title: Self-reported cold sensitivity in patients with traumatic hand injuries or hand-arm vibration syndrome - an eight year follow up.
abstract: BACKGROUND
  Cold sensitivity is a common complaint following hand injuries. Our aim was to investigate long-term self-reported cold sensitivity, and its predictors and the importance of sense of coherence (SOC), 8 years after a hand injury as well as in patients treated for Hand Arm Vibration Syndrome (HAVS) during the same time period.
  
  
  METHODS
  Responses to the Cold Intolerance Symptom Severity (CISS) questionnaire and the Sense of Coherence (SOC) questionnaire were investigated in hand injured patients (n = 64) and in patients with HAVS (n = 26). The Mann-Whitney U-Test was used to identify significant differences between subgroups. When analysing predictors for cold sensitivity severity, the Spearman rank correlation (rS coefficient) were used for quantitative predictive variables, Mann-Whitney U-Test for dichotomous variables and Kruskal-Wallis Test for multiple categorical data. The Wilcoxon's signed rank test was used to investigate longitudinal changes in outcome.
  
  
  RESULTS
  There was a significant change in total CISS score for patients with traumatic hand injury, indicating fewer problems with cold sensitivity over time. Symptoms, such as stiffness, weakness and skin colour change on cold exposure, caused fewer problems, but perceived pain/aching and numbness remained unchanged as well as time needed for relief of symptoms on return to a warm environment. The negative impact of cold sensitivity on daily activities and at work was reduced, but problems when engaged in hobbies or when being exposed to cold wintry weather remained unchanged. None of the investigated predictors related to the hand injury were significantly associated with a change in cold sensitivity at the 8-year follow up. In contrast, no significant change in cold sensitivity was noted in the patients with HAVS for any of the situations included in the CISS questionnaire. A lower sense of coherence score correlated significantly with worse cold sensitivity (CISS score) in both patient groups.
  
  
  CONCLUSIONS
  The negative impact of cold sensitivity on daily life was reduced for patients with traumatic hand injury, but did not change over time in patients with HAVS. A low SOC is associated with worse cold sensitivity in such groups of patients. Information about relieving strategies should be provided for patients with cold sensitivity.
authors.affiliation: Department of Hand Surgery, Skane University Hospital, Lund University, Malmö, SE-205 02, Sweden. ingela.k.carlsson@hotmail.com.
authors.forename: Ingela K
authors.initials: IK
authors.lastname: Carlsson
authors.forename: Lars B
authors.initials: LB
authors.lastname: Dahlin
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000673:Amputation, Traumatic / Q000150:complications; D003080:Cold Temperature / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000150:complications*; D053421:Hand-Arm Vibration Syndrome / Q000150:complications*; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D057566:Self Report; D060685:Sense of Coherence; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires; D063189:Symptom Assessment