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Hegmann KT, Thiese MS, Wood EM, Kapellusch J, Foster JC, Drury DL, Kendall R, Merryweather AS. Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders in a Prospective Cohort. J Occup Environ Med 2023; 65:e527-e533. [PMID: 37264528 PMCID: PMC10417266 DOI: 10.1097/jom.0000000000002895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores. METHODS Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy. RESULTS Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20-6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85-78.62) among those with more than 4 disorders. CONCLUSIONS Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger.
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Acute Whole-Body Vibration Exercise Promotes Favorable Handgrip Neuromuscular Modifications in Rheumatoid Arthritis: A Cross-Over Randomized Clinical. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9774980. [PMID: 34901282 PMCID: PMC8660187 DOI: 10.1155/2021/9774980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
Objective Rheumatoid arthritis (RA) causes progressive changes in the musculoskeletal system compromising neuromuscular control especially in the hands. Whole-body vibration (WBV) could be an alternative for the rehabilitation in this population. This study investigated the immediate effect of WBV while in the modified push-up position on neural ratio (NR) in a single session during handgrip strength (HS) in women with stable RA. Methods Twenty-one women with RA (diagnosis of disease: ±8 years, erythrocyte sedimentation rate: ±24.8, age: 54± 11 years, BMI: 28 ± 4 kg·m−2) received three experimental interventions for five minutes in a randomized and balanced cross-over order: (1) control—seated with hands at rest, (2) sham—push-up position with hands on the vibration platform that remained disconnected, and (3) vibration—push-up position with hands on the vibration platform turned on (45 Hz, 2 mm, 159.73 m·s−2). At the baseline and immediately after the three experimental interventions, the HS, the electromyographic records (EMGrms), and range of motion (ROM) of the dominant hand were measured. The NR, i.e., the ratio between EMGrms of the flexor digitorum superficialis (FDS) muscle and HS, was also determined. The lower NR represented the greater neuromuscular efficiency (NE). Results The NR was similar at baseline in the three experimental interventions. Despite the nonsignificance of within-interventions (p = 0.0611) and interaction effect (p = 0.1907), WBV exercise reduced the NR compared with the sham and control (p = 0.0003, F = 8.86, η2 = 0.85, power = 1.00). Conclusion Acute WBV exercise under the hands promotes neuromuscular modifications during the handgrip of women with stable RA. Thus, acute WBV exercise may be used as a preparatory exercise for the rehabilitation of the hands in this population. This trial is registered with trial registration 2.544.850 (ReBEC-RBR-2n932c).
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Kapellusch JM, Bao SS, Malloy EJ, Thiese MS, Merryweather AS, Hegmann KT. Validation of the Revised Strain Index for Predicting Risk of Incident Carpal Tunnel Syndrome in a Prospective Cohort. ERGONOMICS 2021; 64:1369-1378. [PMID: 34190679 DOI: 10.1080/00140139.2021.1940306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
The Revised Strain Index (RSI), a model that quantifies physical exposure from individual hand/wrist exertions, tasks, and multi-task jobs, was used to quantify exposure for 1372 incident-eligible manufacturing, service and healthcare workers. Workers were followed for an average of 2.5 years (maximum 6 years) and had an average carpal tunnel syndrome (CTS) incidence rate of 4.6 per 100 person-years. Exceeding the a-priori RSI limit of 10.0 showed increased risk of CTS (Hazard Ratio (HR) = 1.45, 95% CI: 1.11-1.91, p = 0.01). There also was a dose-response relationship using proposed low (RSI ≤ 8.5, HR = 1.00), medium (HR = 1.42 (95% CI: 0.96-2.09, p = 0.08)), and high limits (RSI > 15, HR = 1.79 (95% CI: 1.19-2.69, p = 0.01), respectively. RSI as a continuous variable showed CTS risk increased steadily by between 1.9% and 3.3% per unit increase in RSI (p ≤ 0.03). These results suggest that the RSI is a useful tool for surveillance as well as for job intervention/design and continuous improvement processes.Practitioner Summary The Revised Strain Index (RSI) quantifies physical exposure from individual hand/wrist exertions, tasks, and multi-task jobs. Increased cumulative RSI scores (i.e. daily exposure score) are associated with increased risk of carpal tunnel syndrome (CTS). The RSI is potentially useful as a risk surveillance and intervention design tool.
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Affiliation(s)
- Jay M Kapellusch
- Department of Rehabilitation Sciences & Technology, College of Health Sciences, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Stephen S Bao
- Washington State Department of Labor and Industries, Olympia, WA, USA
| | - Elizabeth J Malloy
- Department of Mathematics and Statistics, American University, Washington, DC, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational & Environmental Health, University of Utah, Salt Lake City, UT, USA
| | - Andrew S Merryweather
- Rocky Mountain Center for Occupational & Environmental Health, University of Utah, Salt Lake City, UT, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational & Environmental Health, University of Utah, Salt Lake City, UT, USA
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Fitch MS, Thiese MS, Wood EM, Kapellusch JM, Hegmann KT. The Coexistence of Carpal Tunnel Syndrome in Workers With Trigger Digit. Hand (N Y) 2021; 16:753-758. [PMID: 31965852 PMCID: PMC8647321 DOI: 10.1177/1558944719893048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The objective of this study was to investigate the prevalence of carpal tunnel syndrome (CTS) in workers with trigger digit. There are few cross-sectional studies that assess this relationship. Methods: A baseline examination of 1216 workers from 17 diverse manufacturing facilities was conducted. Worker demographics, medical history, and symptoms of trigger digit were assessed. Age, sex, and body mass index were obtained. Biomechanical factors were individually measured using the Strain Index (SI). Prevalence was assessed with univariate and multivariate logistic regression. Results: Unadjusted prevalence of trigger digit was 12.0%, and among those workers, there was an unadjusted CTS prevalence of 26.7%. The adjusted multivariate model found an odds ratio (OR) of CTS of 1.56 (95% confidence interval [CI], 1.03-2.36) among the workers with trigger digit. The ORs of CTS for SI (OR = 1.53 [95% CI, 1.04-2.23]), age (OR = 1.03 [95% CI, 1.01-1.04]), and current smoking (OR = 1.76 [95% CI, 1.12-2.75]) were also significant. Sex and diabetes were not statistically significant covariates. Conclusion: The prevalence of CTS is higher among workers with trigger digit.
