Metaanalyse zur Bestimmung von Risikofaktoren für das Karpaltunnelsyndrom (KTS) Teil II. Berufliche Risikofaktoren

Zusammenfassung

Studienziel: Durch den Sachverständigenrat Berufskrankheiten des Bundesministeriums für Arbeit und Soziales (BMAS) wurde das KTS (Karpaltunnelsyndrom) zur Aufnahme als Berufskrankheit (BK) empfohlen. Ziel der hier vorgestellten systematischen Literaturrecherche mit anschließender Metaanalyse war es, mit einem KTS assoziierte Faktoren und Risikofaktoren zu identifizieren. Dieser Teil beschreibt die beruflichen Faktoren, die in späteren BK-Begutachtungsverfahren beachtet werden müssen. Material und Methode: Zum Stichtag 15. 02. 2011 wurden aus den Datenbanken PubMed, Medline, Cochrane, EMBASE und Web of Science insgesamt 87 relevante Studien (27 Längsschnitt- und 60 Querschnittstudien) zum Einschluss in die Metaanalyse identifiziert. Die Metaanalyse berücksichtigte die PRISMA-(Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklisten. Die Berechnung der Effektstärken erfolgte im Random Effect Modell. Ergebnisse: Wurden Untersuchungen innerhalb der Gesamtbevölkerung durchgeführt, so wurden im Vergleich zu Studien an Werktätigen signifikant niedrigere Prävalenzen ermittelt (p < 0,001). Auch die Inzidenz in Studien an Werktätigen mit KTS war signifikant (p < 0,001) höher als in Bevölkerungsstudien. Aufgrund unterschiedlicher Studiendesigns war es unmöglich, konkrete Prävalenzen oder Inzidenzen für bestimmte Berufsgruppen zu ermitteln. Generell konnten in einer Reihe von Längsschnittstudien schwere manuelle Arbeiten als signifikanter Risikofaktor für ein KTS identifiziert werden. Unabhängig vom konkreten Berufszweig konnten jedoch Handbelastungen identifiziert werden, die signifikant mit einer erhöhten KTS-Prävalenz assoziiert waren: Repetition, chronische Handflexion, hohe manuelle Kraftausübung und Vibrationsbelastung. In den meisten Fällen liegen kombinierte Handbelastungen vor. Zur Erfassung eignen sich die Hand Activity Level Threshold Limit Values (HAL TLVs®) der ACGIH (American Conference of Governmental Hygienists). Handbelastungen im oberen Quartil dieses Scores bedingen signifikant höhere KTS-Prävalenzen und stellen einen signifikanten Risikofaktor für ein beruflich bedingtes KTS dar. Schlussfolgerungen: Obwohl es unmöglich war, konkrete Prävalenz- oder Inzidenzraten für bestimmte Berufe zu ermitteln, konnte eine Reihe von Faktoren ermittelt werden, die für die BK KTS relevant sind. Dazu zählen Tätigkeiten mit hoher Belastung durch Repetition, chronische Handflexion, hoher manueller Kraftausübung und Vibrationsbelastung. Für die spätere Begutachtung werden vor allem kombinierte Handbelastungen gemäß der HAL TLVs® zu beurteilen sein.

Abstract

Aim: The expert committee of the German Ministry for Labour and Social Affairs suggested carpal tunnel syndrome (CTS) as an “occupational disease”. This systematic literature review and metaanalysis was aimed at identifying associated and risk factors for CTS. Part II addresses the occupational factors of CTS. Material and Method: A systematic literature review was performed by examining papers in PubMed, Cochrane, EMBASE and Web of Science databases that were published on or before February 15th, 2011. A total of 87 studies (27 longitudinal and 60 cross-sectional) were included in this metaanalysis. The PRISMA (preferred reporting items for systematic reviews and metaanalyses) guidelines for performing a metaanalysis were strictly followed. All of the effect sizes were calculated using a random-effects model. Results: The prevalence of CTS in working populations [10.9 % (95 % CI 7.9–14 : 9)] was significantly higher than in the general population [8.2 % (95 % CI 2.3–25.1), p < 0.001]. Working people had a CTS incidence of 17.3 (95 % CI 14.5–20.1)/1,000 person years. In contrast, the crude incidence in the general population was 1.8 (95 % CI 1.4–2.2)/1.000 person years (p < 0.001). The heterogeneity of the different study designs made it impossible to detect concrete prevalence or incidence rates for specific job groups. However, “blue-collar work” was a significant risk factor for CTS [OR = 3.1 (95 % CI 1.9–5.3), p < 0.001]. Thus, it makes sense to evaluate concrete hand burdens. In numerous studies, some factors were associated with CTS: repetition [OR = 2.7 (95 % CI 1.8–39), p < 0.001), chronic wrist flexion [OR = 1.7 (95 % CI 1.0–2.6), p = 0.033], powerful grip [OR = 4.4 (95 % CI 1.4–13.6), p = 0.009], and chronic vibration load [OR = 2.6 (95 % CI 1.7–4.0)]. Primarily, combined hand loadings were estimated. For this evaluation, the hand activity level threshold limit values (HAL TLVs®) of the ACGIH (American Conference of Governmental Hygienists) were useful. Manual work in the 4th quartile of this score was significantly associated with the prevalence of CTS [OR = 2.9 (95 % CI 1.5–5.7), p = 0.001]. These score values were identified as a significant risk factor for occupational CTS. Conclusion: It was impossible to define exact prevalences or incidences of CTS for specific job titles. However, it was possible to identify manual loadings with a significantly higher risk or association with CTS, including repetition, wrist flexion, powerful grip, and vibration. These loadings are usually combined during occupational work. Subsequent expertsʼ reviews have to respect these complex hand loadings. It may be useful to use instruments, such as HAL TLVs®.

Schlüsselwörter

KTS - Hand - Risiko - Metaanalyse

Key words

CTS - hand - risk - metaanalysis

• Literatur

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