Table 3.
Main results of the included systematic reviews and meta-analyses stratified by the exposure factors
| Author, year, ↓quality | Vibration (95 % CI) | Repetition (95 % CI) | Force (95 % CI) | Combined exposure (repetition and force) (95 % CI) | Wrist posture (95 % CI) | Computer exposure (95 % CI) |
|---|---|---|---|---|---|---|
| Barcenilla et al. 2012 [41] Grade B | NIOSH CTS def.: OR 2.7 (1.9–3.9); n = 12 studies Conservative CTS def.a: OR 5.4 (3.1–9.3); n = 3/3 (100 %) studiesd | NIOSH CTS def.: OR 2.3 (1.8–3.0); n = 25 studies Conservative CTS def.a: OR 2.3 (1.7–2.9); n = 5/11 (45 %) studiesd | NIOSH CTS def.: OR 2.2 (1.5–3.3); n = 13 studies Conservative CTS def.a: OR 4.2 (1.5–11.7); n = 3/5 (60 %) studiesd | NIOSH CTS def.: OR 2.0 (1.4–2.9); n = 4/9 (44 %) studiesd Conservative CTS def.a: OR 1.9 (1.0–3.5); n = 5 studies | NIOSH CTS def.: OR 2.7 (1.3–5.5); n = 7 studies Conservative CTS def.a: OR 4.7 (0.4–53.3); n = 1/3 (33 %) studiesd | / |
| Mediouni et al. 2014 [42] Grade B | / | / | / | / | / | Computer use: OR 1.7 (0.8-3.6); n = 5 studies; Keyboard/mouse use: OR 1.1 (0.6–2.0); OR 1.9 (0.9–4.2) |
| Van Rijn et al. 2009 [35] Grade B | OR 2.5–4.8; n = 3/5 (60 %) studiesd | OR 0.5–9.4; n = 5/8 (62 %) studiesd | OR 2.1–9.0; n = 3/7 (43 %) studiesd | OR 3.2–8.4; n = 3/4 (80 %) studiesd | OR 1.3–8.7; n = 4/5 (80 %) studiesd | OR 2.1–4.4; n = 2/7 (29 %) studiesd |
| You et al. 2014 [43] Grade C | / | / | / | / | Non-neutral wrist postures: RR 2.0 (1.7–2.4); n = 4/8 (50 %) studiesd | / |
| Spahn et al. 2012 [31] Grade C | OR 2.6 (1.7–4.0); n = 6/9 (67 %) studiesd | OR 2.7 (1.8–3.9); n = 11/13 (85 %) studiesd OR 2.1 (0.4–11.8); n = 3 cohort studies | OR 4.4 (1.4–13.6); n = 4/4 (100 %) studiesd | OR 8.4 (7.8–8.9)b; n = 2/2 (100 %) studiesd OR 1.8 (1.4–2.2)b; n = 2/3 (67 %) cohort studiesd | Flexion: OR 1.7 (1.0–2.6); n = 2/5 (40 %) studiesd | Computer use: OR 1.8 (0.8–4.1); n = n/a studies |
| Sulsky et al. 2005 [44]c Grade C | Insufficient evidence; n = 1 study | Consistent small positive association; n = 6 studies | Weak positive association of questionable validity; n = 3 studies | / | Insufficient evidence; n = 1 study | Insufficient evidence; n = 2 studies |
| Thomsen et al. 2008 [45] Grade C | / | / | / | / | / | Inconsistent evidence: OR < 1; n = 1 studies; OR > 1; n = 3 studies and n = 4 studies with no effect calculation or n.s. |
| Palmer et al. 2007 [22] Grade C | ≥2 OR elevated risk (e.g., exposure ≥8 years); n = 7 studies | ≥2 OR elevated risk (e.g., exposure <10 s. cycle time); n = 5 studies | Elevated risk for high-force jobs and activities (e.g., exposure >4 kg); n = n/a studies | Elevated risk for jobs with combined exposure; n = 1 study | ≥2 OR elevated risk (e.g., exposure >17 or 20 h/week); n = 4 studies | Inconsistent results; n = 4 studies |
| Abbas et al. 1998 [21] Grade D | / | Significant predictor | Significant predictor | / | / | / |
| Lozano-Calderón et al. 2008 [46] Grade D | Ø OR 5.5; qBHs 6.3/21 points (range 5–8); n = 14/20 (70 %) studiesd | Ø OR 4.0; qBHs 6.5/21 points (range 5–10); n = 30/45 (67 %) studiesd | Ø OR n/a; qBHs 4.5/21 points (range 3–6); n = 15/31 (48 %) studiesd | / | Flexion: Ø OR n/a; qBHs 5.4/21 points (range 4–8); n = 7/17 (41 %) studiesd Extension: Ø OR n/a; qBHs 3.6/21 points (range 3–4); n = 3/7 (43 %) studiesd | / |
Abbreviations: CI Confidence interval, CTS Carpal tunnel syndrome, NIOSH National Institute for Occupational Health and Safety (USA), n.s. not significant, OR Odds ratio, RR Relative risk, qBHs Quantitative score based on Bradford-Hill criteria (max. 21 points)
aConservative CTS case definition: abnormal nerve conduction findings and symptoms (e. g., paraesthesia, pain, numbness) or clinical signs (positive Phalen’s sign or Tinel’s sign)
bResults refer to American Conference of Governmental Industrial Hygienist (ACGIH) Threshold Limit Value (TLV) for Hand-Activity Level (HAL)
cResults refer to eleven studies of high quality with minimised risk of bias
dPositive correlation observed