Evaluation of neurological testing for hand-arm vibration syndrome.

BACKGROUND: The neurological component of hand-arm vibration syndrome (HAVS) uses the Stockholm Workshop Scale sensorineural (SWS SN) stages for classification. Proximal compressive neuropathies are common in HAVS and the symptoms are similar to SN HAVS. The SWS may not be a valid staging tool if a patient has comorbid proximal compression neuropathy. AIMS: To evaluate the prevalence of proximal compression neuropathy in patients presenting for HAVS assessment and examine the association between compressive neuropathies and SWS SN. METHODS: A standardized assessment protocol was used to assess 431 patients for HAVS at St. Michael's Hospital, Toronto, Ontario. The prevalence of median and ulnar compressive neuropathies was determined. The association between proximal compression neuropathies and SWS SN stage (0/1 versus 2/3) was evaluated using Chi-square and Fisher's exact tests as well as multivariable logistic regression. RESULTS: Most patients (79%) reported numbness and 20% had reduced sensory perception (SWS SN Stage 2/3). Almost half (45%) had median neuropathy at the wrist and 7% had ulnar neuropathy. There was no association between the SWS SN stage and median or ulnar neuropathy. CONCLUSIONS: Two neurological lesions should be investigated in patients presenting for HAVS assessment: compressive neuropathy and digital neuropathy. The prevalence of compressive neuropathies is high in patients being assessed for HAVS and therefore nerve conduction studies (NCS) should be included in HAVS assessment protocols. Comorbid proximal neuropathy does not affect the SWS SN stage; therefore, NCS and SWS SN seem to be measuring different neurological outcomes in HAVS patients.

Patient-centred care in an occupational medicine clinic.

BACKGROUND: Patient-centred care (PCC) has been associated with improved patient satisfaction outcomes in a variety of clinical settings. There is a paucity of research addressing the concept of PCC in an occupational medicine context. AIMS: To assess patient perception and compare physician and patient perceptions of patient centredness of the care at a specialty occupational medicine clinic. METHODS: An observational study design using the Patient Perception of Patient Centeredness Questionnaire (PPPC) at an ambulatory tertiary care occupational health clinic. Results were analysed using a standardized coding system. Summary scores were compared to results reported in a primary care setting. Patient and physician scores were compared to detect physician-patient differences in perceived patient centredness of care. RESULTS: Of 47 eligible patients 37 consented to participate and seven were excluded due to incomplete data. Summary scores of patient perceptions of patient centredness were similar but somewhat better than scores reported in a primary care setting. Perceived patient centredness of care was high and there was minimal discordance between patient and physician scores. CONCLUSIONS: This study demonstrated that PCC can be measured in an occupational health setting. In an ambulatory tertiary care occupational health clinic there was a high degree of patient centredness of care which may be explained by a variety of factors. Future research should consider whether similar findings exist in other occupational medicine practice settings.

Health-care barriers for workers with HAVS in Ontario, Canada.

BACKGROUND: Hand-arm vibration syndrome (HAVS) becomes irreversible unless it is identified early and progression prevented. AIMS: To describe the health-care-seeking behaviours of workers with HAVS and barriers to health care. METHODS: We invited all patients assessed for HAVS between 15 January and 27 March 2013 at a hospital-based occupational health clinic (OHC) in Ontario, Canada, to complete a questionnaire asking why and from whom they sought health care, reasons they waited to seek care and barriers they encountered in accessing care. We analysed the data using descriptive statistics. RESULTS: Forty-one (82%) patients agreed to participate. Thirty-seven had confirmed HAVS; 30 (84%) were Stockholm workshop vascular stage 2 or greater and 35 (97%) were sensorineural stage 1 or greater. The commonest employment sectors were construction [21 (57%)] and mining [6 (17%)]. The main reasons for seeking treatment were pain [11 (30%)], finger numbness [8 (22%)] and functional limitations [5 (14%)]. The commonest initial point of health care was the family physician [23 (66%)]. The mean wait between symptom onset and seeking treatment was 3.4 years, while the mean time between onset and OHC assessment was 9 years. Reasons for delay in seeking care were ignorance of the seriousness and irreversibility of HAVS and ability to continue to work. Family physicians suspected HAVS in 17% of cases and recommended job modification in 34%. CONCLUSIONS: Workers with HAVS in Ontario delay seeking health care. Primary care physicians often fail to recognize HAVS. Barriers to health care include ignorance of HAVS and of the importance of prevention.

Vibration-white foot: a case report.

BACKGROUND: Hand-arm vibration syndrome (HAVS) refers to the neurological, vascular and musculoskeletal problems that may arise due to exposure to segmental vibration to the hands. An analogous syndrome may occur in the lower extremities of workers exposed to foot-transmitted vibration. AIMS: This report describes the case of a worker with a history of foot-transmitted vibration exposure presenting with cold intolerance in the feet and blanching in the toes. Case report A 54-year-old miner presented with a chief complaint of blanching and pain in his toes. The worker had a history of foot-transmitted vibration exposure over his 18 year career as a miner, primarily from the operation of vehicle-mounted bolting machines. Cold provocation digital plethysmography showed cold-induced vasospastic disease in the feet, but not in the hands. CONCLUSIONS: This case illustrates a condition descriptively termed 'vibration-white foot': a disease analogous to HAVS arising after segmental vibration exposure to the feet. Further research is required to increase awareness of, and direct preventive efforts for, this potentially debilitating condition.