- Email: [email protected]
Cumulative Trauma Disorders
( RESEARCH FOR THE CLINICIAN
J
A Literature Search Strategy Using the Broad Topic of Carpal Tunnel Syndrome/Cumulative Trauma Disorders Lisa A. Schulz, OTR/L, CHT
Departments of Hand Therap u and Orthopedics , Ulliversity of Massachllsetts Medical Center, Worcester , Massach llsetts
Richard W. Bohannon, EdD, PT, NCS School of A llied Health, Unitersiti; of Connecticut, Storrs , Connecticut
hera pists have an obligation to stay abreast
T of cha nges, adva nces, and new information
that is published abo u t th e pa tien t p opulati ons th ey treat. They may also be required to search th e literature to obtain backg round informati on abo u t a top ic prior to mak ing a pr esentati on or beginning a resea rch study . The most current in for ma tion is u su ally found in journa ls and othe r periodical literature. Given the large number of Eng lish and for eign langu age per iodicals th at contain informa tio n abo u t th e hand and th e up per extre mity, it can be an ove rw he lmi ng task to find informa tion abo u t spe cific topics wi thi n these periodi cals. Altho ug h th e advent of computerized indexes has mad e th is tas k easier, th e availability of man y d iffer ent indexes, w ith dat ab ases including articles from only a select gro up of periodicals, complicates th e process. Therefore, a systematic approach is necessar y to mak e a literature search managea ble and effective. Once a liter ature sea rch has been cond ucte d to ide ntify rece ntly publish ed in form at ion, th e th erapi st also has access to pertinent re fere nces for ea rlie r or origina l wo rk related to the topi c via th e refe re nce lists and bibliogra phies included in the articles . This earlier wo rk is ofte n th e fou nda tio n on w hich th e cur rent work is based and it is critical th at th ese referen ces be reviewed by th er api st s . Other au tho rs ha ve d escrib ed both stra teg ies and outcomes of a ttem pts to iden tify liter ature relevant to topi cs as di ver se as gerontology, physiotherap y, and ga i t.l - ~ Th e purpose of th is article is to describe and review th e res u lts of a search stra tegy for obtain ing info rma tion abo u t th e top ic of carpa l tunnel synd rome/cu mu lative trauma d iso rde rs.
Cor respo ndence and reprin t req ue sts to Lisa A. Schulz, OTR/L, CHT, De partment of Hand Therapy, Unive rsity of Massachusetts Medi cal Ce nter, 55 Lake Ave nue Nor th, Worcester, MA 01655.
212
JO URN A L OF HAN D TH ERA PY
ABSTRACT: Searchin g the pe riodical literatur e for in form atio n relevant to a spe cific topic or diagnosis is an ac tivity th at mu st be undert aken by most thera pist s at one time o r another. A literature sea rch can be inco mp lete and pe rform ing it excessively time con su mi ng unless a care fully plann ed search stra tegy is employe d . This ar ticle pr esents th e p rocess and th e res u lts of a liter ature sea rch of the broad top ic of carpal tunnel sy ndrome /cu mu lative traum a disorders. Th e search in volved bo th com p ute rize d and print ed ind exes . J HAND THE R 8:212- 213, 1995.