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Affiliation(s)
| | | | | | | | - Kurt T. Hegmann
- The University of Utah, Salt Lake City, USA,Kurt T. Hegmann, Rocky Mountain Center for Occupational and Environmental Health, The University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT 84108, USA.
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Metabolic Syndrome in Commercial Truck Drivers: Prevalence, Associated Factors, and Comparison With the General Population. J Occup Environ Med 2021; 62:453-459. [PMID: 32730019 DOI: 10.1097/jom.0000000000001863] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Commercial motor vehicle drivers, such as truck drivers, experience unique health, lifestyle, and occupational challenges directly associated with their profession. METHODS All participants in this multistate cross-sectional study completed questionnaire measurements. Participants were categorized with metabolic syndrome (MetS) if they had at least three of the five modified criteria used in the joint scientific statement on metabolic syndrome. RESULTS Overall MetS prevalence was 52.4% (n = 428) of the 817 participants. Prevalence of MetS criteria were waist circumference (n = 634, 77.0%), low HDL cholesterol (n = 580, 71.0%), elevated triglycerides (n = 552, 67.6%), elevated blood pressure (n = 175, 21.2%), and elevated hemoglobin A1c (n = 97, 11.9%). Truck drivers were 2.7 times more likely to have MetS compared to the general working population. CONCLUSION Truck drivers in the United States have a high prevalence of MetS compared to the general working population.
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Role of Biomechanical Factors in Resolution of Carpal Tunnel Syndrome Among a Population of Workers. J Occup Environ Med 2020; 61:340-346. [PMID: 30789447 DOI: 10.1097/jom.0000000000001558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Identify if Carpal tunnel syndrome (CTS) symptoms vary by measured biomechanical exposures. METHODS A nested prospective cohort within a large, multicenter, 8-year cohort study. The CTS case definition was tingling/numbness in 2+ median nerve-served digits plus a nerve conduction study consistent with CTS. Workers were assigned to: (1) low (strain index [SI] less than or equal to 6.1), and (2) high (SI more than 6.1) job groups. RESULTS Among 1201 workers, 106 had CTS. Those in the high SI group became and remained symptom-free for at least 3 months, faster than the low SI group, adjusted hazard ratio (HR) = 2.07 (95% confidence interval [CI] = 1.21 to 3.56, P = 0.008). Only surgical release trended towards resolving CTS. Light duty had no impact, and job change was associated with delayed symptoms resolution. CONCLUSIONS High biomechanical exposures paradoxically predicted faster improvement in CTS and light duty did not result in symptom resolution.
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Reliability of Common Provocative Tests for Shoulder Tendinitis by Doxey et al-Letter to the Editor. J Occup Environ Med 2019; 61:e300-e301. [PMID: 31166284 DOI: 10.1097/jom.0000000000001575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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The Role of Elbow Tender Point Examination in the Diagnosis of Lateral Epicondylitis. J Occup Environ Med 2018; 61:126-131. [PMID: 30507788 DOI: 10.1097/jom.0000000000001496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To quantify sensitivity and specificity of the tender points and demonstrate how variability in case definition impacts prevalence of lateral epicondylitis (LE). METHODS Baseline data analyzed from 1216 workers from the WISTAH study, a multicenter prospective cohort study of upper extremity musculoskeletal disorders. All workers completed computerized questionnaires, structured interviews, and two independent physical examinations in accordance with an established protocol. RESULTS The prevalence of LE differed based on case definition ranging from 4.7% to 12.1%. Sensitivity was low for tender points 1 to 4 ranging from 6.8% to 34.6%. Specificity was high for tender points 1 to 4 ranging from 95.2% to 97.9%. CONCLUSIONS The prevalence of lateral epicondylitis differs markedly based on case definition used, ranging more than two-fold. Standardization of a case definition is essential to allow for comparisons across studies.
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Holdaway LA, Hegmann KT, Thiese MS, Kapellusch J. Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskelet Disord 2018; 19:408. [PMID: 30470225 PMCID: PMC6260856 DOI: 10.1186/s12891-018-2319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/24/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Glenohumeral pain and rotator cuff tendinopathy (RCT) are common musculoskeletal complaints with high prevalence among working populations. The primary proposed pathophysiologic mechanisms are sub-acromial RC tendon impingement and reduced tendon blood flow. Some sleep postures may increase subacromial pressure, potentially contributing to these postulated mechanisms. This study uses a large population of workers to investigate whether there is an association between preferred sleeping position and prevalence of: (1) shoulder pain, and (2) rotator cuff tendinopathy. METHODS A cross-sectional analysis was performed on baseline data from a multicenter prospective cohort study. Participants were 761 workers who were evaluated by questionnaire using a body diagram to determine the presence of glenohumeral pain within 30 days prior to enrollment. The questionnaire also assessed primary and secondary preferred sleep position(s) using 6 labeled diagrams. All workers underwent a structured physical examination to determine whether RCT was present. For this study, the case definition of RCT was glenohumeral pain plus at least one of a positive supraspinatus test, painful arc and/or Neer's test. Prevalence of glenohumeral pain and RCT were individually calculated for the primary and secondary sleep postures and odds ratios were calculated. RESULTS Age, sex, Framingham cardiovascular risk score and BMI had significant associations with glenohumeral pain. For rotator cuff tendinopathy, increasing age, Framingham risk score and Hand Activity Level (HAL) showed significant associations. The sleep position anticipated to have the highest risk of glenohumeral pain and RCT was paradoxically associated with a decreased prevalence of glenohumeral pain and also trended toward being protective for RCT. Multivariable logistic regression showed no further significant associations. CONCLUSION This cross-sectional study unexpectedly found a reduced association between one sleep posture and glenohumeral pain. This cross-sectional study may be potentially confounded, by participants who are prone to glenohumeral pain and RCT may have learned to avoid sleeping in the predisposing position. Longitudinal studies are needed to further evaluate a possible association between glenohumeral pain or RCT and sleep posture as a potential risk factor.
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Affiliation(s)
- Lincoln A Holdaway
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA.
