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Table 3 Main results of the included systematic reviews and meta-analyses stratified by the exposure factors

From: Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research

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 /
  1. 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)
  2. 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)
  3. bResults refer to American Conference of Governmental Industrial Hygienist (ACGIH) Threshold Limit Value (TLV) for Hand-Activity Level (HAL)
  4. cResults refer to eleven studies of high quality with minimised risk of bias
  5. dPositive correlation observed