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Prevalence, incidence and nature of the musculoskeletal complaints of people studying accordion at the french music academies 
         We surveyed the 985 pupils of the chromatic accordion's classes of French music academies with anonymous self-administered questionnaire. The questionnaires were distributed by their professors on April 2004, after the Easter holidays, and were  filled by 47,3 % of the pupils.
         We elaborated a classification of complaints, according to their topography (right upper limb, left upper limb, and\or axial zone) and their consequences (important or moderate, according to criteria defined in the 2 articles published in Médecine des Arts). 
         53,2 % of the students had at least a complaint that may be performance-related at the time of the survey, and 26,2 % a complaint since the 1st September 2003. Prevalence of severe complaints was 15,0 % and incidence 9,4 %. These figures are probably close to those observed with instruments at strong risk, as piano, guitar or harp, and superior to those observed with the less  affected musicians (winds).
         The monthly incidence was maximal at the beginning of the school year and then slowly decrease. That may lead pupils and teachers to caution already from the beginning of the year, especially because numerous incidental complaints persisted till the end of the school year. This result seems to be generalizable to the pupils learning other instruments.
         The complaints of the left upper limb were the most common, compared with what is met at other instrumentalist's. It was not a surprise, being given the physical constraints on this limb. On the other hand, the accordion seems to lead to fewer distals complaints (wrists, hands and fingers) that strings and that piano do ; maybe because the hand and the fingers do not carry the accordion's weight, and because the distances on the keyboard, as well as the force needed to press on keys are less important.
         
 
         According to most multivariate analyses (except one), people who wanted to become a music teacher or to perform in concerts were more likely to have musculoskeletal complaints.
         The risk factors were completely dependent upon whether the complaint was major or mild. Thus, mild and important  complaints seem to arise for different reasons. This phenomenon was not known, either at the musicians or in the industry, and taking it into account in the future studies concerning the musculoskelettal disorders could improve their quality.
         Among about the forty tested risk factors, 3 groups of factors appeared in the multivariate analyses (= analyses realized on every topographic subgroup, and in each group according to the complaint's consequences) :
-visual-comfort factors were pointed in each subgroup. In the industry, this phenomenon is well known, and had driven to guidelines, which the musicians should know.
-The projects of future supposing the acquisition of a very good instrumental level (becoming a music teacher, or giving concerts) appeared in all the multivariate analyses, except one. It is THE much important psychosocial factor for pupil's of musical academies. Unlike other known psychosocial factors, this factor, by the increasing of motivation that he supposes, takes on a positive connotation. So, the mechanisms by which it causes musculoskeletal disorders may be different (responsibility of the chronic stress? Increase of the perception of pain?). Understanding these mechanisms might lead to preventive measures,  particularly in the management of the motivation, so that it does not become destructive.
-Independently of these previous 2 factors (independence that is insured by the multivariate analysis), technical factors, specific to the instruments, exist. The most interesting, in the group of the major complaints, is the increasing of the risk when closing the bellows bottom-first (to form a fan-like shape). It is consistent with biomechanical data. Thus, you must not recommend this technique to pupils, and rather try other solutions to achieve the same musical end. On the other hand it seems risky, in a desire of prevention, to change a technique, used for a long time by a pupil that does not have symptoms : it may exist a good reason for him\her to do that, even it is not ever clear why. And it is maybe, for himher, the best solution.
         Other factors appeared in a single multivariate analysis, in particular the participation in an training course. This risk factor is already well known at the musician's. It does not question the musical interest of this way of learning ; it is however necessary to find a way to decrease the risk (for example, taking a part of the working time to analyse the scores avay from the instrument, or learning some of the physical techniques used in the reeducation of the musicians, etc.), and watch the strict respect for the usual prevention guidelines.