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Jay Kapellusch
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, 161 W Wisconsin Ave, Suite 6000, Milwaukee, WI, 53203-2602, USA
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Abstract
INTRODUCTION Diagnostic screening tests for carpal tunnel syndrome (CTS) have not been rigorously assessed in large populations. METHODS This study is a cross-sectional analysis from a prospective cohort study. Participants' (n = 1,194) symptoms and disease prevalence were measured. Sensitivity, specificity, and positive and negative predictive values (NPVs) were calculated. RESULTS When defining CTS as tingling/numbness in at least two median nerve-served digits and an abnormal median nerve conduction study, the prevalence was 8.9%. The sensitivity of paresthesias with nocturnal awakening was 77.4%. The sensitivity of the Phalen sign was 52.8% and that of the Hoffman-Tinel sign was only 37.7%. DISCUSSION The highest sensitivity (77.4%) for a case definition of CTS in this population of workers was for nocturnal tingling/numbness in a median nerve distribution, and the highest specificity (97.5%) was for continuous tingling/numbness. The Phalen sign has a sensitivity of 52.8% and NPV of 95%, suggesting that the NPV is of particular diagnostic value. Hoffman-Tinel signs seem primarily helpful for the NPV (93.7%). LEVEL OF EVIDENCE Level II diagnostic study.
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Abstract
OBJECTIVE Accurate and reliable shoulder tendinopathy examination maneuvers are essential for diagnosing and treating shoulder pain; however, studies have reported varying results as to the accuracy of common maneuvers. Thus, data from a large, cross-sectional study were used to systematically quantify the reliability and accuracy of clinical diagnostic tests. METHODS Baseline data from the WISTAH cohort study were used to evaluate inter-tester reliability and accuracy of common provocative shoulder examination tests compared with a case definition of shoulder tendinitis. RESULTS Inter-tester reliability showed reliable consistency between providers with kappa coefficients between 89.5% and 94.8% for all tests. However, sensitivity was generally poor (3.0% to 60.6%). Specificity was consistently high (96.2% to 99.6%). CONCLUSION Common shoulder provocative tests show low sensitivity but high specificity, which implies that the primary utility of examination maneuvers is for their negative predictive values.
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Psychosocial Factors Related to Lateral and Medial Epicondylitis: Results From Pooled Study Analyses. J Occup Environ Med 2018; 58:588-93. [PMID: 27206118 DOI: 10.1097/jom.0000000000000701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The goal is to assess the relationships between psychosocial factors and both medial and lateral epicondylitis after adjustment for personal and job physical exposures. METHODS One thousand eight hundred twenty-four participants were included in pooled analyses. Ten psychosocial factors were assessed. RESULTS One hundred twenty-one (6.6%) and 34 (1.9%) participants have lateral and medial epicondylitis, respectively. Nine psychosocial factors assessed had significant trends or associations with lateral epicondylitis, the largest of which was between physical exhaustion after work and lateral epicondylitis with and odds ratio of 7.04 (95% confidence interval = 2.02 to 24.51). Eight psychosocial factors had significant trends or relationships with medial epicondylitis, with the largest being between mental exhaustion after work with an odds ratio of 6.51 (95% confidence interval = 1.57 to 27.04). CONCLUSIONS The breadth and strength of these associations after adjustment for confounding factors demonstrate meaningful relationships that need to be further investigated in prospective analyses.
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Ayhan C, Tanrıkulu S, Leblebicioglu G. Scapholunate interosseous ligament dysfunction as a source of elbow pain syndromes: Possible mechanisms and implications for hand surgeons and therapists. Med Hypotheses 2018; 110:125-131. [PMID: 29317055 DOI: 10.1016/j.mehy.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 11/02/2017] [Accepted: 12/03/2017] [Indexed: 12/01/2022]
Abstract
Elbow pain syndromes are common upper extremity musculoskeletal disorders, and they are usually associated with repetitive occupational exposure. Ligaments are often one of the sources of musculoskeletal disorders because of their mechanical and neurological properties. The wrist ligaments are some of the ligaments most vulnerable to occupational exposure. Since most occupational tasks require wrist extension for handling tools and loading, the scapholunate interosseous ligament (SLIL) bears greater strain during loading, which results in creep deformation and hysteresis. Ligamentous creep may result in diminished ability to detect signal changes during joint movements, which impairs neuromuscular control established by ligamentomuscular reflex arcs elicited from mechanoreceptors in the ligaments. Changes in muscle activation patterns of forearm muscles due to diminished ligamentomuscular reflexes may initiate a positive feedback loop, leading to musculoskeletal pain syndromes. The relationship between elbow pain syndromes and SLIL injury will be presented through two hypotheses and relevant pain mechanisms: 1. Repetitive tasks may cause creep deformation of the SLIL, which then impairs ligamentomuscular reflexes, leading to elbow pain disorders. 2. Lateral epicondylalgia may increase the risk of SLIL injury through the compensation of the lower extensor carpi radialis muscle activity by higher extensor carpi ulnaris muscle activity, which may alter carpal kinematics, leading to SLIL degeneration over time. The differential diagnosis is usually complicated in musculoskeletal pain disorders. The failure of treatment methods is one of the issues of concern for many researchers. A key element in developing treatment strategies is to understand the source of the disorder and the nature of the injury. We proposed that the differential diagnosis include SLIL injuries when describing elbow pain syndromes, particularly, lateral epicondylalgia.
