Articlehybrid2012

Validation of the ACGIH TLV for hand activity level in the OCTOPUS cohort: a two-year longitudinal study of carpal tunnel syndrome

Roberta Bonfiglioli · Stefano Mattioli · Thomas J. Armstrong · Francesca Graziosi · Francesco Marinelli · Andrea Farioli +1 more

71 citations0/0 files storedScandinavian Journal of Work Environment & Health

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Ergonomics and Musculoskeletal Disorders Occupational Health and Safety in Workplaces Peripheral Nerve Disorders

Abstract

OBJECTIVES: This study aimed to evaluate the risk of musculoskeletal disorders to the hand-wrist system. The American Conference of Governmental Industrial Hygienists (ACGIH) proposed threshold limit values (TLV©) based on hand activity level (HAL) and normalized peak force (PF). We validated ACGIH TLV© in OCTOPUS, a large cohort study on carpal tunnel syndrome (CTS). METHODS: Industrial and service workers were followed from 2000-2003. We classified subjects with respect to action limit (AL) and TLV. Case definitions were: (i) self-reported symptoms; and (ii) combination of symptoms and positive nerve conduction studies. Poisson regression models including age, gender, body mass index, and presence of predisposing pathologies were conducted to estimate incidence rate ratios (IRR) of CTS. RESULTS: There were 4097 eligible workers. Of these, 236 (5.8%) were non-responders, 2194 (53.6%) had a complete follow-up, 728 (17.8%) were lost after intermediate assessment, and 939 (22.9%) were lost after baseline. Among the 3860 subjects with complete information at baseline, 2599 (67.3%) were women [mean age 38.1 [standard deviation (SD) 9.5] years; mean body mass index (BMI) 23.8 (SD 3.9) kg/m2]. ACGIH TLV© classification predicted both CTS symptoms [IRR between AL and TLV 2.43 [95% confidence interval (95% CI) 1.77-3.33]; above TLV 3.32 (95% CI 2.34-4.72)] and CTS confirmed by nerve conduction studies [IRR between AL and TLV 1.95 (95% CI 1.21-3.16); above TLV 2.70 (95% CI 1.48-4.91)]. CONCLUSIONS: We found a dose-response relationship between ACGIH TLV© classification and risk of CTS. The increased risk observed for workers exposed between AL and TLV suggests that the current AL and TLV might not be sufficiently protective.

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References

1986Hand wrist cumulative trauma disorders in industry.2009Systematic evaluation of observational methods assessing biomechanical exposures at work 2009Associations between work-related factors and the carpal tunnel syndrome—a systematic review 1999Cross-sectional study of the relationship between repetitive work and the prevalence of upper limb musculoskeletal disorders 1991Quantifying exposure in occupational manual tasks with cumulative trauma disorder potential 2012The Strain Index (SI) and Threshold Limit Value (TLV) for Hand Activity Level (HAL): risk of carpal tunnelsyndrome (CTS) in a prospective cohort 2009Gender adjustment or stratification in discerning upper extremity musculoskeletal disorder risk?2011Workplace and individual risk factors for carpal tunnel syndrome

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2014Exposure–response relationships for the ACGIH threshold limit value for hand-activity level: results from a pooled data study of carpal tunnel syndrome

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