La modélisation des risques de TMS

Les troubles musculosquelettiques (TMS) sont caractérisés par leur nature multifactorielle, l’environnement professionnel étant un facteur de risque prépondérant. L’objectif du projet "TeM(i)S-ESP" est de développer des modèles permettant de prendre en compte plusieurs niveaux innovants dans le domaine du risque professionnel (ex. biomécaniques, organisationnels, psychosociaux)

The effect of exposure to long working hours on stroke: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of individual experts. Evidence from mechanistic data and prior studies suggests that exposure to long working hours may cause stroke. In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of deaths and disability-adjusted life years from stroke that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on stroke (three outcomes: prevalence, incidence, and mortality). DATA SOURCES: A protocol was developed and published, applying the Navigation Guide to systematic reviews as an organizing framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including Ovid MEDLINE, PubMed, EMBASE, Scopus, Web of Science, CISDOC, PsycINFO, and WHO ICTRP. We also searched grey literature databases, Internet search engines, and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) individuals in the formal and informal economy in any WHO and/or ILO Member State but excluded children (aged \u3c 15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41-48, 49-54 and ≥55 h/week), compared with exposure to standard working hours (35-40 h/week), on stroke (prevalence, incidence or mortality). STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first review stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined relative risks using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using the Navigation Guide and GRADE tools and approaches adapted to this project. RESULTS: Twenty-two studies (20 cohort studies, 2 case-control studies) met the inclusion criteria, comprising a total of 839,680 participants (364,616 females) in eight countries from three WHO regions (Americas, Europe, and Western Pacific). The exposure was measured using self-reports in all studies, and the outcome was assessed with administrative health records (13 studies), self-reported physician diagnosis (7 studies), direct diagnosis by a physician (1 study) or during a medical interview (1 study). The outcome was defined as an incident non-fatal stroke event in nine studies (7 cohort studies, 2 case-control studies), incident fatal stroke event in one cohort study and incident non-fatal or fatal ( mixed ) event in 12 studies (all cohort studies). Cohort studies were judged to have a relatively low risk of bias; therefore, we prioritized evidence from these studies, but synthesised evidence from case-control studies as supporting evidence. For the bodies of evidence for both outcomes with any eligible studies (i.e. stroke incidence and mortality), we did not have serious concerns for risk of bias (at least for the cohort studies). Eligible studies were found on the effects of long working hours on stroke incidence and mortality, but not prevalence. Compared with working 35-40 h/week, we were uncertain about the effect on incidence of stroke due to working 41-48 h/week (relative risk (RR) 1.04, 95% confidence interval (CI) 0.94-1.14, 18 studies, 277,202 participants, I CONCLUSIONS: We judged the existing bodies of evidence for human evidence as inadequate evidence for harmfulness for all exposure categories for stroke prevalence and mortality and for exposure to 41-48 h/week for stroke incidence. Evidence on exposure to 48-54 h/week and ≥55 h/week was judged as limited evidence for harmfulness and sufficient evidence for harmfulness for stroke incidence, respectively. Producing estimates for the burden of stroke attributable to exposures to working 48-54 and ≥55 h/week appears evidence-based, and the pooled effect estimates presented in this systematic review could be used as input data for the WHO/ILO Joint Estimates. PROTOCOL IDENTIFIER: https://doi.org/10.1016/j.envint.2018.06.016. PROSPERO REGISTRATION NUMBER: CRD42017060124

Natural history and predictors of long-term pain and function among workers with hand symptoms

OBJECTIVE: To evaluate predictors of hand symptoms and functional impairment after three years of follow-up among workers with different types of hand symptoms including carpal tunnel syndrome (CTS). Functional status and job limitations were also analyzed as key secondary objectives. DESIGN: Cohort design of 3-years duration SETTING: Working population-based study PARTICIPANTS: 1107 newly employed workers without a pre-existing diagnosis of CTS. Subjects were categorized into four groups at baseline examination: no hand symptoms, any hand symptoms but not CTS (recurring symptoms in hands, wrist or fingers without neuropathic symptoms), any hand symptoms of CTS (neuropathic symptoms in the fingers and normal nerve conduction study), or confirmed CTS (CTS symptoms and abnormal nerve conduction study). Among workers with hand pain at baseline, subject and job characteristics were assessed as prognostic factors for outcomes, using bivariate and multivariate regression models. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: The primary outcome assessed by questionnaire at 3 years was “severe hand pain” in the past 30 days. RESULTS: At baseline, 155 workers (17.5% of 888 followed workers) reported hand symptoms, 21 had confirmed CTS. Presence of hand pain at baseline was a strong predictor of future hand pain and job impairment. Subjects with confirmed CTS at baseline were more likely to report severe hand pain, (adjusted prevalence ratios 1.98 [1.11 – 3.52]) and functional status impairment (adjusted prevalence ratios 3.37 [1.01 – 11.29]) than workers with other hand pain. Among subjects meeting our case definition for CTS at baseline, only 4 (19.1%) reported seeing a physician in the 3 year period. CONCLUSIONS: Hand symptoms persisted among many workers after 3 year follow-up, especially among those with CTS, yet few symptomatic workers had seen a physician

Natural history of upper extremity musculoskeletal symptoms and resulting work limitations over 3 years in a newly hired working population

