ABSTRACT
AIM: The expert committee of the German Ministry for Labour and Social Affairs suggested carpal tunnel syndrome (CTS) as an "occupational disease". This systematic literature review and metaanalysis was aimed at identifying associated and risk factors for CTS. Part I addresses the general factors and possible concurrent factors of CTS. These results may be helpful in later experts' reviews of the "occupational disease CTS". METHODS: A systematic literature review was performed by examining papers in PubMed, Cochrane, EMBASE and Web of Science databases that were published on or before February 15th, 2011. A total of 87 studies (27 longitudinal and 60 cross-sectional) were included in this metaanalysis. The PRISMA (preferred reporting items for systematic reviews and metaanalyses) guidelines for performing a metaanalysis were strictly followed. All of the effect sizes were calculated using a random effects model. RESULTS: The CTS prevalence in all studies independent of study type was 10.6â% (95â% CI 7.8-14.2). The crude incidence calculated from the longitudinal studies was 10.4 (95â% CI 8.9-11.9)/1000 person years. Female patients more frequently suffered from CTS [OR = 1.9 (95â% CI 1.6-2.2), p < 0.001]. The prevalence of CTS was correlated with an increase in age. The highest prevalence was observed in middle-aged patients (40 to 60 years old). Other significant CTS-associated factors were overweight or obesity [OR = 1.4 (95â% CI 1.3-1.6), p < 0.001]. CTS more frequently occurred in the dominant hand [OR = 1.8 (95â% CI 1.4-2.3), p < 0.001] and in persons of "non-white race" [OR = 1.6 (95â% CI 1.2-1.9), p < 0.001]. Furthermore, CTS was often associated with numerous other general diseases. Real risk factors (results from longitudinal studies) were the following: female gender [OR = 3.7 (95â% CI 2.6-5.2), p < 0.001], middle age [OR = 2.2 (95â% CI 0.9-4.9), p < 0.001], overweight or obesity [OR = 1.5 (95â% CI 1.1-1.9), p < 0.001], diabetes mellitus [OR = 5.3 (95â% CI 1.6-16.8), p < 0.001], and excessive alcohol abuse [OR = 2.3 (95â% CI 0.7-2.3), p < 0.001]. CONCLUSION: CTS is an extremely frequent disease. Independent of occupational burden, many patients are suffering from this frequent peripheral nervous compressive syndrome. These data will be essential in later experts' reviews of the "occupational disease CTS".
Subject(s)
Carpal Tunnel Syndrome/epidemiology , Obesity/epidemiology , Age Distribution , Comorbidity , Female , Humans , Male , Prevalence , Risk Factors , Sex DistributionABSTRACT
AIM: The expert committee of the German Ministry for Labour and Social Affairs suggested carpal tunnel syndrome (CTS) as an "occupational disease". This systematic literature review and metaanalysis was aimed at identifying associated and risk factors for CTS. Part II addresses the occupational factors of CTS. MATERIAL AND METHOD: A systematic literature review was performed by examining papers in PubMed, Cochrane, EMBASE and Web of Science databases that were published on or before February 15th, 2011. A total of 87 studies (27 longitudinal and 60 cross-sectional) were included in this metaanalysis. The PRISMA (preferred reporting items for systematic reviews and metaanalyses) guidelines for performing a metaanalysis were strictly followed. All of the effect sizes were calculated using a random-effects model. RESULTS: The prevalence of CTS in working populations [10.9â% (95â% CI 7.9-14â:â9)] was significantly higher than in the general population [8.2â% (95â% CI 2.3-25.1), p < 0.001]. Working people had a CTS incidence of 17.3 (95â% CI 14.5-20.1)/1,000 person years. In contrast, the crude incidence in the general population was 1.8 (95â% CI 1.4-2.2)/1.000 person years (p < 0.001). The heterogeneity of the different study designs made it impossible to detect concrete prevalence or incidence rates for specific job groups. However, "blue-collar work" was a significant risk factor for CTS [OR = 3.1 (95â% CI 1.9-5.3), p < 0.001]. Thus, it makes sense to evaluate concrete hand burdens. In numerous studies, some factors were associated with CTS: repetition [OR = 2.7 (95â% CI 1.8-39), p < 0.001), chronic wrist flexion [OR = 1.7 (95â% CI 1.0-2.6), p = 0.033], powerful grip [OR = 4.4 (95â% CI 1.4-13.6), p = 0.009], and chronic vibration load [OR = 2.6 (95â% CI 1.7-4.0)]. Primarily, combined hand loadings were estimated. For this evaluation, the hand activity level threshold limit values (HAL TLVs®) of the ACGIH (American Conference of Governmental Hygienists) were useful. Manual work in the 4th quartile of this score was significantly associated with the prevalence of CTS [OR = 2.9 (95â% CI 1.5-5.7), p = 0.001]. These score values were identified as a significant risk factor for occupational CTS. CONCLUSION: It was impossible to define exact prevalences or incidences of CTS for specific job titles. However, it was possible to identify manual loadings with a significantly higher risk or association with CTS, including repetition, wrist flexion, powerful grip, and vibration. These loadings are usually combined during occupational work. Subsequent experts' reviews have to respect these complex hand loadings. It may be useful to use instruments, such as HAL TLVs®.
Subject(s)
Carpal Tunnel Syndrome/epidemiology , Obesity/epidemiology , Occupational Diseases/epidemiology , Workload , Age Distribution , Comorbidity , Employment/statistics & numerical data , Female , Humans , Male , Prevalence , Risk Factors , Sex DistributionABSTRACT
The applications for care in a nursing home, proposed by patients in hospitals, should be judged promptly. Judgements based on specifications compiled by the hospital social service are compared to the results of direct examination of the patient in hospital; 96% agreement regarding need for care, 91% agreement regarding necessity of care in a nursing home. We found in 35% a variation in care rank between both methods. In 52% of cases there was no need for a further examination; the care rank was estimated as definite.
