Comparison of Research Case Definitions for Carpal Tunnel Syndrome

• Published in: Scandinavian Journal of Work, Environment ＆ Health Vol. 37; no. 4; pp. 298 - 306
• Main Authors: Descatha, Alexis, Dale, Ann-Marie, Franzblau, Alfred, Coomes, Justin, Evanoff, Bradley
• Format: Journal Article
• Language: English
• Published: Helsinki Scandinavian Journal of Work, Environment ＆ Health 01.07.2011; Finnish Institute of Occupational Health; National Institute of Occupational Health; National Research Centre for the Working Environment; Scandinavian journal of work, environment & health; Scandinavian Journal of Work, Environment & Health; Institute of Occupational Health; Nordic Association of Occupational Safety and Health (NOROSH)
• Subjects: Adult; Agreements; Apprenticeship; Biological and medical sciences; Carpal tunnel syndrome; Carpal Tunnel Syndrome - classification; Carpal Tunnel Syndrome - diagnosis; Carpal Tunnel Syndrome - physiopathology; case definition; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Epidemiologic studies; Female; Fingers; Hands; Humans; Hypesthesia; Male; Median nerve; median neuropathy; Medical sciences; Middle Aged; nerve conduction study; Nerves; Nervous system (semeiology, syndromes); Neurology; Overuse injuries; Physical examinations; Population studies; population study; Questionnaires; Risk factors; screening; Symptoms; Wrist; population study; nerve conduction study; median neuropathy; screening; Human; Carpal tunnel syndrome; Nervous system diseases; Compression; Case definition; Diseases of the osteoarticular system; Neuropathy; Medical screening; Conduction velocity; Epidemiology; Nerve conduction; Scientific research; Population-based survey; Peripheral nerve disease; Comparative study; Occupational medicine; Bibliographic review
• ISSN: 0355-3140; 1795-990X
• DOI: 10.5271/sjweh.3148

Objective The aim of this study was to assess agreement between different case definitions of carpal tunnel syndrome (CTS) for epidemiological studies. Methods We performed a literature search for papers suggesting case definitions for use in epidemiological studies of CTS. Using data elements based on symptom questionnaires, hand diagrams, physical examinations, and nerve conduction studies collected from 1107 newly-hired workers, each subject in the study was classified according to each of the case definitions selected from the literature. We compared each case definition to every other case definition, using the Kappa statistic to measure pair-wise agreement on whether each subject met the case definition. Results We found six unique papers in a 20-year period suggesting a case definition of CTS for use in population-based studies. We extracted seven case definitions. Definitions included different parameters: (i) symptoms only, (ii) symptoms and physical examination, (iii) symptoms and either physical examination or median nerve conduction study, and (iv) symptoms and nerve conduction study. When applied to our study population, the prevalence of CTS using different case definitions ranged from 2.5–11.0%. The percentage of misclassification was between 1–10%, with generally acceptable levels of agreement (kappa values ranged from 0.30–0.85). Conclusions Different case definitions resulted in widely varying prevalences of CTS. Agreement between case definitions was generally good, particularly between those that required very specific symptoms or the combination of symptoms and physical examination or nerve conduction. The agreement observed between different case definitions suggests that the results can be compared across different research studies of risk factors for CTS.