The typ e of search stra tegy used by a th erapist is influen ced by th e resources ava ilable to him or her. Most med ical libraries have at least one medi cal index that is eithe r on-l ine or on compact d isk-read only mem or y (CD-ROM) . Other indexes may be availabl e in a printed form . Fortunately, most of the computerized indexes ar e " user friendly, " with menus and " help" scree ns to guide th e searcher through th e literature sea rch process . The med ical school librar y at w hich thi s search strategy was em ployed has both com pu terize d and standard indexes . Three indexes we re u sed for th e literature sea rch : tw o com p u te rize d ind exes on COROM, MEOLINE (the electro nic ve rs ion of Index MediClls) and th e Cumulat ive Index to Nursin g and Allied Health (CINA HL), and one printed index, th e Science Citation Index. Th e computer syste m u sed for th e electronic indexes was th e CD Plu s -1990 (CD Plu s, New York, NY). The sea rch option s ava ilable for both MEOLINE a nd CI NA H L o n th is sys te m in clu de d free- tex t searc hes usin g key wo rds, terms, or phrases. Addition al op tions are available to further de fine and limit sea rches con ducted usi ng th e electronic indexes. For exam ple, searches can be lim ited to spe cific tim e period s, typ es of ar ticles (e.g ., review articles on ly), and lan gu age (e.g. , Eng lish only). A su bject category wa s used to search th rough th e Science Citation Index by hand . The sea rch stra tegy u sed with both MEOLINE and CIN AHL included a search of titles and ab stracts for key wo rds or phrases. For th e title search, th e key phrases of "carpa l tunnel sy ndrome" an d " re petition strain injury" we re in itially en tered . Within these subject areas, th e syste m generated a n umber of catego ries by w hic h to limit or fu rther defin e th e search . For th is aspect of th e search, th e subject was' limited to th e following areas: com p lications, congenital, diagnosis, drug th erapy, eco nomics, epide miology, etiology, ge ne tic, history, nursing, pathol-
og y, ph ysiopathology, prevention and control, rehabilitation, surgery, therapy, and ps ychology. For the abstract search , th e topics of "carpal tunnel synd rome," "repetition strain injury," and "c~ mulative trauma disorder" wer e entered. No additional information wa s used to further limit the search . . When using th e Science Citation Index, the subjects of carpal tunnel syndrome and c~mulative tra~~a (disorders ) were searched . Th e subject of repetition strain injury wa s not u seful with thi s . index: T~e " manual" search performed with the SCience Citation Index wa s more tedious than were the computerized searches. The Science Citation Index is available on disk at some institutions, and this makes it much ea sier and less time consumin g to us e. Du e to the large volume of articles written about . the top ic of carpal tunnel syndrome and cumulative trauma disorders, all the searches were limited to the years 1990 to 1992 inclusive. Althou~h !his time period represents only 3 years of publication, we concluded that it would provide a representative sample of the articles published and indexed about this subject. The search strategy could be expanded or further narrowed to focu s on spe cific years of publication . The MEDLINE search yielde d 559 reference s, with 104 (18.6%) con sidered inappropriate. The articles that were not applicable to th e topic of carpal tunnel synd rome/cu m ulative trauma disorders focused on lower extremity cumulative trauma di sorders (obtain ed most likely through th e abstract search for cumulative trauma disorders) or complications secondary to dial ysis. The 455 rele vant reference s obtained through MEDLINE con sisted of both ori~inal and review articles . Thirty references w ere obtained usin g CINAHL. All of th e references generated through CINAHL were relevant to the topic. Through the Science Citation Index, 116 refer ences were obtained . When th e three lists were combined and repetition s eliminated , 485 relevant references had been generated. Using the MEDLINE list as the base, 19 additional unique references wer e ge nerated from the Science Citation Index and 11 from CINAHL. If the list of 485 references is consid ered all inclusive of the literature, the MEDLINE se arch identified 93.8%, the Science Citation Index 23.9%, and CIN AHL 6.2%. A combined search of MEDLINE and th e ScienceCitation Index identified 97.7 % of th e availabl e references, and a combined search of MEDLINE and CINAHL identified 96.1% of the references. There ar e other topical indexes not as readily available as MEDLINE, CIN AHL , and th e Science Citaiion Index that ma y also contain a rticles pertinent to the topic of carpal tunnel sy nd rome/cu m ulative trauma dis orders . Among such indexes are those of the British Librar y (e.g. , Ph ysiotherapy Index, Occupationa l Therapy Index, and Rehabilitation Inde~) and Excerpta Medica (Ph ysical Medicine and Rehabilitation, Section 19). In the combined search conducted using these thr ee inde xes th ere were 179 different journals identified that contained articles relevant to the topic of carpa l tunnel synd rome or upper extremity cumu-
TABLE 1.
