The use of continuous exposure data for predicting CTS in fish processing operators

Carpal tunnel syndrome (CTS) remains one of the most commonly reported and studied work related musculoskeletal disorders. Categorical representations of exposures has been critical in identifying associations between risk factors and CTS, however, quantification of exposure-response relationships require using continuous exposure data. Also, few interactions between risk factors, especially between risk factor categories, have been investigated. The objectives of this study were to investigate the utility of using continuous exposure data and to identify interaction effects of risk factors, both within and between risk factor categories, for predicting CTS. A cross sectional study was performed at a fish processing facility in which 53 participants were evaluated during normal task performance. Due to task asymmetry, each hand was considered separately, providing 106 hands for analysis. Direct measurement and a questionnaire were used to quantify exposures to common occupational and personal risk factors. Stepwise logistic regression analysis was performed to identify three models for predicting CTS and assess predictive ability using: occupational risk factors only (three-way interactions considered), personal risk factors only (two-way interactions considered), and a mixed model considering two-way interactions across risk factor categories and previously identified significant interactions. Models including only occupational or personal risk factors were moderately accurate overall (73% and 77% respectively), but were not sensitive in differentiating between CTS cases and non-cases (39% and 33% respectively). The mixed model was found to be accurate (88%) and sensitive (78%), though only one interaction effect was included. The results of this study illustrate the importance of using continuous exposure data, especially in job tasks where exposures to occupational risk factors is similar, when differentiating between high and low risk job tasks.