Lincoln A E, Vernick J S, Ogaitis S, Smith G S, Mitchell C S, Agnew J
Center for Injury Research and Policy, Department of Health Policy and Management, The John's Hopkins School of Public Health, Baltimore, MD 21205-1996, USA.
Am J Prev Med. 2000 May;18(4 Suppl):37-50. doi: 10.1016/s0749-3797(00)00140-9.
To evaluate interventions for the primary prevention of work-related carpal tunnel syndrome (CTS).
Studies had to include an engineering, administrative, personal, or multiple component intervention applied to a working or working-age population. All study designs that included comparison data were considered. Outcome measures included the incidence, symptoms, or risk factors for CTS, or a work-related musculoskeletal disorder of the upper extremity that included CTS in the definition.
Twenty-four studies met our inclusion criteria. Engineering interventions included alternative keyboards, computer mouse designs and wrist supports, keyboard support systems, and tool redesign. Personal interventions included ergonomics training, splint wearing, electromyographic biofeedback, and on-the-job exercise programs. Multiple component interventions (e.g., ergonomic programs) included workstation redesign, establishment of an ergonomics task force, job rotation, ergonomics training, and restricted duty provisions. Multiple component programs were associated with reduced incidence rates of CTS, but the results are inconclusive because they did not adequately control for potential confounders. Several engineering interventions positively influenced risk factors associated with CTS, but the evaluations did not measure disease incidence. None of the personal interventions alone was associated with significant changes in symptoms or risk factors. All of the studies had important methodologic limitations that may affect the validity of the results.
While results from several studies suggest that multiple component ergonomics programs, alternative keyboard supports, and mouse and tool redesign may be beneficial, none of the studies conclusively demonstrates that the interventions would result in the primary prevention of carpal tunnel syndrome in a working population. Given the societal impact of CTS, the growing number of commercial remedies, and their lack of demonstrated effec- tiveness, the need for more rigorous and long-term evaluation of interventions is clear. Fund- ing for intervention research should prioritize randomized controlled trials that include: (1) adequate sample size, (2) adjustment for relevant confounding variables, (3) isolation of speci- fic program elements, and (4) measurement of long-term primary outcomes such as the inci- dence of CTS, and secondary outcomes such as employment status and cost.
评估工作相关腕管综合征（CTS）一级预防的干预措施。
研究必须包括应用于工作人群或工作年龄人群的工程学、管理、个人或多成分干预措施。考虑所有包含对照数据的研究设计。结局指标包括CTS的发病率、症状或危险因素，或定义中包含CTS的上肢工作相关肌肉骨骼疾病。
24项研究符合我们的纳入标准。工程学干预措施包括替代键盘、电脑鼠标设计和手腕支撑、键盘支撑系统以及工具重新设计。个人干预措施包括人体工程学培训、佩戴夹板、肌电图生物反馈和在职锻炼计划。多成分干预措施（如人体工程学计划）包括工作站重新设计、成立人体工程学特别工作组、工作轮换、人体工程学培训和限制工作规定。多成分计划与CTS发病率降低相关，但结果尚无定论，因为它们没有充分控制潜在混杂因素。几种工程学干预措施对与CTS相关的危险因素产生了积极影响，但评估未测量疾病发病率。单独的个人干预措施均未与症状或危险因素的显著变化相关。所有研究都有重要的方法学局限性，可能影响结果的有效性。
虽然几项研究的结果表明，多成分人体工程学计划、替代键盘支撑以及鼠标和工具重新设计可能有益，但没有一项研究能确凿证明这些干预措施会在工作人群中实现腕管综合征的一级预防。鉴于CTS的社会影响、商业治疗方法的不断增加以及它们缺乏已证实的有效性，显然需要对干预措施进行更严格和长期的评估。干预研究的资金应优先用于随机对照试验，这些试验应包括：（1）足够的样本量，（2）对相关混杂变量进行调整，（3）分离特定的计划要素，以及（4）测量长期主要结局，如CTS的发病率，和次要结局，如就业状况和成本。