The Journals Most Frequently Cited in This Literature Search N o. Citations
Journal journal of Hand Surgery Journal of Occupational Medicine Muscle and Nerve Archil1es of Physical Medicine and Rehabilitation . Medical journal of A ustralia Annales de Chirurgie de la Main et du Mem/Jre Superieur Occupational Health and Safety Helvetica Chirurgica Acta ' . . Handchirurgie, Mikrochirurgie, Plastischc Chirurgie Journalof Bone and joint Surgery American journal of Industrial Medicine Hand Clinics Australian Family Physician Lancet Annals of Internal Medicine Ergo/lOmics Aao/Ill journal [ournal of Dental Hygiene American journal of Public Health Electromyography and Clinical Neurophysiology Clinical Orthopaedics and Related Research JAMA Electroencephalography and Clinical Neurophysiology
64 14 13 11 10 10 9 8 8 7 7 6 6
5 5 5 5 5 5 5 5 5 5
lative trauma disorders . Th e journal mo st frequ ently cited was the lourna! of Hand Surgery, with 64 citation s. The importance of u sin g mor e than one ind~x for the search is exemplified by the fact that thi s journal was not identified in th e CINAHL sea rch. The CINAHL search, however, did list refer en ces from journals not indexed by MEDLINE or the Sc~ence Citation Index, e.g ., Phusician Assistant, OccupatlO/.wl Health-London, [ournal of Rehabilitation, and Canadian loumal of Occupational Therapy. Tabl e 1 lists th e journals most frequently cited in thi s literature sea rch. The indexes in w hich a spe cific journal is referenced may also change. For example, at the time this search was done, the [ournal of Hand Therapy wa s ind exed in CINAHL, but not in MEDLINE . Currently, however, it is indexed i~ both CINAH~ and MEDLINE, as well as in th e pnnted Index Medicus. This list of journals is indi cative of the wid e ran ge of periodicals that contain information rele.vant to th e topic of carpal tunnel sy nd rome /cu m u lative trauma disorders. Once a list of core journals is gener at ed , then the yearly indexes of those journals can be scanned for current references to ad d to the dat ab ase . The more the literature search can be limited or focused to the specific area of interest , th e more u seful the citation list and journal list ge ne rated through the search will be to th e u ser. A focu sed search strategy and the use of appropriat e indexes will facilitate the process.
REFERENCES I. Boh annon RW: Core jou rna ls of ph ysioth erapy. Ph ysioth er Prac t
3:126- 128, 1987. 2. Lusa rdi MM , Rob erts D, Boha n no n RW, Sea to n PC: Journals publish in g info rma tion relevan t to ger.on tology a nd its cov e rage by fou r bibli ographic ind exes . Tl~ P Ce ria tr Reh abIi 7:75-88, 1992. 3. Shearer BS, Wall [C, Burnham JI·; Ana to my of a liter ature sea rch. Clin Man age 12:23 - 31, 1992.
JUly - September 1995
213
J
A Literature Search Strategy Using the Broad Topic of Carpal Tunnel Syndrome/Cumulative Trauma Disorders Lisa A. Schulz, OTR/L, CHT
Departments of Hand Therap u and Orthopedics , Ulliversity of Massachllsetts Medical Center, Worcester , Massach llsetts
Richard W. Bohannon, EdD, PT, NCS School of A llied Health, Unitersiti; of Connecticut, Storrs , Connecticut
hera pists have an obligation to stay abreast
T of cha nges, adva nces, and new information
that is published abo u t th e pa tien t p opulati ons th ey treat. They may also be required to search th e literature to obtain backg round informati on abo u t a top ic prior to mak ing a pr esentati on or beginning a resea rch study . The most current in for ma tion is u su ally found in journa ls and othe r periodical literature. Given the large number of Eng lish and for eign langu age per iodicals th at contain informa tio n abo u t th e hand and th e up per extre mity, it can be an ove rw he lmi ng task to find informa tion abo u t spe cific topics wi thi n these periodi cals. Altho ug h th e advent of computerized indexes has mad e th is tas k easier, th e availability of man y d iffer ent indexes, w ith dat ab ases including articles from only a select gro up of periodicals, complicates th e process. Therefore, a systematic approach is necessar y to mak e a literature search managea ble and effective. Once a liter ature sea rch has been cond ucte d to ide ntify rece ntly publish ed in form at ion, th e th erapi st also has access to pertinent re fere nces for ea rlie r or origina l wo rk related to the topi c via th e refe re nce lists and bibliogra phies included in the articles . This earlier wo rk is ofte n th e fou nda tio n on w hich th e cur rent work is based and it is critical th at th ese referen ces be reviewed by th er api st s . Other au tho rs ha ve d escrib ed both stra teg ies and outcomes of a ttem pts to iden tify liter ature relevant to topi cs as di ver se as gerontology, physiotherap y, and ga i t.l - ~ Th e purpose of th is article is to describe and review th e res u lts of a search stra tegy for obtain ing info rma tion abo u t th e top ic of carpa l tunnel synd rome/cu mu lative trauma d iso rde rs.
