Self-reported cold sensitivity in normal subjects and in patients with traumatic hand injuries or hand-arm vibration syndrome

Abstract

Background: Cold sensitivity is a common and disabling complaint following hand injuries. The main purpose of this study was to describe self-reported consequences of cold sensitivity and the association with disability and health-related quality of life in patients with hand injuries or hand-arm vibration syndrome (HAVS) and in normal subjects.

Methods: Responses to the Cold Intolerance Symptom Severity (CISS) questionnaire, Potential Work Exposure Scale (PWES), Disability of the Arm, Shoulder and Hand (DASH) and Short-Form 36 questionnaire (SF-36) were investigated in normal subjects (n = 94), hand injured patients (amputation and nerve injuries, n = 88) and patients with HAVS (n = 30). The results are presented as median (range), percent and mean deviation from norms. The Kruskal Wallis Test or Mann-Whitney U-Test were used to identify significant differences between multiple groups or subgroups. The Spearman rank correlation was used to study the relationship between cold sensitivity and disability.

Results: Abnormal cold sensitivity (CISS score > 50) was seen in 75% and 45% of patients with HAVS and a traumatic hand injury, respectively. Patients were significantly more exposed to cold in their work environment than the normal population, with a consequently negative effect on work ability due to cold sensitivity. Patients with abnormal cold sensitivity were more seriously disabled and had a poorer health-related quality of life than patients with normal cold sensitivity [higher DASH scores and e.g. significantly larger mean deviation from norms in the subscales Role Physical and Bodily Pain (SF-36)].

Conclusion: Severe and abnormal cold sensitivity may have a profound impact on work capacity, leisure, disability and health-related quality of life. It is frequently seen in patients with traumatic hand injuries and particularly apparent in patients with HAVS.

Figure 1

Cold Intolerance Symptom Severity (CISS) score in subgroups. The cut-off for abnormality is based on the 95^th percentile of the highest CISS scores in the normal population [6]). An abnormal CISS score was seen in 39/86 (45%) patients with a traumatic hand injury and in 21/28 (75%) of patients with HAVS. Patients with HAVS had significantly higher CISS scores than patients with traumatic hand injury (p = 0.004).

Figure 2

Perceived problems on exposure to cold. Perceived problems [bars representing median values (q₁-q₃)] on exposure to cold (Question 1 in the CISS questionnaire, not included in the total score) in patients with a traumatic hand injury or HAVS and in normal subjects. 0 = no symptoms/trouble at all and 10 = the most severe symptoms/trouble you can possibly imagine. *Significant differences between patients with a traumatic hand-injury and HAVS were noted for weakness (p = 0.022), numbness (p = 0.016), aching (p = 0.001) and pain (p = 0.001).

Figure 3

DASH scores. DASH scores for patients with a traumatic hand injury or HAVS divided into subgroups with normal versus abnormal CISS scores. Patients with HAVS had overall significantly higher DASH scores than patients with traumatic hand injuries (0 = 0.001). Patients with abnormal CISS scores had significantly higher DASH scores indicating more severe disability than those with normal CISS scores (p = 0.001).

Figure 4

A Health-related quality of life (SF-36) in patients with traumatic hand injury compared to normal values and B - Health-related quality of life (SF-36) in patients with HAVS compared to normal values. A: Mean deviation from norms (95% CI) for patients with a traumatic hand injury with normal (n = 47) and abnormal (n = 39) CISS scores. Patients with abnormal CISS scores had significantly larger mean deviations from norms than patients with normal CISS scores in the subscales; Physical Functioning p = 0.041, Role Physical p = 0.003 and Bodily Pain p = 0.001, indicating poorer health-related quality of life. Normative data with comparable gender and age distribution and was distributed by the Health Related Quality of Life group in Gothenburg, Sweden http://www.hrql.se. B: Mean deviation from norms (95% CI) for patients with HAVS with normal (n = 7) and abnormal (n = 21) CISS scores. Patients with abnormal CISS scores had significantly larger mean deviations from norms than patients with normal CISS scores in the subscales; Role Physical p = 0.036, Bodily Pain p = 0.006, Vitality p = 0.03 and Mental Health p = 0.048, indicating poorer health-related quality of life. Normative data with comparable gender and age distribution and was distributed by the Health Related Quality of Life group in Gothenburg, Sweden http://www.hrql.se.