Cold Sensitivity in injured and normal hands. Consequences for daily life

Abstract: Cold sensitivity is a common and persistent complaint after various hand injuries and diseases. The general aim of the thesis was to investigate the consequences of cold sensitivity for daily life in patients with traumatic hand injuries and hand-arm vibration syndrome (HAVS). To obtain a richer and more comprehensive picture reflecting the aim, studies with a quantitative and a qualitative design were performed. Questionnaires comprising patients’ experience of cold sensitivity were translated into Swedish according to the cross-cultural adaptation process and content and construct validity, internal consistency and test-retest reliability were established. In addition, a cut-off for abnormal cold sensitivity was defined as a total score > 50 on the Cold Intolerance Symptom Severity (CISS) questionnaire based on a normal population. Patients with abnormal self-reported cold sensitivity were more seriously disabled and had a poorer health-related quality of life than patients with normal cold sensitivity. The engagement in occupations was limited because of cold induced symptoms despite access to relieving strategies. The consequences and adaptation in daily life meant a change of occupational patterns and performance, a struggle with self-image and a change in life roles. Factors associated with abnormal cold sensitivity after a hand injury were a larger number of repaired vessels and use of vascular grafts at reconstruction, presence of trauma to bones and a high HISS score, suggesting multifactorial causes of cold sensitivity. Behavioural treatment offered relief to a majority of patients with a traumatic hand injury in contrast to patients with HAVS. Patients with HAVS had in comparison to hand injured patients overall significantly more severe problems with cold sensitivity.