A summary of 'interventions for the primary prevention of work-related carpal tunnel syndrome'

摘要

Our objective was to identity promising interventions for the primary prevention of work-related carpal tunnel syndrome. Studies included either an engineering, administrative, personal, or multiple component intervention applied to a working or working-age population. All study designs that included comparison data were considered. Outcome measures included the incidence, symptoms, or risk factors for carpal tunnel syndrome, or a work-related musculoskeletal disorder of the upper extremity that included carpal tunnel syndrome in the definition. Twenty-four studies met our inclusion criteria. Multiple component programs were associated with reduced incidence rates of carpal tunnel syndrome, but the results are inconclusive because they did not adequately control for potential confounders. Several engineering interventions positively influenced risk factors associated with carpal tunnel syndrome, but the evaluations did not measure disease incidence. None of the personal interventions alone were associated with significant changes in symptoms or risk factors. All of the studies had important methodological limitations that may affect the validity of the results. While results from several studies suggest that multiple component ergonomics programs, alternative keyboard supports, and mouse and tool re-design may be beneficial, none of the studies conclusively demonstrates that the interventions would result in the primary prevention of carpal tunnel syndrome in a working population. Given the societal impact of carpal tunnel syndrome, the growing number of commercial remedies, and their lack of demonstrated effectiveness, the need for more rigorous and long-term evaluation of interventions is clear. Funding for intervention research should prioritize randomized controlled trials that include: 1) adequate sample size; 2) adjustment for relevant confounding variables; 3) isolation of specific program elements; and 4) measurement of long-term primary outcomes such as the incidence of carpal tunnel syndrome, and secondary outcomes such as employment status and Cost.