Postoffer Pre-Placement Screening for Carpal Tunnel Syndrome in Newly Hired Manufacturing Workers

OBJECTIVE: We determined the predictive validity of a post-offer pre-placement (POPP) screen using nerve conduction velocity studies (NCV) to identify future cases of carpal tunnel syndrome (CTS). METHODS: A cohort of 1648 newly hired manufacturing production workers underwent baseline NCS, and were followed for 5 years. RESULTS: There was no association between abnormal POPP NCV results and incident CTS. Varying NCV diagnostic cut-offs did not improve predictive validity. Workers in jobs with high hand/wrist exposure showed greater risk of CTS than those in low exposed jobs (Relative Risk 2.82; 95% CI 1.52, 5.22). CONCLUSIONS: POPP screening seems ineffective as a preventive strategy for CTS

Functional Measures Developed for Clinical Populations Identified Impairment Among Active Workers with Upper Extremity Disorders

PURPOSE: Few studies have explored measures of function across a range of health outcomes in a general working population. Using four upper extremity (UE) case definitions from the scientific literature, we described the performance of functional measures of work, activities of daily living, and overall health. METHODS: A sample of 573 workers completed several functional measures: modified recall versions of the QuickDASH, Levine Functional Status Scale (FSS), DASH Work module (DASH-W), and standard SF-8 physical component score. We determined case status based on four UE case definitions: 1) UE symptoms, 2) UE musculoskeletal disorders (MSD), 3) carpal tunnel syndrome (CTS), and 4) work limitations due to UE symptoms. We calculated effect sizes for each case definition to show the magnitude of the differences that were detected between cases and non-cases for each case definition on each functional measure. Sensitivity and specificity analyses showed how well each measure identified functional impairments across the UE case definitions. RESULTS: All measures discriminated between cases and non-cases for each case definition with the largest effect sizes for CTS and work limitations, particularly for the modified FSS and DASH-W measures. Specificity was high and sensitivity was low for outcomes of UE symptoms and UE MSD in all measures. Sensitivity was high for CTS and work limitations. CONCLUSIONS: Functional measures developed specifically for use in clinical, treatment-seeking populations may identify mild levels of impairment in relatively healthy, active working populations, but measures performed better among workers with CTS or those reporting limitations at work

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

Assessing agreement of self-reported and observed physical exposures of the upper extremity

Assessment of workplace physical exposures by self-reported questionnaires has logistical advantages in population studies but is subject to exposure misclassification. This study measured agreement between eight self-reported and observer-rated physical exposures to the hands and wrists, and evaluated predictors of inter-method agreement. Workers (n=341) from three occupational categories (clerical/technical, construction, and service) completed self-administered questionnaires and worksite assessments. Analyses compared self-reported and observed ratings using a weighted kappa coefficient. Personal and psychosocial factors, presence of upper extremity symptoms and job type were evaluated as predictors of agreement. Weighted kappa values were substantial for lifting (0.67) and holding vibrating tools (0.61), moderate for forceful grip (0.58) and fair to poor for all other exposures. Upper extremity symptoms did not predict greater disagreement between self-reported and observed exposures. Occupational category was the only significant predictor of inter-method agreement. Self-reported exposures may provide a useful estimate of some work exposures for population studies

Predictors of upper extremity symptoms and functional impairment among workers employed for 6 months in a new job

Background We sought to identify personal and work-related predictors of upper extremity symptoms and related functional impairment among 1,108 workers employed for 6 months in a new job. Methods We collected data at baseline and 6-month follow-up using self-administered questionnaires. Multivariate logistic regression models were created for each outcome variable. Predictors included personal risk factors, physical work exposures and psychosocial factors. Results Independent predictors for upper extremity symptoms at 6-month follow-up were age, Caucasian race, female gender, baseline history of UE symptoms, and job tasks involving wrist bending or forceful gripping. Independent predictors for functional impairment were baseline history and severity of UE symptoms, wrist bending, and social support. Conclusions Both personal and work-related factors were independent predictors of upper extremity symptoms and functional impairment in this working population. We found different risk factors for symptoms than for functional impairment related to symptoms. Am. J. Ind. Med. 51:932–940, 2008. © 2008 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61341/1/20625_ftp.pd

