title: Cumulative keyboard strokes: a possible risk factor for carpal tunnel syndrome.
abstract: BACKGROUND
  Contradictory reports have been published regarding the association of Carpal Tunnel Syndrome (CTS) and the use of computer keyboard. Previous studies did not take into account the cumulative exposure to keyboard strokes among computer workers. The aim of the present study was to investigate the association between cumulative keyboard use (keyboard strokes) and CTS.
  
  
  METHODS
  Employees (461) from a Governmental data entry & processing unit agreed to participate (response rate: 84.1 %) in a cross-sectional study. Α questionnaire was distributed to the participants to obtain information on socio-demographics and risk factors for CTS. The participants were examined for signs and symptoms related to CTS and were asked if they had previous history or surgery for CTS. The cumulative amount of the keyboard strokes per worker per year was calculated by the use of payroll's registry. Two case definitions for CTS were used. The first included subjects with personal history/surgery for CTS while the second included subjects that belonged to the first case definition plus those participants were identified through clinical examination.
  
  
  RESULTS
  Multivariate analysis used for both case definitions, indicated that those employees with high cumulative exposure to keyboard strokes were at increased risk of CTS (case definition A: OR = 2.23;95 % CI = 1.09-4.52 and case definition B: OR = 2.41; 95%CI = 1.36-4.25). A dose response pattern between cumulative exposure to keyboard strokes and CTS has been revealed (p < 0.001).
  
  
  CONCLUSIONS
  The present study indicated a possible association between cumulative exposure to keyboard strokes and development of CTS. Cumulative exposure to key-board strokes would be taken into account as an exposure indicator regarding exposure assessment of computer workers. Further research is needed in order to test the results of the current study and assess causality between cumulative keyboard strokes and development of CT.
authors.affiliation: Department of Hygiene and Epidemiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 22, Papakyriazi str, Larissa, Thessaly, 41222, Greece. g.rachiotis@gmail.com.
authors.forename: Andreas
authors.initials: A
authors.lastname: Eleftheriou
authors.forename: George
authors.initials: G
authors.lastname: Rachiotis
authors.forename: Socratis E
authors.initials: SE
authors.lastname: Varitimidis
authors.forename: Charilaos
authors.initials: C
authors.lastname: Koutis
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Malizos
authors.forename: Christos
authors.initials: C
authors.lastname: Hadjichristodoulou1