Collaborative Musicians' Health Advocacy Initiative
Oxford Handbook of Musicians' Health Advocacy Project
Stand Alone Position Papers
Resources
Glossary of Terms
The following will constitute the operational definitions of the terms used in our Delphi surveys and the context surrounding them. Most of these terms are borrowed verbatim from the source indicated while some are adapted.
Association: An organization of persons having a common interest
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​Best practice (in health care): Best practice typically refers to strategies, approaches, or activities proven through research and evaluation to be effective, efficient, sustainable, and reliably leading to desired results. Some view best practice not as a specific practice but as an integrative process to embed research-based knowledge into healthcare. The term "best practice" is often used interchangeably with "good practice," "evidence-based practice," "evidence-based guidelines/clinical practice guidelines," or "standard of care." It can be determined at the government level or within an organization and derived from various sources such as systematic reviews, health technology assessments, and guideline recommendations. Studies are underway to map and better define this term.
https://jbi.global/news/article/defining-best-practice-healthcare
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Clinical assessment and diagnosis: Clinical assessment is a methodologic process through which qualified health care professionals encounter, observe, evaluate, and connect with patients. A comprehensive clinical picture of the patient is then analyzed to 1) make provisional and possible differential diagnoses; 2) determine appropriate investigations or actions required based on the provisional diagnosis; 3) prioritise and delegate interventions, timeframes and appropriate escalation processes; and 4) commence development of an appropriate and effective comprehensive care plan with the patient, families, carers and other support people, and the multidisciplinary team.
https://www.safetyandquality.gov.au/sites/default/files/2020-08/acsqhc_cc_ee1_paper_online.pdf
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Clinical Care: Clinical care refers to provision of healthcare services by a qualified/licensed healthcare professional to a patient with direct interaction. It involves processes for diagnosis, treatment and prevention of illness or disease for the best interest of the patient. Clinical care addresses the needs of the patients, involves real-time decisions and use of treatment and therapies that are known to be safe and effective.
Clinical guidelines (Clinical practice guidelines): Clinical Practice Guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. To be trustworthy, guidelines should 1) be based on a systematic review of the existing evidence; 2) be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups; 3) consider important patient subgroups and patient preferences, as appropriate; 4) be based on an explicit and transparent process that minimizes distortions, biases, and conflicts of interest; 5) provide a clear explanation of the logical relationships between alternative care options and health outcomes, and provide ratings of both the quality of evidence and the strength of recommendations; and 6) be reconsidered and revised as appropriate when important new evidence warrants modifications of recommendations. https://www.ncbi.nlm.nih.gov/books/NBK209546/#:~:text=CLINICAL%20PRACTICE%20GUIDELINES-,Clinical%20Practice%20Guidelines%20are%20statements%20that%20include%20recommendations%20intended%20to,harms%20of%20alternative%20care%20options.
Clinical intervention: An intervention carried out to improve, maintain or assess the health of a person, in a clinical situation.
https://meteor.aihw.gov.au/content/327220#:~:text=Definition:,person%2C%20in%20a%20clinical%20situation
Clinical outcome: A clinical outcome is a measurable change in symptoms, overall health, ability to function, quality of life, or survival outcomes that result from giving care to patients. Clinical outcomes may be used in clinical settings, such as a hospital or doctor’s office, to measure the success of care or to assess a person’s response to an already approved treatment. One or more clinical outcomes may be used in clinical trials as an endpoint to determine how well a new therapy works and/or the safety of a new therapy. https://toolkit.ncats.nih.gov/glossary/clinical-outcome/#:~:text=A%20clinical%20outcome%20is%20a,from%20giving%20care%20to%20patients
Clinical pathways: Clinical pathways (CPWs) are tools used to guide evidence-based healthcare. Their aim is to translate clinical practice guideline recommendations into clinical processes of care within the unique culture and environment of a healthcare institution. A CPW is a structured multidisciplinary care plan with the following characteristics: (1) it is used to translate guidelines or evidence into local structures; (2) it details the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other “inventory of actions”; and (3) it aims to standardize care for a specific clinical problem, procedure or episode of healthcare in a specific population.
https://www.ncbi.nlm.nih.gov/books/NBK549262/#:~:text=The%20main%20aim%20of%20clinical%20pathway%20implementation,thereby%20maximizing%20patient%20outcomes%20and%20clinical%20efficiency.
