Effects of age, sex, and anthropometric factors on nerve conduction measures

Associations among measures of median, ulnar, and sural nerve conduction and age, skin temperature, sex, and anthropometric factors were evaluated in a population of 105 healthy, asymptomatic adults without occupational exposure to highly repetitive or forceful hand exertions. Height was negatively associated with sensory amplitude in all nerves tested ( P < 0.001), and positively associated with median and ulnar sensory distal latencies ( P < 0.01) and sural latency ( P < 0.001). Index finger circumference was negatively associated with median and ulnar sensory amplitudes ( P < 0.05). Sex, in isolation from highly correlated anthropometric factors such as height, was not found to be a significant predictor of median or ulnar nerve conduction measures. Equations using age, height, and finger circumference for prediction of normal values are presented. Failure to adjust normal nerve conduction values for these factors decreases the diagnostic specificity and sensitivity of the described measures, and may result in misclassification of individuals. © 1992 John Wiley & Sons, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50152/1/880151007_ftp.pd

The effectiveness of a joint labor-management program in controlling awkward postures of the trunk, neck, and shoulders: Results of a field study

Awkward working posture at the trunk, neck and shoulders may be caused by a number of factors, including: workstation layout, visual demands of the job, design of equipment and tools, and work methods. Because awkward posture is a recognized risk factor for the development of fatigue, discomfort, and/or disability, the elimination or reduction of awkward work posture is a major objective of many workplace ergonomic programs.A longitudinal study was undertaken in a large automotive corporation to evaluate the effectiveness of a participative union-management program in reducing work-related musculoskeletal injuries and disorders, including those caused by awkward postures. Following a one-week training program, plant personnel used checklists to evaluate posture on 335 jobs in selected departments at four participating plants. The results of these evaluations were used to develop an intervention program in each plant for controlling awkward postures. To evaluate the effectiveness of the intervention programs, a subset of 151 jobs was tracked by an independent team of university-based ergonomists who performed comprehensive posture analyses at six-month intervals.The independent evaluation found that the labor-management teams were generally effective in reducing awkward postures at the trunk and shoulders. There were significant decreases in the time spent in awkward trunk and shoulder postures as a result of interventions that were implemented during the study. However, the teams were not effective in controlling neck postures as the frequency of awkward neck postures actually increased over the course of the study.Most of the successful intervention projects involved modifications to workstation layout in order to reduce or eliminate low, far, or overhead reaches associated with awkward trunk and shoulder postures. Interventions that required changes in product design or major changes in manufacturing processes were generally not observed during the monitoring period.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31032/1/0000709.pd

A checklist for evaluating ergonomic risk factors resulting from awkward postures of the legs, trunk and neck

A one-page checklist for determining the presence of ergonomic risk factors associateed with awkward postures of the lower extremities, trunk and neck was developed and evaluated as part of a joint labor-management ergonomics intervention program. This checklist was used by plant personnel at four work sites to assess the postural requirements on 335 cyclical (i.e., work-cycle duration less than five minutes) manufacturing and warehouse jobs. In addition, results generated by the checklist were compared to the results of ergonomic analyses performed by persons with advanced training in occupational ergonomics.Workers were observed using awkward postures for most of the jobs in the survey. Awkward postures of the lower extrimities were relatively uncommon, occuring in 25 percent or less of the jobs. Awkward postures of the trunk and neck were common, occuring in more than 70 percent of the jobs. Results generated by the checklist were generally in agreement with results generated by the experienced ergonomists; however, the checklist was found to be more sensitive in identifying the presence of awkward postures.The checklist was found to be an effective rapid-screening instrument for identifying cyclical jobs that expose workers to potentially harmful postures. However, the checklist methodology did not include sufficient documentation of work methods to identify the specific job attributes associated with these exposures. Furthermore, the checklist was not used to evaluate non-cyclical jobs (e.g., maintenance and skilled trades).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30007/1/0000375.pd

Evaluation of in-plant ergonomics training

Plant personnel involved in a joint labor-management Ergonomics Pilot Project attended an introductory ergonomics course. The training was developed to provide trainees with the ergonomic knowledge necessary to perform their functions as part of the Ergonomic Pilot Project. A Train-the-Trainer program for Introductory Ergonomics was developed and implemented to provide Pilot Project plants with in-plant Introductory Ergonomics trainers. Trainee course satisfaction, ergonomic knowledge, and performance did not differ significantly for those trained by in-plant trainers compared to those trained by University instructors. This suggests that the Train-the-Trainer approach is a viable way of meeting the increasing demand for ergonomics training in industry.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29101/1/0000137.pd

Biomechanical risk factors for carpal tunnel syndrome: a pooled study of 2474 workers

