Quality of life
A Framework for the Classification and Diagnosis of Work-Related Upper Extremity Conditions: Systematic Review

https://doi.org/10.1016/j.semarthrit.2007.10.006Get rights and content

Objective

A frequently cited problem in epidemiological research is the inadequate operational definition of umbrella terms such as Musculoskeletal Disorders (MSD). Specific conditions attached to these labels and their corresponding signs and symptoms are also poorly defined. The purpose of this study was to identify internationally applied terminology and definitions appropriate to work-related upper extremity (UE) conditions.

Methods

An extensive literature search of 15 electronic databases supplemented by personal communications with representatives from national and international health and safety organizations was undertaken to identify recognized terminology and definitions appropriate to work-related UE conditions.

Results

Information specific to the umbrella terms and their corresponding conditions was obtained from 15 countries. The findings revealed a lack of international consensus over appropriate terminology to encapsulate the wide range of conditions falling within the umbrella terms used by these countries. UE conditions could be classified into 3 broad categories: (1) 14 “specific conditions” with evidence-based diagnostic criteria; (2) 34 “other specific conditions” with no clearly defined diagnosis; and (3) “nonspecific conditions” requiring a clear pattern of signs and symptoms to be present for a diagnosis to be made. A dynamic model for classifying work-related UE conditions is proposed which places greater emphasis on specific diagnosis.

Conclusions

A systematic approach to the classification and diagnosis of work-related UE conditions is attractive, as it is likely to lead to more precise estimates of the prevalence and cost of UE conditions, as well as improved quality of information on the efficacy of medical and workplace interventions.

Section snippets

Methods

An extensive literature search was undertaken to identify suitable publications citing nationally and internationally recognized terminology, conditions, and definitions, inclusive of UE diagnostic criteria. This involved an initial search of the literature from a variety of sources including textbooks and conference proceedings; national and international health and safety organization websites; general internet search; and key review papers. From this initial literature search an extensive

International Nomenclature

Internationally used terms and definitions currently in use throughout 15 countries (Australia, Canada, Denmark, Finland, France, Germany, Italy, Japan, New Zealand, Norway, The Netherlands, Poland, Sweden, United Kingdom, USA) were identified. Considerable variation existed both within and among countries, with some 14 separate terms emerging. These included the following: Activity Related Soft Tissue Disorders; Complaints of the Arm, Neck and/or Shoulder (CANS); CTD; MSD; Occupational

Discussion

There appears to be much international debate and lack of consensus as to the most appropriate nomenclature to describe the range of work-related UE conditions. Terms currently in use to describe these conditions are held as being deficient in that they fail to encapsulate an appropriate meaning consistent with all conditions. For example, terms may often presuppose etiology by defining single risk factors as the proposed disease mechanism (eg, “RSI” presupposes repetition as a causative

Acknowledgments

The support of the Accident Compensation Corporation (ACC) of NZ is greatly appreciated. Acknowledgment also goes to AUT's Information and Education Services, in particular, Andrew South, who provided considerable assistance throughout this work. Sincere thanks are extended to those representatives from international organizations that provided information about the current status of work-related UE conditions in their respective countries.

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