Carpal tunnel syndrome and its relationship to occupation: a meta-analysis.

OBJECTIVE: To examine the association between work place exposure and CTS by meta-analysis, including analyses with respect to exposure to hand force, repetition, vibration and wrist posture. METHODS: All relevant peer-reviewed articles published between January 1980 and December 2009 were identified by a systematic search using the MEDLINE, CINAHL and PubMed databases. Papers were critiqued independently by two researchers and the relevant exposure information was extracted. Using the raw data of exposed and unexposed cases, a cumulative effect of specific exposure risks were calculated for hand force, repetition, a combination of force and repetition, vibration and wrist posture using the statistical program, Stata version 11 (StataCorp, College Station, TX, USA). Heterogeneity, meta-regression, publication bias and subgroup sensitivity analyses were performed. RESULTS: Thirty-seven studies from English-language literature met the inclusion criteria. Using National Institute for Occupational Health and Safety criteria for case definition, a significant positive association between CTS and hand force, repetition, use of vibratory tools and wrist posture was observed with approximate doubling of risk for all exposures. Significant heterogeneity among studies was observed for most exposures and metaregression analyses identified CTS case definition, study design, country and risk of bias score to be the significant determinants. When a more conservative definition of CTS was employed to include nerve conduction abnormality with symptoms and/or signs, risk factors significantly associated with an increased risk of CTS among exposed workers were: vibration [odds ratio (OR) 5.40; 95% CI 3.14, 9.31], hand force (OR 4.23; 95% CI 1.53, 11.68) and repetition (OR 2.26; 95% CI 1.73, 2.94). There was a non-significant trend for the association between CTS and combined exposure to both force and repetition (OR 1.85; 95% CI 0.99, 3.45) and wrist posture (OR 4.73; 95% CI 0.42, 53.32). CONCLUSION: Occupational exposure to excess vibration, increased hand force and repetition increase the risk of developing CTS. Workplace strategies to avoid overexposure to these risk factors should be implemented.

Patient expectations of hip and knee joint replacement surgery and postoperative health status.

OBJECTIVE: To explore the relationship between preoperative patient expectations and postoperative health status in patients undergoing joint replacement surgery, with particular emphasis on the types of expectations held by patients. METHODS: Respondents completed the Hospital for Special Surgery (HSS) Hip/Knee Replacement Expectations Questionnaires pre-surgery, in addition to the Western Ontario and McMaster Osteoarthritis Index (WOMAC™) and the Short-Form 36-Item (SF-36) Health Survey and the Arthritis Self-Efficacy Scale. The WOMAC™ Index and SF-36 were also completed 3 and 6 months post-surgery. RESULTS: A total of 106 patients (total hip replacement [THR] = 28; total knee replacement [TKR] = 78) completed questionnaires. No differences were seen in overall expectations between males and females or older or younger patients, although some differences between the age groups were seen for individual expectations on the HSS expectations questionnaires. For THR, a higher rating of the importance of expectations was correlated with a lesser improvement in pain from pre-surgery to 3 months post-surgery, whereas for TKR, a higher rating of expectations was associated with a greater improvement in function to 6 months post-surgery. CONCLUSIONS: Patients have high expectations of surgery, which are correlated with post-surgery pain and function. Identifying the broad range of expectations may be helpful in preparation for surgery and gaining greater satisfaction with outcomes.

Association Between Measures of Fatigue and Health-Related Quality of Life in Rheumatoid Arthritis and Osteoarthritis.

OBJECTIVE: To assess the relationship between fatigue and health-related quality of life (HR-QOL) among people with osteoarthritis (OA) and rheumatoid arthritis (RA). METHODS: Community-dwelling people with OA, and OA patients on the waiting list for joint replacement surgery, were recruited. RA patients were recruited from rheumatologists' public and private outpatient clinics. Respondents completed a questionnaire containing demographic detail, the Fatigue Severity Scale (FSS), the Multidimensional Assessment of Fatigue (MAF), the SF-36, Western Ontario and McMaster Universities Osteoarthritis Index, and the Health Assessment Questionnaire (HAQ). RESULTS: There were 137 OA and 52 RA respondents. Neither age nor sex was significantly associated with fatigue for OA or RA. The mean FSS score was 3.36 for RA and 3.63 for OA. Fifty percent of respondents with RA and 58% of those with OA met the FSS >3 cut-point for fatigue. Mean MAF Global Fatigue Index was 20.8 for OA and 20.1 for RA. Correlations between health status and fatigue indicated that for both OA and RA those with greater fatigue reported worse health status. CONCLUSIONS: Few studies have measured the impact of fatigue among respondents with OA, despite it affecting a large proportion of the population. Fatigue was significantly correlated with poorer HR-QOL among OA respondents, suggesting that fatigue is a significant issue in OA as well as RA.