Clinical treatment: The action or way of treating a patient or a condition medically or surgically; management and care to prevent, cure, ameliorate, or slow progression of a medical condition
https://www.merriam-webster.com/dictionary/treatment#medicalDictionary
Comparative effectiveness research (CER): The process of comparing the benefits and harms of two or more methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care or decision-making by clinicians
Competency framework: Competency frameworks describe required knowledge, skills, attitudes and other characteristics (KSAOs) for effective professional practice. They are developed for a variety of purposes, including informing education of health professionals and assessment frameworks. These frameworks allow professionals, educators, and regulators to define healthcare professions, promote competent workforces, facilitate assessment, facilitate professional mobility, and help to analyze and evaluate the expertise of the profession and the professional. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.789828/full
Competency/Competence: The ability to regularly perform a task successfully and efficiently. In healthcare, professional competence is defined as the ability of healthcare professional to serve safely and effectively both the individual and the wider community according to the rules of clinical performance. https://onlinelibrary.wiley.com/doi/10.1111/nhs.12804
Core competencies: The essential minimal set of a combination of attributes, such as applied knowledge, skills, and attitudes, that enable an individual to perform a set of tasks to an appropriate standard efficiently and effectively. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2685621
Core Outcome Set (COS): Core outcome sets (COS) are standardized sets of outcomes, which represent the minimum outcomes that should be measured and reported in clinical trials. COS can enhance comparability across health trials by reducing heterogeneity of outcome measurement and reporting and potentially minimizing selective outcome reporting. Interest is growing in using COS within routine care to support delivery of patient-focused care. https://pmc.ncbi.nlm.nih.gov/articles/PMC8684586/#:~:text=Core%20outcome%20sets%20(COS)%20are,perceptions%20and%20experiences%20of%20COS.
Disciplinarity of care teams: There is no consensus. The below is adapted from Martin et al. in 2022. PMID: 35422626
https://pmc.ncbi.nlm.nih.gov/articles/PMC9005079/
Multidisciplinary care: Multidisciplinary teams comprise professionals from multiple disciplines who work independently and complete discipline-specific assessments and treatments to achieve discipline-specific and clinician-directed patient goals (that might or might not complement the work of other professionals). Each member contributes their unique discipline perspective, and all communication occurs through the highest-ranking member (usually the physician) who directs patient care. The alternate term, multiagency, should be referred to only when different healthcare professionals from different organizations come together to provide care.
Interdisciplinary care: Alternatives include interprofessional care, interprofessional collaboration, cross-disciplinary.
Interdisciplinary teams consist of professionals from multiple disciplines who hold equal status (which can include the patient or their representative) and work in an interdependent, patient-centered manner. In these teams, a leader oversees care and the health professionals complete discipline-specific assessments and treatments. Members have an advanced understanding of each other’s roles and expertise, communicate frequently, share decision-making, and collaborate to establish coordinated plans and patient treatment goals. Interdisciplinary collaboration should be referred to as the output of interdisciplinary teams.
Transdisciplinary care: Alternatives include transprofessional, supraprofessional.
Transdisciplinary teams require professionals from multiple disciplines to work beyond traditional professional boundaries (ie, complete tasks that might usually be completed by another professional), redesign roles, blend perspectives, exchange knowledge and skills, and integrate elements of assessment and treatment into one unified and patient-centered plan. In these teams, professionals hold equal status (which can include the patient or their representative), understand and respect other member’s roles, communicate frequently, trust other members, and engage in mutual learning and/or formal training. While members share responsibility, there may also be a designated leader to oversee patient care.
Hybrid teams: Describes teams that are dynamic and take on characteristics of different types of healthcare teams at different phases of healthcare provision (or at any one time).
Disease: A specific condition that can be diagnosed by a health care professional.
Health care professional (Clinician): Qualified/licensed health care professional who provides direct care to and has responsibility for the patients.
Health professional: Health professionals maintain health in humans through the application of the principles and procedures of evidence-based medicine and caring. Health professionals study, diagnose, treat and prevent human illness, injury and other physical and mental impairments in accordance with the needs of the populations they serve. They advise on or apply preventive and curative measures, and promote health with the ultimate goal of meeting the health needs and expectations of individuals and populations, and improving population health outcomes. They also conduct research and improve or develop concepts, theories and operational methods to advance evidence-based health care. Their duties may include the supervision of other health workers (adapted from ILO 2008; WHO 2010).
https://www.ncbi.nlm.nih.gov/books/NBK298950/#:~:text=Definition%20of%20health%20professionals,Go%20to:
Holistic Care/Approach: Holistic medicine (care) is an attitudinal approach to health care rather than a particular set of techniques. It addresses the psychological, familial, societal, ethical and spiritual as well as biological dimensions of health and illness. The holistic approach emphasizes the uniqueness of each patient, the mutuality of the doctor-patient relationship, each person's responsibility for his or her own health care and society's responsibility for the promotion of health.
