Exposure Response Relationships for CTS and Epicondylitis from Pooled Data

Details

• Personal Author:
  Bao SS ; Garg, Arun ; Hegmann KT ; Kapellusch JM ; Malloy E ; Merryweather AS ; Silverstein BA ; Thiese MS
• Description:
  Carpal tunnel syndrome (CTS), and lateral (LEPI) and medial (MEPI) epicondylitis are burdensome occupational MSDs for workers and employers. Prior studies have examined risk factors but only limited information is available about quantified exposure-response relationships for these MSDs using detailed physical exposure data measured at the sub-task level. Data were pooled from three research sites and included workers from 35 facilities in four US states. Demographic, psychosocial, and health outcomes data were collected on each worker and at least quarterly throughout follow-up. Workers were followed for up to 7 years. Detailed, occupational physical exposures were measured at baseline and regularly re-assessed for each task performed by each worker. A total of 2,020 workers were available and complete data were pooled for 1,834 (90.8%) of them. Several workers (710) performed multi-task jobs (i.e., job-rotation) and performed an average of 5.1 tasks/worker during their work day. Exposure-response relationships were quantified for the 1995 Moore and Garg Strain Index (SI), the ACGIH TLV for HAL, and the Revised Strain Index (RSI) - a new physical exposure model developed as a part of this study. Unlike prior models, the RSI quantifies distal upper extremity (DUE) physical exposure for each sub-task performed, and for each task within a multi-task job. The 1995 SI, the TLV for HAL, and the RSI exhibited strong exposure-response relationships with incidence of CTS, LEPI, MEPI, and EPI (i.e., combined LEPI or MEPI). Workers classified as having medium- or high- physical exposures were between 40% to 240% more likely to develop an incident case of one of these MSDs. HRs were higher for LEPI and MEPI than for CTS, suggesting that EPI might be more sensitive to physical exposure levels than CTS, or alternatively that non-occupational factors play a larger role in CTS pathology. Workers with multi-task jobs were found to have higher physical exposures than those performing mono-task jobs and were at higher risk for CTS, LEPI, and MEPI. This suggests that job rotation, as currently practiced in industry, might not be an effective MSD intervention strategy. Workers with higher physical exposures provided less positive psychosocial responses than those with lower exposures (e.g., reported having lower job satisfaction). This might explain why some studies of DUE MSDs have reported associations with psychosocial factors. Another noteworthy finding of this study was the association between cardiovascular disease (CVD) risk factors and prevalence of CTS, LEPI, and MEPI - providing further evidence of the complex pathologies of these occupational MSDs. The findings of this study should help inform comprehensive MSD intervention strategies. Continuous exposure-response relationships provide a basis for companies to develop exposure policies. The RSI model provides a foundation for detailed design-level evaluation and decision making. Evidence of association between job organizational, biomechanical, and psychosocial factors provide insight into comprehensive workplace interventions. Association between CVD risk factors and occupational MSDs provides a basis and possible strategy for workplace wellness initiatives. [Description provided by NIOSH]
• Subjects:
  Biomechanical Phenomena Cardiovascular Diseases Cardiovascular System Demography Ergonomics Musculoskeletal Diseases Musculoskeletal System Occupational Exposure Occupational Health Risk Assessment Risk Factors Safety Workplace

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• Keywords:
  Analytical Instruments Analytical Models Biomechanics Cardiovascular Disease Carpal Tunnel Syndrome CTS Demographic Characteristics Employee Exposure Exposure Assessment Injury Prevention Job Design Job Rotation MSD Musculoskeletal System Disorders Nerve Damage Psychological Factors Psychological Responses Psychophysiological Testing Psychosocial Factors Risk Assessment Risk Factors Upper Extremities Work Organization Workplace Studies

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• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  OSHA Region 10 ; OSHA Region 5 ; OSHA Region 8 ; Utah ; Washington ; Wisconsin
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-47
• NIOSHTIC Number:
  nn:20052058
• NTIS Accession Number:
  PB2018-101414
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-010474, 2017 Dec; :1-47
• Federal Fiscal Year:
  2018
• Performing Organization:
  University of Wisconsin, Milwaukee
• Peer Reviewed:
  False
• Start Date:
  20130901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20170831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:10b1932aef862e5caa6792c3c3fdd4ce2c029c0ba5dc76ca868fba6166aeaad2e7077fbbef59445836cd710f775f9286d2f38313309ed9ec40b2ff60dc85929f
• Download URL:
  https://stacks.cdc.gov/view/cdc/218687/cdc_218687_DS1.pdf
• File Type:
  [PDF - 413.07 KB ]