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Affiliation(s)
- Cigdem Ayhan
- Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey.
| | - Seval Tanrıkulu
- Koc University, Faculty of Medicine, Orthopedics and Traumatology Department, Hand Surgery Unit, İstanbul, Turkey
| | - Gursel Leblebicioglu
- Hacettepe University, Faculty of Medicine, Orthopaedics and Traumatology Department, Hand Surgery Unit, Ankara, Turkey
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Kapellusch JM, Bao SS, Silverstein BA, Merryweather AS, Thiese MS, Hegmann KT, Garg A. Risk assessments using the Strain Index and the TLV for HAL, Part I: Task and multi-task job exposure classifications. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:1011-1019. [PMID: 28825893 DOI: 10.1080/15459624.2017.1366037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Strain Index (SI) and the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value for Hand Activity Level (TLV for HAL) use different constituent variables to quantify task physical exposures. Similarly, time-weighted-average (TWA), Peak, and Typical exposure techniques to quantify physical exposure from multi-task jobs make different assumptions about each task's contribution to the whole job exposure. Thus, task and job physical exposure classifications differ depending upon which model and technique are used for quantification. This study examines exposure classification agreement, disagreement, correlation, and magnitude of classification differences between these models and techniques. METHODS Data from 710 multi-task job workers performing 3,647 tasks were analyzed using the SI and TLV for HAL models, as well as with the TWA, Typical and Peak job exposure techniques. Physical exposures were classified as low, medium, and high using each model's recommended, or a priori limits. Exposure classification agreement and disagreement between models (SI, TLV for HAL) and between job exposure techniques (TWA, Typical, Peak) were described and analyzed. RESULTS Regardless of technique, the SI classified more tasks as high exposure than the TLV for HAL, and the TLV for HAL classified more tasks as low exposure. The models agreed on 48.5% of task classifications (kappa = 0.28) with 15.5% of disagreement between low and high exposure categories. Between-technique (i.e., TWA, Typical, Peak) agreement ranged from 61-93% (kappa: 0.16-0.92) depending on whether the SI or TLV for HAL was used. CONCLUSIONS There was disagreement between the SI and TLV for HAL and between the TWA, Typical and Peak techniques. Disagreement creates uncertainty for job design, job analysis, risk assessments, and developing interventions. Task exposure classifications from the SI and TLV for HAL might complement each other. However, TWA, Typical, and Peak job exposure techniques all have limitations. Part II of this article examines whether the observed differences between these models and techniques produce different exposure-response relationships for predicting prevalence of carpal tunnel syndrome.
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Affiliation(s)
- Jay M Kapellusch
- a Department of Occupational Science & Technology , University of Wisconsin - Milwaukee , Milwaukee , Wisconsin
| | - Stephen S Bao
- b SHARP Program , Washington State Department of Labor and Industries , Olympia , Washington
| | - Barbara A Silverstein
- b SHARP Program , Washington State Department of Labor and Industries , Olympia , Washington
| | - Andrew S Merryweather
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Mathew S Thiese
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Kurt T Hegmann
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Arun Garg
- a Department of Occupational Science & Technology , University of Wisconsin - Milwaukee , Milwaukee , Wisconsin
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Thiese MS, Merryweather A, Koric A, Ott U, Wood EM, Kapellusch J, Foster J, Garg A, Deckow-Schaefer G, Tomich S, Kendall R, Drury DL, Wertsch J, Hegmann KT. Association between wrist ratio and carpal tunnel syndrome: Effect modification by body mass index. Muscle Nerve 2017; 56:1047-1053. [PMID: 28500660 DOI: 10.1002/mus.25692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/04/2017] [Accepted: 05/07/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Previous studies have reported higher wrist ratios (WR) related to carpal tunnel syndrome (CTS) but have not assessed effect modification by obesity and may have inadequately controlled for confounders. METHODS Baseline data of a multicenter prospective cohort study were analyzed. CTS was defined by nerve conduction study (NCS) criteria and symptoms. RESULTS Among the 1,206 participants, a square-shaped wrist was associated with CTS after controlling for confounders (prevalence ratio = 2.27; 95% confidence interval [95% CI], 1.33-3.86). Body mass index (BMI) was a strong effect modifier on the relationship between WR and both CTS and abnormal NCS results, with normal weight strata of rectangular versus square wrists = 8.18 (95% CI, 1.63-49.96) and 7.12 (95% CI, 2.19-23.16), respectively. DISCUSSION A square wrist is significantly associated with CTS after controlling for confounders. Effect modification by high BMI masked the eightfold magnitude adjusted relationship seen between WR and CTS among normal weight participants. Muscle Nerve 56: 1047-1053, 2017.
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Affiliation(s)
- Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Alzina Koric
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
| | - Ulrike Ott
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
| | - Eric M Wood
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
| | - Jay Kapellusch
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - James Foster
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Arun Garg
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | | | - Richard Kendall
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | | | - Jacqueline Wertsch
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
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Hegmann KT, Thiese MS, Kapellusch J, Merryweather A, Bao S, Silverstein B, Wood EM, Kendall R, Foster J, Drury DL, Garg A. Association between Epicondylitis and Cardiovascular Risk Factors in Pooled Occupational Cohorts. BMC Musculoskelet Disord 2017; 18:227. [PMID: 28558776 PMCID: PMC5450050 DOI: 10.1186/s12891-017-1593-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/22/2017] [Indexed: 01/10/2023] Open
Abstract
Background The pathophysiology of lateral epicondylitis (LE) is unclear. Recent evidence suggests some common musculoskeletal disorders may have a basis in cardiovascular disease (CVD) risk factors. Thus, we examined CVD risks as potential LE risks. Methods Workers (n = 1824) were enrolled in two large prospective studies and underwent structured interviews and physical examinations at baseline. Analysis of pooled baseline data assessed the relationships separately between a modified Framingham Heart Study CVD risk score and three prevalence outcomes of: 1) lateral elbow pain, 2) positive resisted wrist or middle finger extension, and 3) a combination of both symptoms and at least one resisted maneuver. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were calculated. Results There was a strong relationship between CVD risk score and lateral elbow symptoms, resisted wrist or middle finger extension and LE after adjustment for confounders. The adjusted ORs for symptoms were as high as 3.81 (95% CI 2.11, 6.85), for positive examination with adjusted odds ratios as high as 2.85 (95% CI 1.59, 5.12) and for combined symptoms and physical examination 6.20 (95% CI 2.04, 18.82). Relationships trended higher with higher CVD risk scores. Conclusions These data suggest a potentially modifiable disease mechanism for LE.
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Affiliation(s)
- Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA.