Cor respo ndence and reprin t req ue sts to Lisa A. Schulz, OTR/L, CHT, De partment of Hand Therapy, Unive rsity of Massachusetts Medi cal Ce nter, 55 Lake Ave nue Nor th, Worcester, MA 01655.
212
JO URN A L OF HAN D TH ERA PY
ABSTRACT: Searchin g the pe riodical literatur e for in form atio n relevant to a spe cific topic or diagnosis is an ac tivity th at mu st be undert aken by most thera pist s at one time o r another. A literature sea rch can be inco mp lete and pe rform ing it excessively time con su mi ng unless a care fully plann ed search stra tegy is employe d . This ar ticle pr esents th e p rocess and th e res u lts of a liter ature sea rch of the broad top ic of carpal tunnel sy ndrome /cu mu lative traum a disorders. Th e search in volved bo th com p ute rize d and print ed ind exes . J HAND THE R 8:212- 213, 1995.
The typ e of search stra tegy used by a th erapist is influen ced by th e resources ava ilable to him or her. Most med ical libraries have at least one medi cal index that is eithe r on-l ine or on compact d isk-read only mem or y (CD-ROM) . Other indexes may be availabl e in a printed form . Fortunately, most of the computerized indexes ar e " user friendly, " with menus and " help" scree ns to guide th e searcher through th e literature sea rch process . The med ical school librar y at w hich thi s search strategy was em ployed has both com pu terize d and standard indexes . Three indexes we re u sed for th e literature sea rch : tw o com p u te rize d ind exes on COROM, MEOLINE (the electro nic ve rs ion of Index MediClls) and th e Cumulat ive Index to Nursin g and Allied Health (CINA HL), and one printed index, th e Science Citation Index. Th e computer syste m u sed for th e electronic indexes was th e CD Plu s -1990 (CD Plu s, New York, NY). The sea rch option s ava ilable for both MEOLINE a nd CI NA H L o n th is sys te m in clu de d free- tex t searc hes usin g key wo rds, terms, or phrases. Addition al op tions are available to further de fine and limit sea rches con ducted usi ng th e electronic indexes. For exam ple, searches can be lim ited to spe cific tim e period s, typ es of ar ticles (e.g ., review articles on ly), and lan gu age (e.g. , Eng lish only). A su bject category wa s used to search th rough th e Science Citation Index by hand . The sea rch stra tegy u sed with both MEOLINE and CIN AHL included a search of titles and ab stracts for key wo rds or phrases. For th e title search, th e key phrases of "carpa l tunnel sy ndrome" an d " re petition strain injury" we re in itially en tered . Within these subject areas, th e syste m generated a n umber of catego ries by w hic h to limit or fu rther defin e th e search . For th is aspect of th e search, th e subject was' limited to th e following areas: com p lications, congenital, diagnosis, drug th erapy, eco nomics, epide miology, etiology, ge ne tic, history, nursing, pathol-
og y, ph ysiopathology, prevention and control, rehabilitation, surgery, therapy, and ps ychology. For the abstract search , th e topics of "carpal tunnel synd rome," "repetition strain injury," and "c~ mulative trauma disorder" wer e entered. No additional information wa s used to further limit the search . . When using th e Science Citation Index, the subjects of carpal tunnel syndrome and c~mulative tra~~a (disorders ) were searched . Th e subject of repetition strain injury wa s not u seful with thi s . index: T~e " manual" search performed with the SCience Citation Index wa s more tedious than were the computerized searches. The Science Citation Index is available on disk at some institutions, and this makes it much ea sier and less time consumin g to us e. Du e to the large volume of articles written about . the top ic of carpal tunnel syndrome and cumulative trauma disorders, all the searches were limited to the years 1990 to 1992 inclusive. Althou~h !his time period represents only 3 years of publication, we concluded that it would provide a representative sample of the articles published and indexed about this subject. The search strategy could be expanded or further narrowed to focu s on spe cific years of publication . The MEDLINE search yielde d 559 reference s, with 104 (18.6%) con sidered inappropriate. The articles that were not applicable to th e topic of carpal tunnel synd rome/cu m ulative trauma disorders focused on lower extremity cumulative trauma di sorders (obtain ed most likely through