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Occupational risk factors for work disability following carpal tunnel syndrome: a pooled prospective study
  1. Carisa Harris-Adamson1,2,
  2. Ellen A Eisen2,
  3. Jay Kapellusch3,
  4. Kurt T Hegmann4,
  5. Matthew S Thiese4,
  6. Ann-Marie Dale5,
  7. Bradley Evanoff5,
  8. Alysha Rose Meyers6,
  9. Stephen Bao7,
  10. Fred Gerr8,
  11. Niklas Krause9,
  12. David Rempel1
  1. 1Department of Medicine, University of California at San Francisco, San Francisco, California, USA
  2. 2School of Public Health, University of California at Berkeley, Berkeley, California, USA
  3. 3Occupational Therapy Science, Technology, & Rehabiliation, University of Wisconsin at Milwaukee, Milwaukee, Wisconsin, USA
  4. 4Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
  5. 5Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
  6. 6Division of Surveillance, Hazard Evaluations and Field Studies, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
  7. 7SHARP, Washington State Department of Labor and Industries, Olympia, Washington, USA
  8. 8Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
  9. 9School of Public Health, University of California at Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Carisa Harris-Adamson, Department of Medicine, University of California San Francisco, San Francisco, California, USA; carisa.harris-adamson{at}ucsf.edu

Abstract

Background Although recent studies have identified important risk factors associated with incident carpal tunnel syndrome (CTS), risk factors associated with its severity have not been well explored.

Objective To examine the associations between personal, workplace psychosocial and biomechanical factors and incident work disability among workers with CTS.

Methods Between 2001 and 2010 five research groups conducted coordinated prospective studies of CTS and related work disability among US workers from various industries. Workers with prevalent or incident CTS (N=372) were followed for up to 6.4 years. Incident work disability was measured as: (1) change in work pace or work quality, (2) lost time or (3) job change following the development of CTS. Psychosocial factors were assessed by questionnaire. Biomechanical exposures were assessed by observation and measurements and included force, repetition, duty cycle and posture. HRs were estimated using Cox models.

Results Disability incidence rates per 100 person-years were 33.2 for changes in work pace or quality, 16.3 for lost time and 20.0 for job change. There was a near doubling of risk for job change among those in the upper tertile of the Hand Activity Level Scale (HR 2.17; 95% CI 1.17 to 4.01), total repetition rate (HR 1.75; 95% CI 1.02 to 3.02), % time spent in all hand exertions (HR 2.20; 95% CI 1.21 to 4.01) and a sixfold increase for high job strain. Sensitivity analyses indicated attenuation due to inclusion of the prevalent CTS cases.

Conclusion Personal, biomechanical and psychosocial job factors predicted CTS-related disability. Results suggest that prevention of severe disability requires a reduction of both biomechanical and organisational work stressors.

  • disability
  • ergonomics
  • epidemiology
  • musculoskeletal system

Data availability statement

Data are available on reasonable request. Individuals or groups who would like to use the dataset to address specific scientific questions must provide a proposal to the ULMSD Consortium for full consideration. For more information, please email carisa.harris-adamson@ucsf.edu.

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Data availability statement

Data are available on reasonable request. Individuals or groups who would like to use the dataset to address specific scientific questions must provide a proposal to the ULMSD Consortium for full consideration. For more information, please email carisa.harris-adamson@ucsf.edu.

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Footnotes

  • Twitter @eaeisen

  • Contributors CH-A was the primary author of the paper, completed the statistical analyses and serves as the guarantor of this work. EAE assisted with study design and statistical methodology. NK provided expertise on the phase-disability approach to analyses. DR, NK, ARM, A-MD, BE, KTH, MST, FG, JK and SB provided input on study design, analysis and interpretation of findings. All authors contributed to revisions of the manuscript.

  • Funding These consortial data were collected at multiple consortial sites and used many sources of support that include research grants, training grants and other funding sources. These include 1U01OH007917-01, 1R01OH07914-01, 1R01OH009712-01, 1R01OH010474-01, UL1RR-24992, T42/CCT810426-10, 3TC42OH008414, and T42OH008429. Additionally, the data collection, data abstraction, data reduction, analyses and other activities required major support beyond usual funding mechanisms including state funds, donations and extensive in-kind support.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

  • Competing interests None declared.

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

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