Harris-Adamson Carisa, Eisen Ellen A, Neophytou Andreas, Kapellusch Jay, Garg Arun, Hegmann Kurt T, Thiese Matthew S, Dale Ann Marie, Evanoff Bradley, Bao Stephen, Silverstein Barbara, Gerr Fred, Burt Susan, Rempel David
Division of Occupational and Environmental Medicine, University of California, San Francisco, San Francisco, California, USA Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA.
Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA.
Occup Environ Med. 2016 Nov;73(11):727-734. doi: 10.1136/oemed-2016-103634. Epub 2016 Jul 27.
Between 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure-response relationships.
This analysis examined the presence and magnitude of confounding between biomechanical and workplace psychosocial factors and incidence of dominant-hand CTS.
1605 participants, without CTS at enrolment, were followed for up to 3.5 years (2471 person-years). Demographic information, medical history and workplace psychosocial stress measures were collected at baseline. Individual workplace biomechanical exposures were collected for each task and combined across the workweek using time-weighted averaging (TWA). CTS case criteria were based on symptoms and results of electrophysiological testing. HRs were estimated with Cox proportional hazard models. Confounding was assessed using causal diagrams and an empirical criterion of 10% or greater change in effect estimate magnitude.
There were 109 incident CTS cases (IR=4.41/100 person-years; 6.7% cumulative incidence). The relationships between CTS and forceful repetition rate, % time forceful hand exertion and the Threshold Limit Value for Hand Activity Level (TLV-HAL) were slightly confounded by decision latitude with effect estimates being attenuated towards the null (10-14% change) after adjustment. The risk of CTS among participants reporting high job strain was attenuated towards the null by 14% after adjusting for the HAL Scale or the % time forceful hand exertions.
Although attenuation of the relationships between CTS and some biomechanical and work psychosocial exposures was observed after adjusting for confounding, the magnitudes were small and confirmed biomechanical and work psychosocial exposures as independent risk factors for incident CTS.
2001年至2010年间，六个研究小组对美国不同行业工人的腕管综合征（CTS）发病率进行了协同前瞻性研究，以估计暴露-反应关系。
本分析研究了生物力学和工作场所心理社会因素之间混杂的存在情况及其程度，以及优势手CTS的发病率。
1605名入组时无CTS的参与者被随访长达3.5年（2471人年）。在基线时收集人口统计学信息、病史和工作场所心理社会压力指标。针对每项任务收集个体工作场所生物力学暴露情况，并使用时间加权平均法（TWA）在整个工作周进行汇总。CTS病例标准基于症状和电生理测试结果。使用Cox比例风险模型估计风险比（HRs）。使用因果图和效应估计量变化10%或更大的经验标准评估混杂情况。
有109例CTS新发病例（发病率=4.41/100人年；累积发病率6.7%）。CTS与用力重复率、用力手部 exertion的时间百分比以及手部活动水平阈限值（TLV-HAL）之间的关系因决策自由度而略有混杂，调整后效应估计值向无效值衰减（变化10-14%）。在调整HAL量表或用力手部exertion的时间百分比后，报告高工作压力的参与者中CTS风险向无效值衰减了14%。
尽管在调整混杂因素后观察到CTS与一些生物力学和工作心理社会暴露之间的关系有所衰减，但幅度较小，并证实生物力学和工作心理社会暴露是CTS新发的独立危险因素。