https://pmc.ncbi.nlm.nih.gov/articles/PMC1273970/
ICF (International Classification of Functioning, Disability and Health): The International Classification of Functioning, Disability and Health (ICF) is a framework developed by the World Health Organization (WHO) that provides a common language and classification system for understanding a person's functioning as it relates to their disability, health, and environment. ICF standardizes information on how disability, health, and environment affect a person's ability to function and enables data sharing across countries, disciplines, and time. (Not be confused with ICD which stands for International Classification of Diseases. It is a globally used medical classification system that provides a standardized way to classify diseases, injuries, and health conditions).
https://www.cdc.gov/nchs/icd/icf/index.html
ICF Core Sets: ICF Core Sets provide lists of essential categories that are relevant for specific health conditions and health care contexts to facilitate the description of functioning, for example in clinical practice. These ICF categories were selected from the entire ICF following a scientific process based on preparatory studies and the involvement of a multidisciplinary group of experts. Please see “International Classification of Functioning, Disability and Health (ICF)” for context.
Illness: Subjective experience of feeling unwell.
Institution: An established organization or corporation (such as a bank or university) especially of a public character; a facility or establishment in which people (such as the sick or needy) live and receive care typically in a confined setting and often without individual consent; a significant practice, relationship, or organization in a society or culture
https://www.merriam-webster.com/dictionary/institution
Instrument specific musician’s injury/disorder retraining specialist: Professionally trained musician providing retraining or other return-to-play training to a musician with playing related disorder.
Instrumentalist: A musician who primarily plays an instrument.
Job analysis/Practice analysis: Job analysis provides a way to develop a crucial understanding of a job by examining the tasks performed in a job, the competencies required to perform those tasks, and the connection between the tasks and competencies. Job analysis/practice analysis is a required step in the established framework of The American Board of Physical Therapy Residency and Fellowship Education – the accrediting body for accreditation of physical therapist residency and fellowship education programs and The American Board of Physical Therapy Specialties for petitioning for a new sub-specialty. Demonstrating demand, need for specific education and training, and evidence of current practitioners in subspecialty are emphasized among the criteria for establishing a new sub-specialty.
https://www.neuropt.org/docs/default-source/fellowship/petition-for-subspecialty-resources.pdf?sfvrsn=65845f43_2
Minimal Clinically Important Difference (MCID): MCID represents the minimum amount of change in an outcome that might be considered important by the patient or clinician.
https://www.sralab.org/statistical-terms-use
Minimal Detectable Change (MDC): MDC is a statistical estimate of the smallest amount of change that can be detected by a measure ensuring that the change is not the result of measurement error.
https://www.sralab.org/statistical-terms-use
Musculoskeletal and neurological conditions related to musical activity: Musculoskeletal conditions and/or neurological conditions that interfere with a musician’s ability to engage in music making. These conditions can manifest as a variety of symptoms such as pain, electric shock sensation, numbness, tingling, pinching, weakness, spasms, decreased dexterity/coordination or others. In this definition, mild transient aches or pains, as well as conditions that primarily impact hearing or voice-box will not be considered.
Adapted from https://link.springer.com/article/10.1007/s10926-023-10130-6#Sec1
and https://www.sciencedirect.com/science/article/pii/S0277953698003074?via%3Dihub
Musculoskeletal condition: Disease/illness that affects muscles, bones, joints and adjacent connective tissues.
Musician: Anyone who plays a musical instrument and/or sings, and/or conducts, and/or composes music and/or otherwise engages in music making at the recreational, serious leisure, preprofessional, semi-professional and professional engagement levels.
Neurological condition: Disease /illness that affects central and peripheral nervous system including the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, or muscles. When a condition affects the nerves and muscles, and/or the connection between them, it is categorized as “neuromuscular disorder”; common examples include Amyotrophic Lateral Sclerosis (ALS), muscular dystrophy, and myasthenia gravis.
Organization: An organized body of people with a particular purpose, especially a business, society, association, etc (from Oxford English Dictionary); an administrative and functional structure (such as a business or a political party)
https://www.oed.com/dictionary/organization_n?tab=meaning_and_use#33331060
https://www.merriam-webster.com/dictionary/organization
Patient centered clinical outcome (PCO): Patient-centered outcomes (PCOs) comprise measurable health outcomes that are important, impactful, and/or meaningful to patients. PCOs are comprised of variables collected directly from patients – patient reported outcomes (PROs) – and variables collected through other sources. https://rethinkingclinicaltrials.org/cores-and-working-groups/patient-reported-outcomes-2/#:~:text=Patient%2Dcentered%20outcomes%20(PCOs),variables%20collected%20through%20other%20sources.
