Overviews – Status Quo, Potentiale und Ausblick

Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research

BACKGROUND

Occupational risks for carpal tunnel syndrome (CTS) have been examined in various occupations, and several systematic reviews (SRs) have been published on this topic. There has been no critical appraisal or synthesis of the evidence in the SRs. The aims of this study are (1) to synthesise the observational evidence and evaluate the methodological quality of SRs that assess the effect of biomechanical risk factors on the development of CTS in workers, (2) to provide an update of current primary research on this association, (3) to assess a potential dose-response relationship.

METHODS

We searched MEDLINE, EMBASE, CINAHL, the Cochrane Library and the reference lists of articles. The first step covered SRs (1998-2014), and the second step covered current primary studies (2011-2014). The methodological quality of the SRs was evaluated by using the AMSTAR-R tool; primary studies were assessed using a list of 20 items. A qualitative approach was used for synthesising evidence. In addition, we undertook a meta-analysis of the primary studies to determine risk ratios in the dose-response relationship.

RESULTS

We identified ten SRs that covered a total of 143 original studies. Seven primary studies met the criteria for inclusion, of which four provided longitudinal data. We found high quality of evidence for risk factors such as repetition, force and combined exposures. Moderate quality of evidence was observed for vibration, and low quality of evidence was found for wrist postures. An association between computer use and CTS could not be established. Recent primary studies supported the existence of a significant relationship between CTS and repetition, force and combined exposure. The meta-analysis of current research revealed a dose-response relationship between CTS and the American Conference of Governmental Industrial Hygienists' (ACGIH) threshold limit value (TLV) for hand-activity level (HAL). Those between the action limit and TLV and above TLV had RR of 1.5 (95% CI 1.02-2.31) and RR 2.0 (95% CI 1.46-2.82), respectively.

CONCLUSIONS

Occupational biomechanical factors play a substantial role in the causation of CTS. Data from current primary studies on dose-response suggest that the risk of CTS increases with the ACGIH TLV levels.

[SR/PS-method for using data of primary studies from systematic reviews in the evaluation of health technologies]

In general, the evaluation of health technologies is a time-consuming process being performed on the basis of systematic reviews of clinical (primary) studies. In order to save time, health technologies may be assessed based on previously published systematic reviews. However, this assessment method can be associated with a high risk of bias of the obtained results. We developed, therefore, the "Systematic Reviews for assessment based on Primary Studies" (SR/PS) method to enable a transparent, valid and time-saving evaluation of the technologies. Using the SR/PS method the evaluation of the hits that were identified through the literature search for systematic reviews and, if appropriate, through additional search for primary studies is being performed in three stages, namely identification, quality assessment and information synthesis. This process results in the ascertainment of the three most important sets of information: the pool of identified studies, the pool of methodologically sound studies and the results of the information synthesis. Each stage of the evaluation comprises the comprehensive use of relevant data on primary studies from the systematic reviews. At each stage, the corresponding systematic reviews will be selected from the identified hits using certain quality criteria. If information obtained from the systematic reviews is insufficient it will be completed by additionally incorporating the primary studies. The SR/PS method can be especially helpful in performing projects with many primary studies (e. g., guidelines development).