Defining abnormal cold sensitivity using the Cold Intolerance Symptom Severity questionnaire: a population study

Abstract

Cold sensitivity, a common and disabling sequela of hand injury, can be assessed using the Cold Intolerance Symptom Severity (CISS) questionnaire, rating symptoms on a scale from 4 to 100. The primary objective of this study was to define a clinical cut-off for abnormal cold sensitivity based on the CISS score in a healthy working-age population. The secondary objective was to investigate how age, gender and previous injuries and diseases influence CISS scoring. In this study, 1239 out of 1582 selected healthy subjects of working age living in northern Sweden completed the questionnaire, yielding a response rate of 78%. The 95th percentile for the CISS score was 49.5 for men and 53.0 for women. The effects of age, gender and previous injuries and diseases were minor and not considered clinically relevant. The results support that a CISS score above 50 should be considered as abnormal cold sensitivity.Level of evidence: III.

Keywords: Hand; Sweden; cold exposure; hand-arm vibration; nerve injury; occupational exposure.

Figure 1.

Data collection. Roman numerals describe the stepwise exclusion process from the healthy (Study Group A) to the even healthier subjects (Study Group B). CHINS 1-2: Cold and Health in Northern Sweden questionnaire 1 and 2. HAV: hand-arm vibration.

Figure 2.

Box plots showing total Cold Intolerance Symptom Severity (CISS) scoring for the healthy (Study Group A) and the even healthier subjects (Study Group B), separated by gender. The grey boxes represent interquartile ranges (IQR), the lines across the boxes the medians and the whiskers 1.5 × IQR. Open circles display outliers (beyond 1.5 × IQR), and stars extreme outliers (beyond 3.0 × IQR).

Figure 3.

Distribution of Cold Intolerance Symptom Severity (CISS) scoring, presented as percentage of the total score in healthy subjects (Study Group A).