Patient reported outcome measures (PROMs): Patient-reported outcome measures (PROMs) are tools that are used to measure the PROs, most often self-report questionnaires. Although investigators may address patient-relevant outcomes via proxy reports or observations from caregivers, health professionals, or parents and guardians, these are not PROMs but rather clinician-reported or observer-reported outcomes. https://training.cochrane.org/handbook/current/chapter-18#:~:text=A%20patient%2Dreported%20outcome%20(PRO,review%20authors%20address%20the%20challenges.
Patient reported outcomes (PRO): A patient-reported outcome (PRO) is “any report of the status of a patient’s health condition that comes directly from the patient without interpretation of the patient’s response by a clinician or anyone else” (FDA 2009). PROs are one of several clinical outcome assessment methods that complement biomarkers, measures of morbidity (e.g. stroke, myocardial infarction), burden (e.g. hospitalization), and survival used and reported in clinical trials and non-randomized studies (FDA 2018). https://training.cochrane.org/handbook/current/chapter-18#:~:text=A%20patient%2Dreported%20outcome%20(PRO,review%20authors%20address%20the%20challenges.
Patient-centered care: A partnership among practitioners, patients, and their families ensures that decisions respect patients’ wants, needs, and preferences, and that patients have the education and support they need to make decisions and participate in their own care, as well as participate in quality improvement efforts
Prevention
The natural history of a disease classifies into five stages: underlying, susceptible, subclinical, clinical, and recovery/disability/death. Corresponding preventive health measures have been grouped into similar stages to target the prevention of these stages of a disease. In our discussions, prevention is going to be considered within the paradigm of clinical care of a patient.
Primary prevention: Primary prevention consists of measures aimed at a susceptible individual. The purpose of primary prevention is to prevent a disease from ever occurring. For example, a patient with radial wrist pain in their dominant limb will be susceptible to overuse their currently healthy non-dominant limb. Education and training to reduce exposure to overuse their non-dominant limb is a primary prevention effort.
Secondary prevention: Secondary prevention emphasizes early detection of subclinical disease. The subclinical disease consists of pathologic changes but no overt symptoms. Secondary prevention often occurs in the form of clinical screenings. For example, ulnar and median neuropathies are common in urban dwelling adults as well as musicians. Screening of a musician with radial wrist pain for upper limb neuropathies in both limbs is a secondary prevention effort.
Tertiary prevention: Tertiary prevention targets both the clinical and outcome stages of a disease. It is implemented in symptomatic patients and aims to reduce the severity of the disease as well as any associated sequelae. While secondary prevention seeks to prevent the onset of illness, tertiary prevention aims to reduce the effects of the disease once established in an individual. Forms of tertiary prevention are commonly rehabilitation efforts.
Adapted from: https://www.ncbi.nlm.nih.gov/books/NBK537222/
Scope of practice: Scope of practice refers to those activities that a person licensed to practice as a health professional is permitted to perform.
https://www.ama-assn.org/practice-management/scope-practice/what-scope-practice#:~:text=Scope%20of%20practice%20refers%20to,by%20the%20appropriate%20licensing%20entity.
Standard of Care: Standard of care refers to the degree of care a prudent and reasonable person would exercise under the circumstances. Legislatures, administrative agencies, and courts define the legal degree of care required. Authoritative clinical guidelines, policies and guidelines from professional organizations, journal/research articles, accreditation standards, and facility policies and procedures are other sources that support determination of standard of care.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8667701/#:~:text=The%20standard%20of%20care%20is%20a%20legal%20term%2C%20not%20a,legal%20standard%20varies%20by%20state.
Treatment effect: A treatment effect refers to the difference between the outcomes that would occur if a specific treatment is implemented and if it is not implemented. There is a wide variety of terminology related to treatment effects in health services and research at the individual, sample and population levels.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6794006/
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Treatment effectiveness: Treatment effectiveness refers to the extent to which a treatment produces the desired beneficial effect in real-world clinical practice, as opposed to ideal or controlled conditions. (“treatment efficacy”, on the other hand, is the extent to which a treatment produces the desired beneficial effect under ideal or controlled conditions)
PAMA PreConference Presentations
July 17 2024
