Emilie Chazelle

Theoretical impact of simulated workplace-based primary prevention of carpal tunnel syndrome in a French region

BackgroundCarpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs.To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS.MethodsSurgical CTS were assessed using regional hospital discharge records for persons aged 20–59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors.ResultsA limited proportion of CTS were work-related in the region’s population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137–2212] CTS, of which 906 [450–1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46–153], 81 [58–111] and 159 [114–223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs).ConclusionThe impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.

67 Theoretical impact of workplace-based primary prevention of carpal tunnel syndrome in a french region: a pilot study

Introduction To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for carpal tunnel syndrome (CTS). Methods Cases of CTS were assessed using regional hospital discharge records for persons aged 20–59 in 2004. Using work-related attributable fractions (AFEs), we estimated the number of work-related cases of CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centred intervention reducing the incidence of WR-CTS by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical cases of CTS by 5% and 10% by targeting personal and work risk factors. Result Nine jobs at high risk of CTS were identified in the region, amounting to 1,618 [1,143–2,233] CTS cases, of which 952 [488–1,575] were WR-CTS. The 10%-WI, 5% GI and 10% GI hypothetically prevented 95 [49–158], 81 [57–112] and 162 [114–223] CTS cases, respectively. The hypothetical preventive efficiency varied depending on the job. The 10% GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5% GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs). Discussion This study found that work-related CTS cases were concentrated in several high-risk jobs. Simulated workplace-based WI and GI showed that preventive efficiency varied depending on the intervention design, the number of workers in different jobs and the proportion of work-related CTS. This suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.