Cold Intolerance of the Hand Measured By the Ciss Questionnaire in a Normative Study Population

Abstract

Cold intolerance has been recognized as one of the most disabling sequelae of upper extremity trauma, especially when neurovascular structures are involved. In this study, we aimed to describe cold intolerance in a normative study population, validate the Cold Intolerance Symptom Severity (CISS) questionnaire and define the threshold for abnormal cold intolerance. One hundred and eight volunteers participated in our study. In addition to the CISS score, information about age, gender and previous surgery or trauma to the upper extremity was obtained. There were no volunteers with previous peripheral nerve injury and subjects with a history of Raynaud's disease, upper extremity injury or surgery were excluded (n=40). The CISS scores of the study population (n=68) averaged 12.9 (SD 8.2). Age and gender were not correlated with CISS score. The upper 95% confidence interval of the CISS scores for healthy subjects is about 30. We suggest this value as a threshold for pathological cold intolerance.

Cold Intolerance after Brachial Plexus Nerve Injury

“…Irwin et al showed that patients with a complete median or ulnar nerve injury and a vascular injury had more severe cold intolerance [19]. In healthy uninjured subjects, Ruijs et al found that neither gender nor age was associated with symptoms of cold intolerance [37]. Traynor and MacDermid compared cold water immersion assessment and patientreported questionnaires in healthy uninjured subjects [42].…”

Biomedical and Psychosocial Factors Associated with Disability after Peripheral Nerve Injury

“…Pain may also be associated with cold sensitivity 15,27,28,[64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] . The present study showed that patients with peripheral nerve injury had high levels of cold sensitivity and disability and that disability was predicted by pain and cold sensitivity.…”

“…The CISS was designed to evaluate the patient's sensitivity to exposure to cold 27,28 . The item scores are summed for a total score ranging from 0 to 100; higher scores indicate greater cold sensitivity.…”

“…The item scores are summed for a total score ranging from 0 to 100; higher scores indicate greater cold sensitivity. Good validity and reliability have been shown for the CISS [27][28][29] . The CISS includes questions regarding physical tasks, and some patients did not answer those questions because they were unable to perform those tasks.…”

“…The mean CISS score was 33 ± 26, indicating substantial cold sensitivity. Eighty-one patients (51%) were classified as having abnormal cold sensitivity (a CISS score of >30 28 ). In this study of patients with upper-extremity peripheral nerve injury, excellent internal consistency was found for the DASH (Cronbach alpha = 0.96), PCS (Cronbach alpha = 0.96), PCL-C (Cronbach alpha = 0.93), and CISS (standardized item alpha = 0.95), and good internal consistency was found for the HADS anxiety and depression subscales (Cronbach alpha = 0.83 and 0.82, respectively).…”