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA
| | - Jay Kapellusch
- Department of Occupational Science & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, 1495 East 100 South, Salt Lake City, UT, 84112, USA
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, 243 Israel Road SE Bldg 3, Tumwater, WA, 98501, USA
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention (SHARP) Program, 243 Israel Road SE Bldg 3, Tumwater, WA, 98501, USA
| | - Eric M Wood
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA
| | - Richard Kendall
- Physical Medicine and Rehabilitation, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - James Foster
- United Occupational Medicine, 9555 76th St., Pleasant Prairie, WI, 53158, USA
| | - David L Drury
- Clement J Zablocki VA Medical Center, Compensation & Pension Department, 5000 W National Avenue, Milwaukee, WI, 53295, USA
| | - Arun Garg
- Department of Occupational Science & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA
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Association Between Cardiovascular Disease Risk Factors and Rotator Cuff Tendinopathy. J Occup Environ Med 2017; 59:154-160. [DOI: 10.1097/jom.0000000000000929] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Bao SS, Kapellusch JM, Merryweather AS, Thiese MS, Garg A, Hegmann KT, Silverstein BA, Marcum JL, Tang R. Impact of Work Organizational Factors on Carpal Tunnel Syndrome and Epicondylitis. J Occup Environ Med 2016; 58:760-4. [PMID: 27414007 PMCID: PMC4980299 DOI: 10.1097/jom.0000000000000790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify relationships between work organizational variables (job rotation, overtime work, having a second job, and work pacing) (These work organizational variables and their relationships with biomechanical and psychosocial exposures were studied previously and published in a separate paper.) and health outcome measures [carpal tunnel syndrome (CTS), lateral and medial epicondylitis (LEPI/MEPI)]. METHODS Using a pooled baseline cohort of 1834 subjects, the relationships were studied using logistic regression models. RESULTS Varied degrees of associations between the work organizational and outcomes variables were found. Job rotation was significantly associated with being a CTS case [odds ratio (OR) = 1.23, 95% confidence interval (95% CI): 1.00 to 1.50]. Overtime work was significantly associated with lower LEPI prevalence (OR = 0.48, 95% CI: 0.28 to 0.84). No statistically significant associations were found between having a second job and different work pacing and any of the three health outcome measures. CONCLUSIONS Work organizational variables were only partially associated with the studied health outcomes.
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Affiliation(s)
- Stephen S Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia (Drs Bao, Silverstein, Marcum); Department of Occupational Science & Technology, University of Wisconsin-Milwaukee (Drs Kapellusch, Garg, Tang); Department of Mechanical Engineering (Dr Merryweather), and Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City (Drs Thiese, Hegmann)
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Two industrial cohorts: baseline characteristics and factors associated with obesity. J Occup Environ Med 2016; 57:562-70. [PMID: 25738945 DOI: 10.1097/jom.0000000000000404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe demographic and health characteristics, and factors associated with obesity among production workers. METHODS This cross-sectional study analyzed baseline data from two occupational cohorts. Regression modeling was used to assess associations between worker characteristics and obesity. RESULTS A total of 1974 subjects were included in these analyses. The mean body mass index was 29.5 kg/m (SD = 6.5). Having smoked in the past and currently smoking decreased the odds of being obese in the WISTAH Distal Upper Extremity cohort, whereas those feeling depressed had increased odds of being obese. Being a Pacific Islander/Native Hawaiian and married increased the odds of obesity in the BackWorks Low Back Pain cohort. CONCLUSIONS Factors associated with obesity differed substantially between the two cohorts. Recognizing factors associated with obesity in specific work settings may provide opportunities for optimizing preventive workplace interventions.
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Association Between Cardiovascular Risk Factors and Carpal Tunnel Syndrome in Pooled Occupational Cohorts. J Occup Environ Med 2016; 58:87-93. [DOI: 10.1097/jom.0000000000000573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Associations between Distal Upper Extremity Job Physical Factors and Psychosocial Measures in a Pooled Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:643192. [PMID: 26557686 PMCID: PMC4628736 DOI: 10.1155/2015/643192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/10/2015] [Indexed: 11/24/2022]
Abstract
Introduction. There is an increasing body of literature relating musculoskeletal diseases to both job physical exposures and psychosocial outcomes. Relationships between job physical exposure measures and psychosocial factors have not been well examined or quantified. These exploratory analyses evaluate relationships between quantified exposures and psychosocial outcomes. Methods. Individualized quantification of duration, repetition, and force and composite scores of the Strain Index (SI) and the Threshold Limit Value for Hand Activity Level (TLV for HAL) were compared to 10 psychosocial measures. Relationships and predicted probabilities were assessed using ordered logistic regression. Analyses were adjusted for age, BMI, and gender. Results and Discussion. Among 1834 study participants there were multiple statistically significant relationships. In general, as duration, repetition, and force increased, psychosocial factors worsened. However, general health and mental exhaustion improved with increasing job exposures. Depression was most strongly associated with increased repetition, while physical exhaustion was most strongly associated with increased force. SI and TLV for HAL were significantly related to multiple psychosocial factors. These relationships persisted after adjustment for strong confounders. Conclusion. This study quantified multiple associations between job physical exposures and occupational and nonoccupational psychosocial factors. Further research is needed to quantify the impacts on occupational health outcomes.
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Factors Associated With Truck Crashes in a Large Cross Section of Commercial Motor Vehicle Drivers. J Occup Environ Med 2015; 57:1098-106. [DOI: 10.1097/jom.0000000000000503] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bao SS, Kapellusch JM, Merryweather AS, Thiese MS, Garg A, Hegmann KT, Silverstein BA. Relationships between job organisational factors, biomechanical and psychosocial exposures. ERGONOMICS 2015; 59:179-194. [PMID: 26102483 DOI: 10.1080/00140139.2015.1065347] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/17/2015] [Indexed: 06/04/2023]
Abstract
UNLABELLED The relationships between work organisational, biomechanical and psychosocial factors were studied using cross-sectional data from a pooled dataset of 1834 participants. The work organisational factors included: job rotation, overtime work, having second jobs and work pace. Task and job level biomechanical variables were obtained through sub-task data collected in the field or analysed in the laboratory. Psychosocial variables were collected based on responses to 10 questions. The results showed that job rotations had significant effects on all biomechanical and most psychosocial measures. Those with job rotations generally had higher job biomechanical stressors, and lower job satisfaction. Overtime work was associated with higher job biomechanical stressors, and possibly self-reported physical exhaustion. Those having second jobs reported getting along with co-workers well. Work pace had significant influences on all biomechanical stressors, but its impact on job biomechanical stressors and psychosocial effects are complicated. PRACTITIONER SUMMARY The findings are based on a large number of subjects collected by three research teams in diverse US workplaces. Job rotation practices used in many workplaces may not be effective in reducing job biomechanical stressors for work-related musculoskeletal disorders. Overtime work is also associated with higher biomechanical stressors.
