Work-Related Musculoskeletal Disorders Report, Workshop Summary, and Workshop Papers (1999) / Chapter Skim
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Epidemiology Panel: Collected Papers
Epidemiology Panel: Collected Papers
Pages 152-174
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From page 152... ...
In my review of this document, ~ focused on the studies of elbow disorclers, carpal tunnel syndrome (CTS) , and hancI/wrist tendinitis.
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From page 153... ...
3. Would either the inclusion of any omitted studies or the assessment of the quality of those reviewed substantially alter the interpretation of the epidemiological evidence that certain physical stressors in the workplace increase risk of acquiring certain MSDs?
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From page 154... ...
Many clinicians make the working diagnoses of CTS, and start therapy in individual patients, based on the same symptom and physical examination criteria used in those weighted studies which did not use EDS.
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From page 155... ...
~ clon't believe that the NIOSH document has overlooked any important body of epidemiological evidence pertaining to workplace factors and musculoskeletal disorders. Overall, ~ am impressed with the thoroughness of what was a massive and unprecedented review of literature.
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From page 156... ...
3. Would either the inclusion of any omitted studies or the assessment of the quality of those reviewed substantially after the interpretation of the epidemiological evidence that certain physical stressors in the workplace increase risk of acquiring certain MSDs?
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From page 157... ...
It is notable that the incidence rates for carpal tunnel syndrome in this stiffly increaser! substantially over this 20 year period, probably reflecting better diagnosis, and greater attention pair!
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From page 158... ...
Musculoskeletal Disorders and Workplace Factors: A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck. upper extremity, and low back.
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From page 159... ...
the health outcome of interest was defined by symptoms and physical examination, 3) the investigators were blinded to health or exposure status when assessing health or exposure status, and 4)
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From page 160... ...
considering studies of high epiclemiological quality might otherwise suggest. Two examples are provided for illustration: NIOSH included numerous studies of neck and neck/shoulder MSDs in which the exposure variable was a measure of ergonomic exposure of the hand and/or wrist in which no measures of force, repetition, or posture directly applicable to the neck or neck/shouIclers were obtained.
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From page 161... ...
Virtually were cross-sectional and few, if any, such population based studies used objective assessment of both health and ergonomic exposure, however. As a result, such studies are subject to reporting bias in which those with a painful MSD may be more likely to report exposure than those without such a condition.
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From page 162... ...
Most of the omitted studies that ~ have noted were investigations of changes in health status following reductions in exposure, either from intentional ergonomic interventions in the workplace or from evolving production processes, equipment, and work environments. The documentation of such health benefits speaks directly to the question of temporal relationship and is often held to provide very strong evidence of a causal relationship.
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From page 163... ...
With reference to carpal tunnel syndrome (CTS) , Bernard et al.
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From page 164... ...
However, the literature reviewed by NTOSH clearly demonstrates that people occupationally exposed to physical ergonomic stressors, especially at the extremes of magnitude, duration and frequency, have higher prevalences of many MSDs than people without or with lower exposures. in fact, it is impressive that a group of over one dozen studies, utilizing different study designs and data collection protocols and carried out on several continents, have all produced findings consistent with the hypothesis that occupational exposure to physical stressors increases the risk of MSDs.
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From page 165... ...
(1997~. Musculoskeletal disorders and workplace factors: A critical review of epidemiologic evidence for work-related musculoskeletal (lisorders of the neck, upper extremity, and low back.
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From page 166... ...
(1998~. Ergonomic stressors and upper extremity disorders in vehicle manufacturing: Cross-sectional exposure- response trends.
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From page 167... ...
Several reviews of the epidemiologic data, including those employing meta-analytic techniques have yielded conflicting conclusions about the work - MSD association for specific disor(lers, e.g., carpal tunnel syndrome and low back pain. The NAS workshop session on physical factor epidemiology will endeavor to assess the overall contribution of published epidemiological studies associating physical stressors with musculoskeletal disorders.
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From page 168... ...
The NIOSH document also examined a limited number of specific MSDs in certain anatomical locations, e.g., the back, hands/wrists, elbows and neck; carpal tunnel syndrome, epicondylitis, shoulder tendonitis, low back pain, etc. Study Critique NIOSH chose four criteria to qualitatively critique each study: participation rate, health outcome definition, blinding, and exposure status.
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From page 169... ...
Unfortunately, the NIOSH document does not define the methodology it employed to classify each physical factor or physical factor combination and associated health outcomes. Without a clearly defined epidemiologic basis for this approach and a defined methodology for applying the critique and causal criteria to derive the ratings, it is not possible to determine whether the ratings are appropriate and scientifically supported.
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From page 170... ...
This includes dose-response, specific factor or factor combination relationships and safe levels, as well as other areas of inquiry. An assessment of the NIOSH document's approach to the weight of the epidemiologic evidence to determine the causal associations between various work factors and MSDs is a key element in this scientific undertaking.
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From page 171... ...
Fully defined and validated scientific methodology for epidemiologic literature critique, classification and weighting should provide a valid assessment of the present state of the art for various physical Work factors and MSD development. Additionally, NIOSH, NTOSH-funded, and various other studies currently underway by a vast array of academic, government, labor and business researchers should start to provide answers to specific causal and prevention questions which are so vital in establishing scientifically-based regulatory and enforcement approaches.
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From page 172... ...
To select studies, NIOSH developed a comprehensive approach that combined several factors to serve as the basis for judgements about work-relatedness. The quality of the studies that were most heavily weighted was generally quite high because they met the multiple criteria set out by NIOSH for weighting: high participation rates, appropriate "blinding" of investigators, health outcomes defined by symptoms and physical exam and independent exposure measures.
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From page 173... ...
. Since the assessment examined specific physical factors, several of which may have been inclucled in a particular study, the reviewers take care to determine that a proper unexposed or low exposed group is defined in terms of the specific exposure factor studies!
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From page 174... ...
174 Notes: WORK-RELATED MUSCULOSKELETAL DISORDERS Hagberg M, Wegman DH. Prevalence Rates and Odds Ratios of Shoulder Neck Diseases in Different Occupational Groups.
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