th e abstract search for cumulative trauma disorders) or complications secondary to dial ysis. The 455 rele vant reference s obtained through MEDLINE con sisted of both ori~inal and review articles . Thirty references w ere obtained usin g CINAHL. All of th e references generated through CINAHL were relevant to the topic. Through the Science Citation Index, 116 refer ences were obtained . When th e three lists were combined and repetition s eliminated , 485 relevant references had been generated. Using the MEDLINE list as the base, 19 additional unique references wer e ge nerated from the Science Citation Index and 11 from CINAHL. If the list of 485 references is consid ered all inclusive of the literature, the MEDLINE se arch identified 93.8%, the Science Citation Index 23.9%, and CIN AHL 6.2%. A combined search of MEDLINE and th e ScienceCitation Index identified 97.7 % of th e availabl e references, and a combined search of MEDLINE and CINAHL identified 96.1% of the references. There ar e other topical indexes not as readily available as MEDLINE, CIN AHL , and th e Science Citaiion Index that ma y also contain a rticles pertinent to the topic of carpal tunnel sy nd rome/cu m ulative trauma dis orders . Among such indexes are those of the British Librar y (e.g. , Ph ysiotherapy Index, Occupationa l Therapy Index, and Rehabilitation Inde~) and Excerpta Medica (Ph ysical Medicine and Rehabilitation, Section 19). In the combined search conducted using these thr ee inde xes th ere were 179 different journals identified that contained articles relevant to the topic of carpa l tunnel synd rome or upper extremity cumu-
TABLE 1.
The Journals Most Frequently Cited in This Literature Search N o. Citations
Journal journal of Hand Surgery Journal of Occupational Medicine Muscle and Nerve Archil1es of Physical Medicine and Rehabilitation . Medical journal of A ustralia Annales de Chirurgie de la Main et du Mem/Jre Superieur Occupational Health and Safety Helvetica Chirurgica Acta ' . . Handchirurgie, Mikrochirurgie, Plastischc Chirurgie Journalof Bone and joint Surgery American journal of Industrial Medicine Hand Clinics Australian Family Physician Lancet Annals of Internal Medicine Ergo/lOmics Aao/Ill journal [ournal of Dental Hygiene American journal of Public Health Electromyography and Clinical Neurophysiology Clinical Orthopaedics and Related Research JAMA Electroencephalography and Clinical Neurophysiology
64 14 13 11 10 10 9 8 8 7 7 6 6
5 5 5 5 5 5 5 5 5 5
lative trauma disorders . Th e journal mo st frequ ently cited was the lourna! of Hand Surgery, with 64 citation s. The importance of u sin g mor e than one ind~x for the search is exemplified by the fact that thi s journal was not identified in th e CINAHL sea rch. The CINAHL search, however, did list refer en ces from journals not indexed by MEDLINE or the Sc~ence Citation Index, e.g ., Phusician Assistant, OccupatlO/.wl Health-London, [ournal of Rehabilitation, and Canadian loumal of Occupational Therapy. Tabl e 1 lists th e journals most frequently cited in thi s literature sea rch. The indexes in w hich a spe cific journal is referenced may also change. For example, at the time this search was done, the [ournal of Hand Therapy wa s ind exed in CINAHL, but not in MEDLINE . Currently, however, it is indexed i~ both CINAH~ and MEDLINE, as well as in th e pnnted Index Medicus. This list of journals is indi cative of the wid e ran ge of periodicals that contain information rele.vant to th e topic of carpal tunnel sy nd rome /cu m u lative trauma disorders. Once a list of core journals is gener at ed , then the yearly indexes of those journals can be scanned for current references to ad d to the dat ab ase . The more the literature search can be limited or focused to the specific area of interest , th e more u seful the citation list and journal list ge ne rated through the search will be to th e u ser. A focu sed search strategy and the use of appropriat e indexes will facilitate the process.
REFERENCES I. Boh annon RW: Core jou rna ls of ph ysioth erapy. Ph ysioth er Prac t
3:126- 128, 1987. 2. Lusa rdi MM , Rob erts D, Boha n no n RW, Sea to n PC: Journals publish in g info rma tion relevan t to ger.on tology a nd its cov e rage by fou r bibli ographic ind exes . Tl~ P Ce ria tr Reh abIi 7:75-88, 1992. 3. Shearer BS, Wall [C, Burnham JI·; Ana to my of a liter ature sea rch. Clin Man age 12:23 - 31, 1992.
JUly - September 1995
213