Developing a pooled job physical exposure data set from multiple independent studies: an example of a consortium study of carpal tunnel syndrome.

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.

Exposure-response relationships for the ACGIH threshold limit value for hand-activity level: results from a pooled data study of carpal tunnel syndrome.

OBJECTIVES: This paper aimed to quantify exposure-response relationships between the American Conference of Governmental Industrial Hygienists' (ACGIH) threshold limit value (TLV) for hand-activity level (HAL) and incidence of carpal tunnel syndrome (CTS). METHODS: Manufacturing and service workers previously studied by six research institutions had their data combined and re-analyzed. CTS cases were defined by symptoms and abnormal nerve conduction. Hazard ratios (HR) were calculated using proportional hazards regression after adjusting for age, gender, body mass index, and CTS predisposing conditions. RESULTS: The longitudinal study comprised 2751 incident-eligible workers, followed prospectively for up to 6.4 years and contributing 6243 person-years of data. Associations were found between CTS and TLV for HAL both as a continuous variable [HR 1.32 per unit, 95% confidence interval (95% CI) 1.11-1.57] and when categorized using the ACGIH action limit (AL) and TLV. Those between the AL and TLV and above the TLV had HR of 1.7 (95% CI 1.2-2.5) and 1.5 (95% CI 1.0-2.1), respectively. As independent variables (in the same adjusted model) the HR for peak force (PF) and HAL were 1.14 per unit (95% CI 1.05-1.25), and 1.04 per unit (95% CI 0.93-1.15), respectively. CONCLUSION: Those with exposures above the AL were at increased risk of CTS, but there was no further increase in risk for workers above the TLV. This suggests that the current AL may not be sufficiently protective of workers. Combinations of PF and HAL are useful for predicting risk of CTS.

Pooling job physical exposure data from multiple independent studies in a consortium study of carpal tunnel syndrome.

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.

National occupational research agenda (NORA) future directions in occupational musculoskeletal disorder health research.

Musculoskeletal disorders are among the most costly health care problems facing society today. The scientific literature has indicated that psychosocial factors, individual factors, workplace physical requirements, and workplace organizational factors have been associated with risk. Since musculoskeletal risk is multi-dimensional, the magnitude of risk attributable to various factors can be of importance to scientists and policy makers in designing countermeasures to reduce injury incidence. Traditionally, the disciplines of biomechanics, physiology, and psychophysics have dominated the body of knowledge that has defined exposure limitations to work. However, recent research has explored the association of psychosocial and work organization factors with musculoskeletal problems. Advances have been made to better quantify the levels of occupational exposure by improved exposure metrics, quantification of three-dimensional loads experienced by certain joints (e.g. the spine), identification of tissue tolerance limits and tissue response to mechanical stresses, and the impact of psychosocial stresses. However, efforts to quantitatively link epidemiological, biomechanical loading, soft tissue tolerance, and psychosocial studies should be pursued to establish a better understanding of the pathways of injury and resultant preventive strategies. Although we are beginning to understand how the major risk factors influence the load-tolerance relationship of human tissue, how these risk factors interact is virtually unexplored. Since the impact of the interactions may be far greater than that of any individual factor, the impact of the interactions between risk factors must be delineated so that work-related risk can be better quantified. Efforts to quantitatively link epidemiological, biomechanical loading, soft tissue tolerance, and psychosocial studies should be pursued to establish a better understanding of the pathways of injury and resultant preventive strategies.