BACKGROUND: Between 2001 and 2010, five research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries and collected detailed subject-level exposure information with follow-up of symptoms, electrophysiological measures and job changes. OBJECTIVE: This analysis examined the associations between workplace biomechanical factors and incidence of dominant-hand CTS, adjusting for personal risk factors. METHODS: 2474 participants, without CTS or possible polyneuropathy at enrolment, were followed up to 6.5 years (5102 person-years). Individual workplace exposure measures of the dominant hand were collected for each task and included force, repetition, duty cycle and posture. Task exposures were combined across the workweek using time-weighted averaging to estimate job-level exposures. CTS case-criteria were based on symptoms and results of electrophysiological testing. HRs were estimated using Cox proportional hazard models. RESULTS: After adjustment for covariates, analyst (HR=2.17; 95% CI 1.38 to 3.43) and worker (HR=2.08; 95% CI 1.31 to 3.39) estimated peak hand force, forceful repetition rate (HR=1.84; 95% CI 1.19 to 2.86) and per cent time spent (eg, duty cycle) in forceful hand exertions (HR=2.05; 95% CI 1.34 to 3.15) were associated with increased risk of incident CTS. Associations were not observed between total hand repetition rate, per cent duration of all hand exertions, or wrist posture and incident CTS. CONCLUSIONS: In this prospective multicentre study of production and service workers, measures of exposure to forceful hand exertion were associated with incident CTS after controlling for important covariates. These findings may influence the design of workplace safety programmes for preventing work-related CTS

Personal and workplace psychosocial risk factors for carpal tunnel syndrome: a pooled study cohort

BACKGROUND: Between 2001 and 2010, six research groups conducted coordinated multiyear, prospective studies of carpal tunnel syndrome (CTS) incidence in US workers from various industries and collected detailed subject-level exposure information with follow-up symptom, physical examination, electrophysiological measures and job changes. OBJECTIVE: This analysis of the pooled cohort examined the incidence of dominant-hand CTS in relation to demographic characteristics and estimated associations with occupational psychosocial factors and years worked, adjusting for confounding by personal risk factors. METHODS: 3515 participants, without baseline CTS, were followed-up to 7 years. Case criteria included symptoms and an electrodiagnostic study consistent with CTS. Adjusted HRs were estimated in Cox proportional hazard models. Workplace biomechanical factors were collected but not evaluated in this analysis. RESULTS: Women were at elevated risk for CTS (HR=1.30; 95% CI 0.98 to 1.72), and the incidence of CTS increased linearly with both age and body mass index (BMI) over most of the observed range. High job strain increased risk (HR=1.86; 95% CI 1.11 to 3.14), and social support was protective (HR=0.54; 95% CI 0.31 to 0.95). There was an inverse relationship with years worked among recent hires with the highest incidence in the first 3.5 years of work (HR=3.08; 95% CI 1.55 to 6.12). CONCLUSIONS: Personal factors associated with an increased risk of developing CTS were BMI, age and being a woman. Workplace risk factors were high job strain, while social support was protective. The inverse relationship between CTS incidence and years worked among recent hires suggests the presence of a healthy worker survivor effect in the cohort

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

BackgroundSix 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.ObjectiveThis paper provides a detailed description of the characteristics of the pooled physical exposure variables and the source data information from the individual research studies.MethodsPhysical 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.ResultsAt 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.ConclusionsThe 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

OBJECTIVE: 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 subcommittee 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

Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort

OBJECTIVE: To analyze differences in carpal tunnel syndrome (CTS) prevalence using a combination of electrodiagnostic studies (EDSs) and symptoms using EDS criteria varied across a range of cutpoints and compared with symptoms in both ≥1 and ≥2 median nerve–served digits. DESIGN: Pooled data from 5 prospective cohorts. SETTING: Hand-intensive industrial settings, including manufacturing, assembly, production, service, construction, and health care. PARTICIPANTS: Employed, working-age participants who are able to provide consent and undergo EDS testing (N=3130). INTERVENTIONS: None. MAIN OUTCOME MEASURES: CTS prevalence was estimated while varying the thresholds for median sensory latency, median motor latency, and transcarpal delta latency difference. EDS criteria examined included the following: median sensory latency of 3.3 to 4.1 milliseconds, median motor latency of 4.1 to 4.9 milliseconds, and median-ulnar sensory difference of 0.4 to 1.2 milliseconds. EDS criteria were combined with symptoms in ≥1 or ≥2 median nerve–served digits. EDS criteria from other published studies were applied to allow for comparison. RESULTS: CTS prevalence ranged from 6.3% to 11.7%. CTS prevalence estimates changed most per millisecond of sensory latency compared with motor latency or transcarpal delta. CTS prevalence decreased by 0.9% to 2.0% if the criteria required symptoms in 2 digits instead of 1. CONCLUSIONS: There are meaningful differences in CTS prevalence when different EDS criteria are applied. The digital sensory latency criteria result in the largest variance in prevalence