Ann Occup Environ Med.  2019 ;31(1):6. 10.1186/s40557-019-0284-x.

Application of cold intolerance symptom severity questionnaire among vibration-exposed workers as a screening tool for the early detection of hand-arm vibration syndrome: a cross-sectional study

  • 1Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033 Republic of Korea.
  • 2Department of Occupational and Environmental Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Institute of Health Science, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeonsangnam-do 52727 Republic of Korea.


The detection rate of hand-arm vibration syndrome (HAVS) is very low in South Korea compared with other countries. The absence of uniform consensus and guidelines for diagnosing HAVS has been presumed to be one of the reasons. The HAVS has various manifestations including cold intolerance and its severity can be measured using the cold intolerance symptom severity (CISS) questionnaire. This study aimed to determine whether the CISS questionnaire, being used as a screening tool, can aid in the early detection of HAVS.
A total of 76 male workers with vibration-induced symptoms were enrolled as the final study participants. To compare the CISS score of healthy individuals, 41 men who had never been exposed to local vibration were included in the study. In addition to the former medical questionnaire, the participants answered the CISS questionnaire. A statistical analysis was conducted to identify the association of CISS scores with vibration induced symptom and to determine its cut off value.
The reliability of the CISS questionnaire was proven to be good, with a total Cronbach's alpha of 0.922. The mean CISS score of the exposed group increased in every vascular stage [stage 0"‰="‰42.6 (18.5); stage 1"‰="‰59.4 (14.1); and over stage 2"‰="‰60.2 (21.6)]. They were significantly higher than that of the non-exposed group. The result was fairly consistent with those in the sensorineural stage. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under curve (AUC) of 30 were 88.5, 65.3, 76.1, 82.1 and 0.769, respectively. From the result of logistic regression, the adjusted odds ratio of both components increased by the CISS score grouped by 30s.
The self-reported CISS questionnaire, used to measure the degree of cold intolerance, showed high agreement with the Stockholm classification of HAVS. Hence, we recommend the use of this questionnaire to assess the level of cold intolerance among vibration-exposed workers and detect individuals who are at risk of vibration-induced impairment with a cutoff value of 30. TRIAL REGISTRATION: IRB No. 2018-07-040-001. Registered on 4 September 2018.


Hand-arm vibration syndrome; Cold intolerance; CISS questionnaire; Screening test

MeSH Terms

Area Under Curve
Cross-Sectional Studies*
Ethics Committees, Research
Hand-Arm Vibration Syndrome*
Logistic Models
Mass Screening*
Odds Ratio
Sensitivity and Specificity
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