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Affiliation(s)
- Stephen S Bao
- a Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries , Olympia , USA
| | - Jay M Kapellusch
- b Department of Occupational Science & Technology , University of Wisconsin-Milwaukee , Milwaukee , USA
| | - Andrew S Merryweather
- c Department of Mechanical Engineering , University of Utah , Salt Lake City , Utah , USA
| | - Matthew S Thiese
- d Rocky Mountain Center for Occupational and Environmental Health (RMCOEH) , University of Utah , Salt Lake City , Utah , USA
| | - Arun Garg
- b Department of Occupational Science & Technology , University of Wisconsin-Milwaukee , Milwaukee , USA
| | - Kurt T Hegmann
- d Rocky Mountain Center for Occupational and Environmental Health (RMCOEH) , University of Utah , Salt Lake City , Utah , USA
| | - Barbara A Silverstein
- a Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries , Olympia , USA
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Predictors Associated With Changes of Weight and Total Cholesterol Among Two Occupational Cohorts Over 10 Years. J Occup Environ Med 2015; 57:743-50. [PMID: 26147542 DOI: 10.1097/jom.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To ascertain worker health characteristics and psychosocial factors associated with changes in body weight and total cholesterol (TC) among two production operation populations. METHODS We performed descriptive and predictive analysis of questionnaire data and biomedical measurements from two prospective cohort studies. Our key outcomes were changes in weight, and TC over 5 to 10 years between baseline and exit assessments. RESULTS A total of 146 subjects were analyzed. Increases in weight were associated with belief in being overweight and baseline overweight and obesity. Increases in TC levels were associated with female sex, belief that TC levels were "not good," and feeling depressed. CONCLUSIONS Most of the reported associations with increases in weight and TC levels are amenable to interventions and may be a target for workplace intervention programs.
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Bao SS, Kapellusch JM, Garg A, Silverstein BA, Harris-Adamson C, Burt SE, Dale AM, Evanoff BA, Gerr FE, Hegmann KT, Merlino LA, Thiese MS, Rempel DM. Developing a pooled job physical exposure data set from multiple independent studies: an example of a consortium study of carpal tunnel syndrome. Occup Environ Med 2014; 72:130-7. [PMID: 25504866 DOI: 10.1136/oemed-2014-102396] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Six research groups independently conducted prospective studies of carpal tunnel syndrome (CTS) incidence in 54 US workplaces in 10 US States. Physical exposure variables were collected by all research groups at the individual worker level. Data from these research groups were pooled to increase the exposure spectrum and statistical power. OBJECTIVE This paper provides a detailed description of the characteristics of the pooled physical exposure variables and the source data information from the individual research studies. METHODS Physical exposure data were inspected and prepared by each of the individual research studies according to detailed instructions provided by an exposure subcommittee of the research consortium. Descriptive analyses were performed on the pooled physical exposure data set. Correlation analyses were performed among exposure variables estimating similar exposure aspects. RESULTS At baseline, there were a total of 3010 participants in the pooled physical exposure data set. Overall, the pooled data meaningfully increased the spectra of most exposure variables. The increased spectra were due to the wider range in exposure data of different jobs provided by the research studies. The correlations between variables estimating similar exposure aspects showed different patterns among data provided by the research studies. CONCLUSIONS The increased spectra of the physical exposure variables among the data pooled likely improved the possibility of detecting potential associations between these physical exposure variables and CTS incidence. It is also recognised that methods need to be developed for general use by all researchers for standardisation of physical exposure variable definition, data collection, processing and reduction.
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Affiliation(s)
- Stephen S Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
| | - Jay M Kapellusch
- Department of Occupational Science & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Arun Garg
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Barbara A Silverstein
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
| | | | - Susan E Burt
- Formerly Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - Ann Marie Dale
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bradley A Evanoff
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Frederic E Gerr
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
| | - Linda A Merlino
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
| | - David M Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, California, USA
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Thiese MS, Gerr F, Hegmann KT, Harris-Adamson C, Dale AM, Evanoff B, Eisen EA, Kapellusch J, Garg A, Burt S, Bao S, Silverstein B, Merlino L, Rempel D. Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort. Arch Phys Med Rehabil 2014; 95:2320-6. [PMID: 25175160 DOI: 10.1016/j.apmr.2014.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To analyze differences in carpal tunnel syndrome (CTS) prevalence using a combination of electrodiagnostic studies (EDSs) and symptoms using EDS criteria varied across a range of cutpoints and compared with symptoms in both ≥1 and ≥2 median nerve-served digits. DESIGN Pooled data from 5 prospective cohorts. SETTING Hand-intensive industrial settings, including manufacturing, assembly, production, service, construction, and health care. PARTICIPANTS Employed, working-age participants who are able to provide consent and undergo EDS testing (N=3130). INTERVENTIONS None. MAIN OUTCOME MEASURES CTS prevalence was estimated while varying the thresholds for median sensory latency, median motor latency, and transcarpal delta latency difference. EDS criteria examined included the following: median sensory latency of 3.3 to 4.1 milliseconds, median motor latency of 4.1 to 4.9 milliseconds, and median-ulnar sensory difference of 0.4 to 1.2 milliseconds. EDS criteria were combined with symptoms in ≥1 or ≥2 median nerve-served digits. EDS criteria from other published studies were applied to allow for comparison. RESULTS CTS prevalence ranged from 6.3% to 11.7%. CTS prevalence estimates changed most per millisecond of sensory latency compared with motor latency or transcarpal delta. CTS prevalence decreased by 0.9% to 2.0% if the criteria required symptoms in 2 digits instead of 1. CONCLUSIONS There are meaningful differences in CTS prevalence when different EDS criteria are applied. The digital sensory latency criteria result in the largest variance in prevalence.
