背景:对于流行病学研究中使用的与工作相关的肌肉骨骼疾病和疾病(MSD)的病例定义,需要国际共识。我们的目标是:1)研究与工作相关的下腰痛(LBP)的病例定义需要哪些信息,腰骶神经根综合征(LRS),肩峰下疼痛综合征(SAPS),腕管综合征(CTS),肘部外侧和内侧肌腱病,膝盖和髋部骨关节炎,2)就这些与工作相关的MSD的病例定义寻求职业卫生专业人员/研究人员的共识。
方法:对来自24个国家的职业卫生专业人员/研究人员进行了两轮Delphi研究。与工作相关的MSD的定义由具有工作暴露的案例定义组成。第1轮包括32个案例定义和第2轮60个案例定义。两轮过后,共识要求75%的小组成员对病例定义进行评分,包括工作暴露≥7分的9分评分表(完全不同意/完全同意)。
结果:58名小组成员完成了两轮(应答率90%)。45名(70%)的小组成员认为,对于LBP,病例定义只能基于症状。仅就与工作相关的肘内侧肌腱病达成共识,而膝关节骨性关节炎的一致性最低。如果没有达成共识,除LBP外,这与体格检查和影像学检查有关,而不是与主要症状存在分歧.
结论:仅就工作相关的肘内侧肌腱病达成病例定义共识。流行病学研究将受益于所有MSD的统一病例定义,包括LRS的成像和体检,SAPS,CTS,肘外侧肌腱病和髋膝骨关节炎。
BACKGROUND: International consensus is needed on
case definitions of work-related musculoskeletal disorders and diseases (MSDs) for use in epidemiological research. We aim to: 1) study what information is needed for the
case definition of work-related low back pain (LBP), lumbosacral radicular syndrome (LRS), subacromial pain syndrome (SAPS), carpal tunnel syndrome (CTS), lateral and medial elbow tendinopathy, and knee and hip osteoarthritis, and to 2) seek consensus among occupational health professionals/researchers regarding the case definitions of these work-related MSDs.
METHODS: A two-round Delphi study was conducted with occupational health professionals/researchers from 24 countries. Definition of work-related MSDs were composed of a
case definition with work exposures. Round 1 included 32
case definitions and round 2, 60
case definitions. After two rounds, consensus required 75% of the panellists to rate a case definition including work exposures ≥7 points on a 9-point rating scale (completely disagree/completely agree).
RESULTS: Fifty-eight panellists completed both rounds (response rate 90%). Forty-five (70%) panellists thought that for LBP a
case definition can be based on symptoms only. Consensus was only reached for work-related medial elbow tendinopathy, while the lowest agreement was found for knee osteoarthritis. Where consensus was not reached, this was - except for LBP - related to physical examination and imaging rather than disagreement on key symptoms.
CONCLUSIONS: Consensus on case definitions was reached only for work-related medial elbow tendinopathy. Epidemiological research would benefit from harmonized case definitions for all MSDs including imaging and physical examination for LRS, SAPS, CTS, lateral elbow tendinopathy and hip and knee osteoarthritis.