PT Journal AU Bonfiglioli, R Mattioli, S Armstrong, TJ Graziosi, F Marinelli, F Farioli, A Violante, FS TI Validation of the ACGIH TLV for hand activity level in the OCTOPUS cohort: a two-year longitudinal study of carpal tunnel syndrome SO Scandinavian Journal of Work, Environment & Health PD 3VL PY 2013 BP 155 EP 163 IS 2 DI 10.5271/sjweh.3312 WP https://www.sjweh.fi/show_abstract.php?abstract_id=3312 DE ACGIH TLV; American Conference of Governmental Industrial Hygienists; biomechanical overload; carpal tunnel syndrome; CTS; hand activity level; hand force; industrial worker; longitudinal study; MSD; musculoskeletal disorder; occupational exposure; OCTOPUS cohort; repetition; validation SN 0355-3140 AB '

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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).

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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.

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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)].

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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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