Biomechanical and psychosocial exposures are independent risk factors for carpal tunnel syndrome: assessment of confounding using causal diagrams

Details

• Personal Author:
  Bao S ; Burt, Susan E. ; Dale, Ann M. ; Eisen EA ; Evanoff B ; Garg, Arun ; Gerr F ; Harris-Adamson C ; Hegmann KT ; Kapellusch J ; Neophytou A ; Rempel D ; Silverstein B ; Thiese MS
• Description:
  Background: Between 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure-response relationships. Objective: This analysis examined the presence and magnitude of confounding between biomechanical and workplace psychosocial factors and incidence of dominant-hand CTS. Methods: 1605 participants, without CTS at enrolment, were followed for up to 3.5 years (2471 person-years). Demographic information, medical history and workplace psychosocial stress measures were collected at baseline. Individual workplace biomechanical exposures were collected for each task and combined across the workweek using time-weighted averaging (TWA). CTS case criteria were based on symptoms and results of electrophysiological testing. HRs were estimated with Cox proportional hazard models. Confounding was assessed using causal diagrams and an empirical criterion of 10% or greater change in effect estimate magnitude. Results: There were 109 incident CTS cases (IR=4.41/ 100 person-years; 6.7% cumulative incidence). The relationships between CTS and forceful repetition rate, % time forceful hand exertion and the Threshold Limit Value for Hand Activity Level (TLV-HAL) were slightly confounded by decision latitude with effect estimates being attenuated towards the null (10-14% change) after adjustment. The risk of CTS among participants reporting high job strain was attenuated towards the null by 14% after adjusting for the HAL Scale or the % time forceful hand exertions. Conclusions Although attenuation of the relationships between CTS and some biomechanical and work psychosocial exposures was observed after adjusting for confounding, the magnitudes were small and confirmed biomechanical and work psychosocial exposures as independent risk factors for incident CTS. [Description provided by NIOSH]
• Subjects:
  Biomechanical Phenomena Demography Electrophysiology Environmental Exposure Musculoskeletal Diseases Musculoskeletal System Occupational Health Risk Assessment Risk Factors Safety
• Keywords:
  Biomechanics Carpal Tunnel Syndrome CTS Demographic Characteristics Exposure Levels Hand Injuries Models Psychological Stress Psychosocial Factors Risk Factors Threshold Limit Values TLV Workers

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• ISSN:
  1351-0711
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Georgia ; Iowa ; Missouri ; Ohio ; OSHA Region 10 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 7 ; OSHA Region 8 ; OSHA Region 9 ; Utah ; Washington ; Wisconsin
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  73
• Issue:
  11
• NIOSHTIC Number:
  nn:20048396
• Citation:
  Occup Environ Med 2016 Nov; 73(11):727-734
• Contact Point Address:
  Dr Carisa Harris-Adamson, University of California, San Francisco, 1301 South 46th Street, Bldg 163, Richmond, CA 94804
• Email:
  carisa.harris-adamson@ucsf.edu
• Federal Fiscal Year:
  2017
• Performing Organization:
  University of California-San Francisco
• Peer Reviewed:
  True
• Start Date:
  20100901
• Source Full Name:
  Occupational and Environmental Medicine
• End Date:
  20140831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:a8fbdd23917d0757c731df1c057c13fcc975abadf602fed91f8408bd183f35c7fc47cc7d867f68515fb26b2c8fb12f58d34d7d02a39cf364eebb7186d55241d4
• Download URL:
  https://stacks.cdc.gov/view/cdc/203156/cdc_203156_DS1.pdf
• File Type:
  [PDF - 362.27 KB ]