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Affiliation(s)
- Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT.
| | - Fred Gerr
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT
| | | | - Ann Marie Dale
- Division of General Medical Science, Washington University School of Medicine, Saint Louis, MO
| | - Bradley Evanoff
- Division of General Medical Science, Washington University School of Medicine, Saint Louis, MO
| | - Ellen A Eisen
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, CA
| | - Jay Kapellusch
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Arun Garg
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Susan Burt
- National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention Program, Washington State Department of Labor and Industries, Olympia, WA
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention Program, Washington State Department of Labor and Industries, Olympia, WA
| | - Linda Merlino
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, IA
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California at San Francisco, San Francisco, CA
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Thiese MS, Hegmann KT, Wood EM, Garg A, Moore JS, Kapellusch J, Foster J, Ott U. Prevalence of low back pain by anatomic location and intensity in an occupational population. BMC Musculoskelet Disord 2014; 15:283. [PMID: 25146722 PMCID: PMC4153910 DOI: 10.1186/1471-2474-15-283] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/15/2014] [Indexed: 01/07/2023] Open
Abstract
Background Low Back Pain (LBP) is a common and costly problem, with variation in prevalence. Epidemiological reports of rating of pain intensity and location within the low back area are rare. The objective is to describe LBP in a large, multi-center, occupational cohort detailing both point and 1-month period prevalence of LBP by location and intensity measures at baseline. Methods In this cross-sectional report from a prospective cohort study, 828 participants were workers enrolled from 30 facilities performing a variety of manual material handling tasks. All participants underwent a structured interview detailing pain rating and location. Symptoms in the lower extremities, demographic and other data were collected. Body mass indices were measured. Outcomes are pain rating (0–10) in five defined lumbar back areas (i) LBP in the past month and (ii) LBP on the day of enrollment. Pain ratings were reported on a 0–10 scale and subsequently collapsed with ratings of 1–3, 4–6 and 7–10 classified as low, medium and high respectively. Results 172 (20.8%) and 364 (44.0%) of the 828 participants reported pain on the day of enrollment or within the past month, respectively. The most common area of LBP was in the immediate paraspinal area with 130 (75.6%) participants with point prevalence LBP and 278 (77.4%) with 1-month period prevalence reported having LBP in the immediate paraspinal area. Among those 364 reporting 1-month period prevalence pain, ratings varied widely with 116 (31.9%) reporting ratings classified as low, 170 (46.7%) medium and 78 (21.4%) providing high pain ratings in any location. Among the 278 reporting 1-month period prevalence pain in the immediate paraspinal area, 89 (32.0%) reported ratings classified as low, 129 (46.4%), medium and 60 (21.6%) high pain ratings. Conclusions Pain ratings varied widely, however less variability was seen in pain location, with immediate paraspinal region being the most common. Variations may suggest different etiological factors related to LBP. Aggregation of different locations of pain or different intensities of pain into one binary classification of LBP may result in loss of information which may potentially be useful in prevention or treatment of LBP. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-283) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthew S Thiese
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational & Environment Health, School of Medicine, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT 84108, USA.
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Garg A, Kapellusch JM, Hegmann KT, Thiese MS, Merryweather AS, Wang YC, Malloy EJ. The strain index and TLV for HAL: risk of lateral epicondylitis in a prospective cohort. Am J Ind Med 2014; 57:286-302. [PMID: 24243166 DOI: 10.1002/ajim.22279] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study's objective was to quantify exposure-response relationships between job physical exposure (JPE) and incidence of lateral epicondylitis (LE). METHODS A cohort of 536 workers was enrolled from 10 manufacturing facilities and followed monthly for 6 years to ascertain changes in JPE and health status. JPE was individually measured and quantified using the Strain Index (SI) and TLV for HAL. Worker demographics, medical history, psychosocial factors, and current musculoskeletal disorders were obtained. RESULTS Fifty-six workers developed LE. In multivariate models JPE, age, family problems, and swimming were associated with increased risk of LE. SI showed an exposure-response relationship with maximum hazard ratio (HR) of 4.5(P = 0.04). TLV for HAL showed a non-statistically significant trend for increased risk of LE (P = 0.19). CONCLUSION JPE is associated with increased risk of LE. The SI and TLV for HAL are useful metrics for estimating JPE.
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Affiliation(s)
- Arun Garg
- Department of Occupational Science & Technology; University of Wisconsin-Milwaukee; Milwaukee Wisconsin
| | - Jay M. Kapellusch
- Department of Occupational Science & Technology; University of Wisconsin-Milwaukee; Milwaukee Wisconsin
| | - Kurt T. Hegmann
- Rocky Mountain Center for Occupational & Environmental Health, Department of Family and Preventive Medicine; University of Utah; Salt Lake City Utah
| | - Matthew S. Thiese
- Rocky Mountain Center for Occupational & Environmental Health, Department of Family and Preventive Medicine; University of Utah; Salt Lake City Utah
| | - Andrew S. Merryweather
- Rocky Mountain Center for Occupational & Environmental Health, Department of Family and Preventive Medicine; University of Utah; Salt Lake City Utah
| | - Ying-Chih Wang
- Department of Occupational Science & Technology; University of Wisconsin-Milwaukee; Milwaukee Wisconsin
| | - Elizabeth J. Malloy
- Department of Mathematics & Statistics; American University; Washington District of Columbia
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Hegmann KT, Thiese MS, Wood EM, Garg A, Kapellusch JM, Foster J, Biggs J, Edwards H, Wertsch J, Kendall R. Impacts of differences in epidemiological case definitions on prevalence for upper-extremity musculoskeletal disorders. HUMAN FACTORS 2014; 56:191-202. [PMID: 24669553 DOI: 10.1177/0018720813487202] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of this study was to systematically evaluate prevalence based on variations in case definitions used for epidemiological studies of musculoskeletal disorders (MSDs). BACKGROUND Prior studies of MSDs have mostly relied on a single case definition based on questionnaires. METHOD In a multicenter prospective cohort study, we systematically collected data to evaluate impacts of differences in case definitions of MSDs on prevalence of three common musculoskeletal disorders: (a) shoulder tendinosis, (b) lateral epicondylalgia, and (c) carpal tunnel syndrome. Production workers were from 21 employment settings in three diverse U.S. states and performed widely varying work. All workers completed laptop-administered structured interviews, two standardized physical examinations, and nerve conduction studies (NCS). Case definitions included symptoms only, and symptoms plus physical examinations and/or NCS. RESULTS A total of 1,227 subjects had complete health data at baseline. The prevalence for shoulder tendinosis is 23.0% if only glenohumeral pain is used for a case definition, compared with 8.0% if a combination of pain plus a positive supraspinatus test is used. The prevalence for lateral epicondylalgia varied on the basis of lateral elbow pain (12.0%), pain plus tenderness on palpation (9.9%), or pain plus tenderness on palpation plus resisted wrist or middle finger extension (3.5%). Carpal tunnel syndrome prevalence varied on the basis of tingling or numbness in a median nerve-served digit (29.9%) or tingling or numbness plus NCS abnormalities consistent with carpal tunnel syndrome (9.0%). CONCLUSION Variations in epidemiological case definitions have major impacts on prevalence of common MSDs. Wide-ranging differences in prevalence may have impacts on purported risk factors that need to be determined.
