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Optimising case definitions of upper limb disorder for aetiological research and prevention: a review
  1. Keith T Palmer,
  2. E Clare Harris,
  3. Cathy Linaker,
  4. Cyrus Cooper,
  5. David Coggon
  1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  1. Correspondence to Professor Keith T Palmer, MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton SO16 6YD, UK; ktp{at}mrc.soton.ac.uk

Abstract

Experts disagree about the optimal classification of upper limb disorders (ULDs). To explore whether differences in associations with occupational risk factors offer a basis for choosing between case definitions in aetiological research and surveillance, we analysed previously published research. Eligible reports (those with estimates of relative risk (RR) for >1 case definition relative to identical exposures were identified from systematic reviews of ULD and occupation and by hand-searching five peer-review journals published between January 1990 and June 2010. We abstracted details by anatomical site of the case and exposure definitions employed and paired estimates of RR, for alternative case definitions with identical occupational exposures. Pairs of case definitions were typically nested, a stricter definition being a subset of a simpler version. Differences in RR between paired definitions were expressed as the ratio of RRs, using that for the simpler definition as the denominator. We found 21 reports, yielding 320 pairs of RRs (82, 75 and 163 respectively at the shoulder, elbow, and distal arm). Ratios of RRs were frequently ≤1 (46%), the median ratio overall and by anatomical site being close to unity. In only 2% of comparisons did ratios reach ≥4. We conclude that complex ULD case definitions (e.g. involving physical signs, more specific symptom patterns, and investigations) yield similar associations with occupational risk factors to those using simpler definitions. Thus, in population-based aetiological research and surveillance, simple case definitions should normally suffice. Data on risk factors can justifiably be pooled in meta-analyses, despite differences in case definition.

  • Musculoskeletal
  • occupational health practice
  • epidemiology
  • back disorders
  • epidemiology
  • risk assessment
  • mortality studies
  • longitudinal studies

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Footnotes

  • Funding This study was supported by a grant from the UK Health and Safety Executive with the aim of improving consensus over case definitions for upper limb disorders (grant number OH1939).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data on which this report is based are all in the public domain-sources are identified in reference lists in the main text and in the online supplement.

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