Evaluation of the Effectiveness of Application-Supported Preventive Advice on Student Musicians' Health

As part of the feasibility assessment guided by the CONSORT extension for pilot and feasibility trials, this outcome evaluates the attractiveness of the application-based intervention, measured by the number of participants who will express interest in the intervention at baseline.

This outcome measures the use of the app-based intervention as part of the feasibility assessment. Use is evaluated by tracking the frequency of mobile app access by each participant throughout the intervention period.

Participant satisfaction is measured using a Visual Analog Scale (VAS), where participants rate their overall satisfaction from 0 (not satisfied) to 10 (fully satisfied).

This outcome assesses the usability of the mobile app-based intervention using the System Usability Scale (SUS), which is a validated 10-item questionnaire designed to evaluate perceived ease of use. The total SUS score ranges from 0 to 100, with higher scores indicating better perceived usability. This measure is part of the feasibility assessment guided by the CONSORT extension for pilot and feasibility trials.

As part of the feasibility assessment guided by the CONSORT extension for pilot and feasibility trials, this outcome evaluates participant satisfaction with the mobile app using the Visual Analog Scale (VAS): satisfaction scores at 6 and 12 weeks, where participants rate overall satisfaction from 0 (not satisfied) to 10 (fully satisfied).

This questionnaire is considered the gold standard for assessing musculoskeletal pain and discomfort related to practice of music. It evaluates the intensity of pain and its interference with musical performance with 22-items (8 for musician characteristics and 14 related with pain related with musical practice). The MPIIQM includes a subscale about pain intensity (0 to 40) and pain interference (0 to 50).

Higher scores indicate greater pain intensity and interference with musical practice.

The SF-36 assesses the perceived physical and mental quality of life across eight dimensions: physical functionning (10 items), role limitations (4 items); bodily pain (2 items); general health perceptions (5 items); energy/vitality (4 items); social functioning (2 items); emotional role limitations (3 items); general mental health (5 items) and health transition (1 item). The total score ranges from 0 to 30. Higher score indicates better perceived health-related quality of life.

The questionnaire assesses professional health and psychosocial adaptation among musicians. It evaluates multiple dimensions relevant to musical performance, including 7 domains: satisfaction with professional achievement, confidence in stage situations, breathing while playing, satisfaction with posture, movement sensations, symptoms during performance, and perceived ability to meet musical demands. The total score ranges from 6 to 42. High score shows good adaptability to constraint. Changes in this score may reflect the impact of the preventive intervention on physical and mental health in the context of musical work.

The Kessler Psychological Distress Scale (K10) is a validated 10-item self-report questionnaire designed to assess symptoms of anxiety and depression over the past 4 weeks. Scores of the 10 items are then summed, yielding a minimum score of 10 and a maximum score of 50. Low score indicates low levels of psychological distress and high scores indicate high levels of psychological distress. Since student musicians have a high level of general stress, a change will allow us to observe whether interventions have an effect on this risk factor.

The K-MPAI-R is a validated 40-item with a 7-point Likert scale measuring anxiety related to music performance specific to the target population. Total score: 7 to 280 points. A high total score corresponds to high anxiety and distress regarding musical performance and vice versa. Since student musicians have a high level of performance-related stress, a change will allow us to observe whether interventions have an effect on this risk factor.

Following recommendations from a Delphi consensus study, a general fatigue rating is collected. Participants rate their current level of fatigue using a single-item self-report scale ranging from 0 (no fatigue) to 10 (maximum fatigue), providing a quick global indicator of perceived fatigue.

Fatigue will also be assessed using the McCrary Fatigue Questionnaire. It is a 5-item validated scale developed specifically for musicians. It evaluates dimensions such as pain, sleep, recovery, workload, and physical condition. Items are rated on a 0-10 scale. A high total score represents greater fatigue. The intervention includes education on fatigue management, which may impact both perceived and reported fatigue levels.

The Occupational Balance Questionnaire (OBQ) is used to evaluate satisfaction with how time is spent and the variety of activities undertaken. A 13-item self-report scale. Each item is scored 0-3; total score range: 0-39. Higher score represents better occupational balance.The advice includes recommendations for time management, periodization, and health-promoting activities. A change will highlight whether the interventions have an effect on occupational balance.

Health literacy will be assessed using the Musicians' Health Literacy Questionnaire (MHL-Q19), a 19-item scale developed specifically for student musicians. It evaluates the ability to access, understand, and apply health information across clinical care, prevention, and health promotion contexts. Each item is scored as either difficult (0) or easy (1), producing a total score ranging from 0 to 19. Scores are categorized as:

• Inadequate (0-9)
• Problematic (10-14)
• Sufficient (15-19). The app includes information on health and good behaviors. A change will highlight the effects on health knowledge.

Self-perceived performance quality will be measured using a Visual Analog Scale (VAS) ranging from 0 (lowest imaginable performance) to 10 (best imaginable performance). Participants will rate their average performance quality over the previous 3 days. This outcome assesses the participant's subjective perception of their musical performance and whether it is influenced by the preventive intervention.

The General Self-Efficacy Scale (GSES) assesses confidence in one's coping ability in difficult situations with 10-items. Each item is evaluated with a 4-point scale (1 = not at all true and 4 = absolutely true). The total score ranges from 10 to 40. Higher scores reflect stronger self-efficacy.

Baseline demographic data will be collected, including age, sex, type of musical discipline background, general health history, prior musculoskeletal pain or disorders (PRMDs), any other extracurricular activities outside of music studies, work and music practice habits, and lifestyle habits. This information will be used to characterize the study sample and explore potential demographic and baseline factors that may influence study outcomes.