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Kapellusch JM, Garg A, Hegmann KT, Thiese MS, Malloy EJ. The Strain Index and ACGIH TLV for HAL: risk of trigger digit in the WISTAH prospective cohort. HUMAN FACTORS 2014; 56:98-111. [PMID: 24669546 DOI: 10.1177/0018720813493115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the association between job physical exposure (JPE) and incidence of flexor tendon entrapment of the digits (FTED). BACKGROUND FTED, commonly known as trigger digit, is associated with age, gender, and certain health disorders. Although JPE has been suggested as a risk factor for FTED, there are no prospective cohort studies. METHOD A cohort of 516 workers was enrolled from 10 diverse manufacturing facilities and followed monthly for 6 years. Worker demographics, medical history, and symptoms of FTED were assessed. JPE was individually measured using the Strain Index (SI) and American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value for hand activity level (TLV for HAL). Changes in JPE (assessed quarterly) and symptoms (assessed monthly) were recorded during follow-up. FTED was defined as demonstrated triggering on examination. RESULTS Point prevalence of FTED at baseline was 3.6%. During follow-up there were 23 incident FTED cases (left and/or right hands). The incident rate for first occurrence of FTED from enrollment was 1.38 per 100 person-years. Risk factors were JPE, age, gender, diabetes mellitus, carpometacarpal osteoarthrosis, and rheumatoid arthritis. In multivariate models, the SI showed strong association with risk of FTED when treated as a continuous variable and marginal association when dichotomized (SI > 6.1). TLV for HAL showed a statistical trend of increasing risk of FTED using the ACGIH limits, but no association as a continuous variable. CONCLUSIONS Both JPE and personal risk factors are associated with FTED development. The SI and TLV for HAL are useful tools for estimating JPE.
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Dale AM, Harris-Adamson C, Rempel D, Gerr F, Hegmann K, Silverstein B, Burt S, Garg A, Kapellusch J, Merlino L, Thiese MS, Eisen EA, Evanoff B. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health 2013; 39:495-505. [PMID: 23423472 DOI: 10.5271/sjweh.3351] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Most studies of carpal tunnel syndrome (CTS) incidence and prevalence among workers have been limited by small sample sizes or restricted to a small subset of jobs. We established a common CTS case definition and then pooled CTS prevalence and incidence data across six prospective studies of musculoskeletal outcomes to measure CTS frequency and allow better studies of etiology. METHODS Six research groups collected prospective data at > 50 workplaces including symptoms characteristic of CTS and electrodiagnostic studies (EDS) of the median and ulnar nerves across the dominant wrist. While study designs and the timing of data collection varied across groups, we were able to create a common CTS case definition incorporating both symptoms and EDS results from data that were collected in all studies. RESULTS At the time of enrollment, 7.8% of 4321 subjects met our case definition and were considered prevalent cases of CTS. During 8833 person-years of follow-up, an additional 204 subjects met the CTS case definition for an overall incidence rate of 2.3 CTS cases per 100 person-years. CONCLUSIONS Both prevalent and incident CTS were common in data pooled across multiple studies and sites. The large number of incident cases in this prospective study provides adequate power for future exposure-response analyses to identify work- and non-work-related risk factors for CTS. The prospective nature allows determination of the temporal relations necessary for causal inference.
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Affiliation(s)
- Ann Marie Dale
- Division of General Medical Science, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8005, St Louis, MO 63110, USA.
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Kapellusch JM, Garg A, Bao SS, Silverstein BA, Burt SE, Dale AM, Evanoff BA, Gerr FE, Harris-Adamson C, Hegmann KT, Merlino LA, Rempel DM. Pooling job physical exposure data from multiple independent studies in a consortium study of carpal tunnel syndrome. ERGONOMICS 2013; 56:1021-37. [PMID: 23697792 PMCID: PMC4557727 DOI: 10.1080/00140139.2013.797112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
UNLABELLED Pooling data from different epidemiological studies of musculoskeletal disorders (MSDs) is necessary to improve statistical power and to more precisely quantify exposure-response relationships for MSDs. The pooling process is difficult and time-consuming, and small methodological differences could lead to different exposure-response relationships. A sub-committee of a six-study research consortium studying carpal tunnel syndrome: (i) visited each study site, (ii) documented methods used to collect physical exposure data and (iii) determined compatibility of exposure variables across studies. Certain measures of force, frequency of exertion and duty cycle were collected by all studies and were largely compatible. A portion of studies had detailed data to investigate simultaneous combinations of force, frequency and duration of exertions. Limited compatibility was found for hand/wrist posture. Only two studies could calculate compatible Strain Index scores, but Threshold Limit Value for Hand Activity Level could be determined for all studies. Challenges of pooling data, resources required and recommendations for future researchers are discussed. PRACTITIONER SUMMARY There is a need for standardised measures and measurement protocols of physical exposure for the upper extremity. This study may provide guidance for those planning to conduct an epidemiological study on quantified job physical exposures, or planning to merge physical exposure data from similar studies with some methodologic differences.
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Affiliation(s)
- Jay M Kapellusch
- Department of Occupational Science & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
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