OBJECTIVE: To describe the proportions of workers with upper extremity (UE) symptoms and work limitations due to symptoms in a newly hired working population over a 3-year study period and to describe transitions between various outcome states. METHODS: 827 subjects completed repeat self-reported questionnaires including demographics, medical and work history, symptoms and work status. Outcomes of interest were UE symptoms and work limitations due to symptoms. RESULTS: 72% of workers reported symptoms at least once during the study, with 12% reporting persistent symptoms and 27% reporting fluctuating symptoms. 31% reported work limitations at least once, with 3% reporting consistent work limitations and 8% reporting fluctuating limitations. CONCLUSIONS: UE symptoms and work limitations are common among workers and dynamic in their course. A better understanding of the natural course of symptoms is necessary for targeted interventions

Self-reported physical exposure association with medial and lateral epicondylitis incidence in a large longitudinal study

INTRODUCTION: Although previous studies have related occupational exposure and epicondylitis, the evidence is moderate, and mostly based on cross-sectional studies. Suspected physical exposures were tested over a three year period in a large longitudinal cohort study of workers in the United States. METHOD: In a population-based study including a variety of industries, 1107 newly employed workers were examined; only workers without elbow symptoms at baseline were included. Baseline questionnaires collected information on personal characteristics and self-reported physical work exposures and psychosocial measures for the current or most recent job at 6 months. Epicondylitis (lateral and medial) was the main outcome, assessed at 36 months based on symptoms and physical examination (palpation or provocation test). Logistic models included the most relevant associated variables. RESULTS: Of 699 workers tested after 36 months who did not have elbow symptoms at baseline, 48 suffered from medial or lateral epicondylitis (6.9%), with 34 cases of lateral epicondylitis (4.9%), 30 cases of medial epicondylitis (4.3%), and 16 workers who had both. After adjusting for age, lack of social support, and obesity, consistent associations were observed between self-reported wrist bending/twisting and forearm twisting/rotating/screwing motion and future cases of medial or lateral epicondylitis (odds ratios 2.8 [1.2;6.2] and 3.6 [1.2;11.0] respectively in men and women). CONCLUSION: Self-reported physical exposures that implicate repetitive and extensive/prolonged wrist bend/twisting and forearm movements were associated with incident cases of lateral and medial epicondylitis in a large longitudinal study, although other studies are needed to better specify the exposures involved

Comparison of research case definitions for carpal tunnel syndrome

OBJECTIVE: The aim of our study was to assess agreement between different case definitions of carpal tunnel syndrome (CTS) for epidemiological studies. METHODS: We performed a literature search for papers suggesting case definitions for use in epidemiological studies of CTS. Using data elements based on symptom questionnaires, hand diagrams, physical examinations and nerve conduction studies collected from 1107 newly-hired workers, each subject in the study was classified according to each of the case definitions selected from the literature. We compared each case definition to every other case definition, using the Kappa statistic to measure pairwise agreement on whether each subject met the case definition. RESULTS: We found six unique papers in a twenty year period suggesting a case definition of CTS for use in population-based studies. We extracted seven case definitions. Definitions included different parameters: symptoms only, symptoms and physical examination, symptoms and either physical examination or median nerve conduction study, symptoms and nerve conduction study. When applied to our study population, the prevalence of CTS using different case definitions ranged from 2.5% to 11.0%. The percentage of misclassification was between 1 to 10%, with generally acceptable levels of agreement (Kappa values ranged from 0.30 to 0.85). CONCLUSION: Different case definitions resulted in widely varying prevalences of CTS. Agreement between case definitions was generally good, particularly between those that required very specific symptoms or the combination of symptoms and physical examination or nerve conduction. The agreement observed between different case definitions suggests that the results can be compared across different research studies of risk factors for CTS

Performance of simplified scoring systems for hand diagrams in carpal tunnel syndrome screening

PURPOSE: Katz et al have published a standardized scoring system of hand diagrams for carpal tunnel syndrome. The purpose of this study was to quantitatively evaluate alternative scoring of the hand diagram for detection of carpal tunnel syndrome. METHODS: In a prospective study of 1107 workers, 221 workers with hand symptoms completed hand diagrams and electrodiagnostic testing for carpal tunnel syndrome. Scoring algorithms for the hand diagrams included the Katz rating; a median nerve digit score (0–2) with a maximum of 2 symptomatic digits of thumb, index, and long; and isolated digit scores (0–1) of thumb, index, or long. Intraclass correlation coefficients quantified inter-rater reliability. Sensitivity, specificity, and logistic regression analyses evaluated scoring systems performances ability to predict abnormal median nerve conduction. RESULTS: One hundred ten (50%) subjects illustrated symptoms within the median nerve distribution. All scoring systems demonstrated substantial inter-rater reliability. “Classic” or “probable” Katz scores, median nerve digit score of 2, and positive long finger scores were significantly associated with abnormal median nerve distal sensory latency and median-ulnar difference. Abnormal distal motor latency was significantly associated with the median nerve digit score of 2 and positive long finger scores. Increasing Katz scores from “possible” to “probable” and “classic” were not associated with greater odds of electrodiagnostic abnormality. Positive long finger scores performed at least as well as the most rigorous scoring by Katz. CONCLUSIONS: Symptoms diagramed within the median nerve distribution are associated with abnormal nerve conduction among workers. The median nerve digit score and the long finger score offer increased ease of use compared to the Katz method while maintaining similar performance characteristics. The long finger appears best suited for isolated digit scoring to predict abnormal median nerve conduction in a working population