Psychosocial risk factors for injury in performing artists: A scoping review of screening and predictive instruments

The performing arts is a diverse collection of disciplines. However common to all disciplines is an elevated risk of injury and an array of biopsychosocial risk factors. While screening for physical risk factors is common practice, and largely routine, psychosocial screening for injury in performance artists (PAs) is less well established. This scoping review aimed to systematically map, and report the suitability of, instruments used to screen or assess psychosocial risk factors for injury in non-recreational adult performing artists (PA)s. This scoping review was conducted in accordance with the Joanna Briggs Institute Evidence Synthesis guidelines. Twelve databases relating to performance, health, medicine, kinesiology, and sport were searched. Studies that investigated associations between psychosocial factors and injury in non-recreational (professional, pre-professional, full-time collegiate students, elite competitive) adult PAs were eligible. Fifty-one studies of 7,457 participants (25 of musicians (n=4,505 (60.5%)); 24 of dancers (n=2,680 (35.9%)); 1 of vocalists (n=225 (3.0%)), and 1 of circus performers (n=47 (0.6%))) met the inclusion criteria. Most participants were professional PAs (n=4,547 (61.0%)), followed by collegiate PAs (n=1,424 (19.1%)), and mixed professional, pre-professional, elite competitive, and collegiate PAs (n=1,486 (19.9%)). A total of 90 distinct instruments evaluating 45 different psychosocial factors were identified. Stress, anxiety, depression, perfectionism and coping were the factors most frequently investigated. Stress was commonly reported across all PA cohorts. Just 19 (21%) instruments were psychometrically appropriate for the cohort being measured. Many other instruments were valid/reliable in patient, sporting or general population cohorts, but not in PAs. There is a common link between psychosocial risk factors and injury in non-recreational adult PAs. Screening programmes should incorporate comprehensive evaluations of these factors. Instruments appropriate for the cohort being investigated should be used. The development and/or validation of instruments for use across all PAs should be considered.