Lifestyle correlates of Carpal Tunnel Syndrome

A Comparison of Four Measures of Self-Control Skills

This study compares the psychometric characteristics of four questionnaires designed to assess self-control skills: the Self-Control Questionnaire, the Frequency of Self-Reinforcement Questionnaire, the Cognitive Self-Management Test, and the Lifestyle Approaches Inventory. Content validity was judged to be fairly comparable by three raters in Study 1. In Study 2, convergent and divergent validity support was obtained for all four questionnaires when administered to 369 multiethnic college students, but the relative degree of support varied across constructs. Hence, selection of a self-control instrument may be guided by the target behavior of interest.

An interpreter's interpretation: sign language interpreters' view of musculoskeletal disorders

INTRODUCTION

Sign language interpreters are at increased risk for musculoskeletal disorders associated with work. Previous studies have used survey techniques to identify potential risk factors and approaches to their medical management. Little is known about risk factors and management of symptoms in this group from the perspective of the interpreter. Such qualitative information should help inform future research related to this professional group.

METHOD

One thousand ninety-two sign language interpreters recruited from the Registry of Interpreters for the Deaf completed an open-ended question that was a component of a national prevalence survey. Responses were evaluated using content analysis. Inter and intra rater reliability were high (.88 and .92, respectively).

RESULTS

Risk factors for initiation and/or exacerbation of symptoms included: difficult job, interpreting setting (educational), interpreting style (e.g., posture, self generated force), and emotional and physical stressors. Exercise (e.g., stretching, aerobics) was a common prevention strategy. Conventional medical treatment was used as the first line approach to symptom control. Self-care methods such as exercise, diet and warm up prior to interpreting were also reported. While massage and chiropractic care was used as commonly as in the general population, acupuncture was found to be used more often. Coping strategies that were more active (e.g. exercise, diet, more control over work schedule) were also reported as useful.

CONCLUSIONS

These findings provide a description of factors that interpreters view as important in the development and exacerbation of hand and wrist pain. The results also indicate that interpreters used many self-management approaches. Future research should carefully investigate the utility of such approaches using well-controlled designs. Also, because of its widespread use in this group the evaluation of acupuncture in the management of these symptoms appears warranted. The qualitative approach used in the present study permitted an analysis of the worker perspectives regarding risk and management of these work related symptoms. This information can be used to further inform future research.

Group Training with Healthy Computing Practices to Prevent Repetitive Strain Injury (RSI): A Preliminary Study

This pilot study investigated whether group training, in which participants become role models and coaches, would reduce discomfort as compared to a nontreatment Control Group. Sixteen experimental participants participated in 6 weekly 2-hr group sessions of a Healthy Computing program whereas 12 control participants received no training. None of the participants reported symptoms to their supervisors nor were they receiving medical treatment for repetitive strain injury prior to the program. The program included training in ergonomic principles, psychophysiological awareness and control, sEMG practice at the workstation, and coaching coworkers. Using two-tailed t tests to analyze the data, the Experimental Group reported (1) a significant overall reduction in most body symptoms as compared to the Control Group and (2) a significant increase in positive work-style habits, such as taking breaks at the computer, as compared to the Control Group. This study suggests that employees could possibly improve health and work style patterns based on a holistic training program delivered in a group format followed by individual practice.

Upper extremity disorders in women

Carpal tunnel syndrome, Colles' fracture, and osteoarthritis of the basilar joint of the thumb are only three of the many upper extremity conditions that preferentially affect women. With more and more women entering the workplace, these conditions become more disruptive of patients' lifestyles and even may be increasing in incidence. Orthopaedic surgeons traditionally have focused on the surgical treatment of patients with these conditions, but it is becoming increasingly clear that surgeons also must focus on delineating pathophysiology to better identify those individuals at risk and help prevent these potentially disabling disorders.

Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability

Upper extremity disorders (UEDs) account for a significant number of work-related illnesses in the US workforce. Little information exists on the distribution of UEDs, their associated health care and indemnity costs, or patterns of work disability. The study presented is an analysis of upper extremity claims within the federal workforce. In this study, the universe consisted of all claims accepted by the US Department of Labor, Office of Workers' Compensation Programs (OWCP), from October 1, 1993, through September 30, 1994. A total of 185,927 claims of notices of injury were processed during the study period, and of these, 8,147 or 4.4% had an UED diagnosis coded according to the International Classification of Diseases, Clinical Modification (ICD-9-CM). 5,844 claims involved a single UED diagnosis and were the only claims field by these employees between October 1, 1990, and September 30, 1994. These single claims with single diagnoses comprised the sample for further analysis. Mononeuritis and enthesopathies of the upper limb were the most common diagnoses, accounting for 43% and 31% of the claims, respectively. Women had a higher proportion of carpal tunnel syndrome, "unspecified" mononeuritis, and "unspecified" enthesopathies. The majority of claimants for both the mononeuritis- and enthesopathy-related diagnoses were between 31 and 50 years of age, received only health care benefits, and did not incur wage loss. Health care costs for mononeuritis and enthesopathy claims were $12,228,755 (M = $2,849). Carpal tunnel syndrome (CTS) and enthesopathy of the elbow were the most costly diagnoses, accounting for 57% and 16% of the total, respectively. Surgical services represented the highest expenditures in CTS claims. Physical therapy accounted for the majority of health care costs for enthesopathy cases. The mean number of workdays lost for CTS and enthesopathy claims were 84 and 79, and the average indemnity costs were $4,941 and $4,477, respectively. These findings indicate that while UEDs represent a relatively small percentage of all workers' compensation cases, the health care and indemnity costs are considerable. Also mean duration and pattern of work disability revealed that these disorders can result in chronic work disability similar to that observed in low back pain. The results highlight the need to determine whether interventions that account for the majority of costs significantly impact long-term outcomes. There is also a need to identify risk factors for prolonged disability in those who experience problems with delayed recovery.