The development of risk assessment models for carpal tunnel syndrome: a case-referent study

The present study developed risk assessment models for carpal tunnel syndrome (CTS) which can provide information of the likelihood of developing CTS for an individual having certain personal characteristics and occupational risks. A case-referent study was conducted consisting of two case groups and one referent group: (1) 22 work-related CTS patients (W-CTS), (2) 25 non-work related CTS patients (NW-CTS), and (3) 50 healthy workers (HEALTHY) having had no CTS history. The classification of CTS patients into one of the case groups was determined according to the type of insurance covering their medical costs. Personal characteristics, psychosocial stresses at work, and physical work conditions were surveyed by using a questionnaire tailor-designed to CTS (reliability of each scale > or = 0.7). By contrasting the risk information of each case group to that of the referent group, three logistic regression models were developed: W-CTS/HEALTHY, NW-CTS/HEALTHY, and C-CTS/HEALTHY (C-CTS, the combined group of W-CTS and NW-CTS). ROC analysis indicated that the models have satisfactory discriminability (d' = 1.91 to 2.51) and high classification accuracy (overall accuracy = 83-89%). Both W-CTS/HEALTHY and C-CTS/HEALTHY include personal and physical factors, while NW-CTS/HEALTHY involves only personal factors. This suggests that the injury causation of NW-CTS patients should be attributable mainly to their 'high' personal susceptibility to the disorder rather than exposure to adverse work conditions, while that of W-CTS patients be attributable to improper work conditions and CTS-prone personal characteristics in combination.