Reliability of job-title based physical work exposures for the upper extremity: comparison to self-reported and observed exposure estimates

OBJECTIVES. To evaluate the agreement between job-title based estimates for upper extremity physical work exposures, compared to exposure estimates from work observation and worker self-report. METHODS. Self-reported exposure questionnaires were completed by 972 workers, and exposure estimates based on worksite observation were completed for a subset of 396 workers. Job-title based estimates were obtained from O*NET, an American database of job demands. Agreement between self-reported, observed, and job-title based physical work exposures were assessed using Spearman correlations and intraclass correlation coefficients. RESULTS. Job-title based exposure estimates from O*NET, self-reported, and observer-rated exposures showed moderate to good levels of agreement for some upper extremity exposures, including lifting, forceful grip, use of vibrating tools, and wrist bending. CONCLUSIONS. Job-title based physical work exposure variables may provide useful surrogate measures of upper extremity exposure data in the absence of other individual level data such as observed or self-reported exposure. Further validation of these data is necessary to determine the utility of the O*NET databases in future epidemiological studies

The effectiveness of post-offer pre-placement nerve conduction screening for carpal tunnel syndrome

OBJECTIVE: We evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for carpal tunnel syndrome (CTS), testing diagnostic yield and cost-effectiveness. METHODS: 1027 newly hired workers underwent baseline NCS, and were followed for an average of 3.7 years for diagnosed CTS. Measures of diagnostic yield included sensitivity, specificity, and positive predictive value (PPV). Cost-effectiveness of POPP screening was evaluated using a range of inputs. RESULTS: Abnormal NCS was strongly associated with future CTS with univariate hazard ratios ranging from 2.95 to 11.25, depending on test parameters used. However, PPV was poor, 6.4–18.5%. Cost-effectiveness of POPP varied with CTS case costs, screening costs, and NCS thresholds. CONCLUSIONS: Although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost effective to employers in most scenarios tested

Responsiveness of a 1-year recall modified DASH Work module in active workers with upper extremity musculoskeletal symptoms

OBJECTIVES: To evaluate the responsiveness to change of a modified version of the Work module of the Disabilities of the Arm, Shoulder, and Hand (DASH-W) in a prospective, longitudinal cohort study of active workers. METHODS: We compared change on a 1-year recall modified DASH-W to change on work ability, work productivity, and symptom severity, according to predetermined hypotheses following the Consensus-based standards for the selection of health measurement instruments (COSMIN). We evaluated concordance in the direction of change, and magnitude of change using Spearman rank correlations, effect sizes (ES), standardized response means (SRM), and area under the receiver operating characteristic curves (AUC). RESULTS: In a sample of 551 workers, change in 1-year recall modified DASH-W scores showed moderate correlations with changes in work ability, work productivity, and symptom severity (r=0.47, 0.44, and 0.36, respectively). ES and SRM were moderate for 1-year recall modified DASH-W scores in workers whose work ability (ES=−0.58, SRM=−0.52) and work productivity improved (ES=−0.59, SRM=−0.56), and larger for workers whose work ability (ES=1.24, SRM=0.68) and work productivity worsened (ES=1.02, SRM=0.61). ES and SRM were small for 1-year recall modified DASH-W scores of workers whose symptom severity improved (−0.32 and −0.29, respectively). Responsiveness of the 1-year recall modified DASH-W was moderate for those whose symptom severity worsened (ES=0.77, SRM=0.50). AUC met responsiveness criteria for work ability and work productivity. CONCLUSIONS: The 1-year recall modified DASH-W is responsive to changes in work ability and work productivity in active workers with upper extremity symptoms