to explore what is known about 43 the current and potential role of occupational therapy in instrumental musicians’ health. 44 45 46 Patient and Public Involvement 47 No patient or public involvement was sought for this scoping review protocol. 48 49 50 LIMITATIONS 51 52 A limitation of this scoping review is that the databases we will be searching 53 54 contain only bibliographic information and abstracts, rather than full-texts of articles, so 55 articles containing only in-text references to our search terms cannot be retrieved. As 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 9 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 such, studies relevant to our review may be missed. To decrease this limitation, the 4 5 reference lists of, and citations in, the selected studies will be screened for relevance to 6 our study. 7 ETHICS AND DISSEMINATION 8 9 Formal ethics approval is not required at our institution for a review of published 10 literature. The results of this review will be shared through peer-reviewed publications, 11 conference presentations and traditional and social media. 12 13 14 CONTRIBUTORSHIP STATEMENT 15 CG is the corresponding author, and conceived of the idea for this project. BV 16 For peer review only 17 developed the research question and conducted a preliminary review to determine the 18 feasibility of the research questions. BV, LS, UW and CG participated in the 19 development of the draft data extraction form. BV, CG, SC and UW wrote the initial 20 manuscript. UW, AM and MH managed the process of manuscript revisions. All authors 21 22 read and provided feedback on the revisions and final manuscript. 23 24 COMPETING INTERESTS 25 26 None declared. 27 28 FUNDING STATEMENT 29 30 The authors declare no specific grant for this review from any funding agency in the 31 public, commercial or not-for-profit sectors. 32

33 http://bmjopen.bmj.com/ 34 DATA SHARING STATEMENT 35 As this is a protocol, there are no data as yet, and as such, no data are available. 36 37 38 PATIENT AND PUBLIC INVOLVEMENT 39 No patient or public involvement was sought for this scoping review protocol. 40

41 on September 28, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 10 of 13 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

33 8. Goodman G, Staz S. Occupational therapy for musicians with upper extremity http://bmjopen.bmj.com/ 34 35 overuse syndrome: patient perceptions regarding effectiveness of treatment. Med 36 Probl Perform Art 1989;4:9-14. 37 9. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. 38 Implement Sci 2010;5:69. https://doi.org/10.1186/1748-5908-5-69 39 40 10.Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J

41 Soc Res Methodol 2005;8:19-32. https://doi.org/10.1080/1364557032000119616 on September 28, 2021 by guest. Protected copyright. 42 11.Aromataris E, Munn Z. Joanna Briggs Institute Reviewer's Manual. The Joanna 43 44 Briggs Institute, 2017. Available: https://reviewersmanual.joannabriggs.org/ 45 (accessed 24 May 2020). 46 12.Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA- 47 ScR): Checklist and explanation. Annals of Internal Medicine 2018;169:467-473. 48 https://doi.org/10.7326/M18-0850 49 13.Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic 50 reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:332-336. 51 52 https://doi.org/10.1371/journal.pmed.1000097 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 11 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 14.Townsend EA., Polatajko HJ. Enabling Occupation II: Advancing an Occupational 4 Therapy Vision for Health, Well-being, & Justice through Occupation (2nd Ed.). 5 6 Ottawa, ON: CAOT Publications ACE 2013. 7 8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40

41 on September 28, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 12 of 13 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

41 on September 28, 2021 by guest. Protected copyright. 42 2 Occupational Therapy.mp. or exp Occupational Therapy/ 16697 43 44 45 3 Occupational therapist*.mp. 5386 46 47 4 2 or 3 18814 48 49 5 1 and 4 17 50 51 52 (Alzheimer* or "nursing home*" or "music* therap*").mp. [mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword 53 6 194983 54 heading word, organism supplementary concept word, protocol supplementary concept 55 word, rare disease supplementary concept word, unique identifier, synonyms] 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 13 of 13 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 4 7 5 not 6 12 5 6 7

8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

33 http://bmjopen.bmj.com/ 34 35 36 37 38 39 40

41 on September 28, 2021 by guest. Protected copyright. 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 14 of 13 BMJ Open: first published as 10.1136/bmjopen-2020-040922 on 30 December 2020. Downloaded from

1 2 3 Appendix II. Proposed data extraction tool 4 5 6 Study ID: Date form completed: 7 First author: Year of study: Reviewer: 8 9 1. General Information 10 Publication type: Journal Article  Abstract  Other (specify e.g. book chapter)______11 12 Country of study: 13 14 2. Study Eligibility 15 16 Study CharacteristicsFor peer review only 17 Type of study Is the study health related? Yes  No  �Exclude Unclear  18 Details: 19 20 Participants Are participants defined as Yes  No  �Exclude Unclear  21 instrumental musicians? Details: 22 23 24 Health care Do occupational therapists have Yes  No  �Exclude Unclear  25 provider explicit involvement? Details: 26 27 28 Is there potential for occupational Yes  No  �Exclude Unclear  29 therapist involvement? Details: 30