International consensus criteria for diagnosing and staging hand\u2013arm vibration syndrome

C J M Poole,R House,R House,T Nilsson,S Youakim,A Thompson,A Thompson,I J Lawson,M Bovenzi

doi:10.1007/s00420-018-1359-7

Abstract

PurposeIn the 30 years since the Stockholm Workshop Scale (SWS) was published, the scientific literature on hand–arm vibration syndrome (HAVS) has grown and experience has been gained in its practical application. This research was undertaken to develop an up-to-date evidence-based classification for HAVS by seeking consensus between experts in the field.MethodsSeven occupational physicians who are clinically active and have had work published on HAVS in the last 10 years were asked to independently take part in a three-round iterative Delphi process. Consensus was taken when 5/7 (72%) agreed with a particular statement. Experts were asked to provide evidence from the literature or data from their own research to support their views.ResultsConsensus was achieved for most of the questions that were used to develop an updated staging system for HAVS. The vascular and neurological components from the SWS are retained, but ambiguous descriptors and tests without adequately developed methodology such as tactile discrimination, or discriminating power such as grip strength, are not included in the new staging system. A blanching score taken from photographs of the hands during vasospastic episodes is recommended in place of self-recall and frequency of attacks to stage vascular HAVS. Methods with the best evidence base are described for assessing sensory perception and dexterity.ConclusionsA new classification has been developed with three stages for the clinical classification of vascular and neurological HAVS based on international consensus. We recommend it replaces the SWS for clinical and research purposes.

Highlights

It has been 30 years since the Stockholm Workshop Scale (SWS) was published for the classification of hand–arm vibration syndrome (HAVS) (Gemne et al 1987; Brammer et al 1987)
Consensus was achieved by clinical experts using the Delphi method on several issues related to the assessment and staging of HAVS, enabling a more evidence-based and objective classification to be developed in workers exposed to sufficient hand-transmitted vibration (HTV) to cause HAVS (Table 5)
The photographs serve the purpose of confirming symptom description and that the blanching is of the type associated with Raynaud’s phenomenon (RP)

Summary

Introduction

It has been 30 years since the Stockholm Workshop Scale (SWS) was published for the classification of hand–arm vibration syndrome (HAVS) (Gemne et al 1987; Brammer et al 1987). An improvement on the previous Taylor–Pelmear scale, it contains subjective terms such as ‘occasional’ and ‘frequent’ which can cause difficulty with vascular staging. Concern has previously been expressed about a scale that combines frequency of attacks with extent of blanching (Palmer and Coggon 1997). Factors such as the ambient temperature, whether protective clothing was being worn, or the worker’s ability to accurately report their symptoms can cause difficulty with staging. Since the SWS was published, various clinical and laboratory tests of vascular and sensorineural function have been studied, but their place in clinical practice is unclear. Stage 2 of the sensorineural component requires sensory perception to be reduced, but the modalities for testing and how

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Discussion

Conclusion