Occupational Medicine Advance Access originally published online on June 20, 2008
Occupational Medicine 2008 58(6):431-435; doi:10.1093/occmed/kqn075
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The validity of Raynaud's phenomenon symptoms in HAVS cases
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Background Raynaud's phenomenon, a common manifestation of the hand–arm vibration syndrome (HAVS), is typically diagnosed by a subjective history provided by employees.
Aim This study evaluates the validity of the subjective history of Raynaud's phenomenon provided by individuals applying for compensation for HAVS.
Methods Thirty-six workers with a history of occupational hand–arm vibration exposure who were labelled as having Raynaud's phenomenon were asked to photographically document their finger symptoms before undergoing a detailed clinical assessment. Each individual was provided with a disposable camera and instructions. Returned photographs were reviewed for signs of Raynaud's phenomenon. The reliability of photograph interpretation was tested with three physicians and a non-physician.
Results Inter and intra-rater reliability was very good, Kappa coefficient >0.80. Six individuals (17%) did not return cameras. Thirty individuals provided photographs and underwent a clinical evaluation. The photographs of 13 individuals (43%) did not show Raynaud's phenomenon and for four of these the diagnosis was not supported by careful symptom history. Seventeen individuals (57%) had photographic evidence of Raynaud's phenomenon.
Conclusions A presenting history of Raynaud's phenomenon in workers seeking compensation for HAVS may not be accurate since approximately half the cases are unable to provide objective photographic evidence of Raynaud's phenomenon.
Keywords Blanching; hand–arm vibration syndrome; photography; Raynaud's phenomenon; vibration white finger
Correspondence to: Sami Youakim, PO Box 53507, Broadmead RPO, Victoria, BC V8X 5K2, Canada. Tel: +1 250 858 1559; fax: +1 250 658 9451; e-mail: syouakim{at}telusplanet.net