A medical assessment process for a large volume of medico-legal compensation claims for hand-arm vibration syndrome

Lawson, Ian; McGeoch, K. L.

doi:10.1093/occmed/kqg011

Cited by 42 publications

(23 citation statements)

References 12 publications

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“…e) A scoring system to facilitate staging of the sensorineural and vascular components. Further details of the MAP and scoring system have been described elsewhere 1) . f) Staging using Stockholm Workshop Scales (SWS).…”

Section: Department Of Trade and Industry Coal Miners Contractmentioning

confidence: 99%

Diagnostic Criteria and Staging of Hand-Arm Vibration Syndrome in the United Kingdom

McGeoch¹,

Lawson

Burke

et al. 2005

Ind Health

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In the United Kingdom the diagnosis of Hand-arm Vibration Syndrome varies depending on the purpose of that diagnosis. The criteria differ in three situations. More than 100,000 miners and ex-miners with claims for HAVS have been examined using a Medical Assessment Process which included the use of standardised tests. This contract is unique but it has had significant effects on the two other processes. The Industrial Injuries Disablement Benefit Scheme provides a benefit that can be paid to an employed earner because of an accident or Prescribed Disease. New recommendations have been published to remove the anomalies in the present format for assessing HAVS. If implemented the new scheme will recognise the Stockholm Workshop Scales and workers with neurological problems will also be compensated. The Health and Safety Executive will issue new guidance in the near future on the hazards of hand-arm vibration. Health surveillance in the workplace will be fundamental and the HSE propose a tiered approach with levels 1 to 5. Specialist occupational nurses and doctors with training in the diagnosis and assessment of HAVS will be needed for levels 3 and 4. Only at this level may a diagnosis of HAVS be made. The Medical Assessment Process has demonstrated that it is possible to examine a large number of claimants in a standardised manner. The IIAC and HSE recommendations contain very important improvements on the existing positions in the UK and it must be hoped that they will be implemented in the near future.

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Section: Department Of Trade and Industry Coal Miners Contractmentioning

confidence: 99%

Diagnostic Criteria and Staging of Hand-Arm Vibration Syndrome in the United Kingdom

McGeoch¹,

Lawson

Burke

et al. 2005

Ind Health

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“…Using a cold-provocation test (15°C for 5 min) that has been most notably used in the DTI scheme for coalminers' compensation 5) , the median time to rewarm by 4°C increased in individuals with HAVS stage 2/3V but was not found to be statistically significantly different from controls. This specific combination of outcome metric and cold-provocation has been suggested to be of limited diagnostic value based on the data from the miners' compensation scheme 4,7) .…”

Section: Discussionmentioning

confidence: 99%

“…Mis-classification of cases appears unlikely; individuals were assigned to this group after a prior full HAVS assessment 5) as part of health surveillance rather than within a medicolegal context. Prior to testing these individuals underwent a repeat of the symptom questionnaire of this assessment to confirm their staging.…”

Section: Discussionmentioning

confidence: 99%

“…The recovery of finger skin temperature following the cold-stimulus is used as a measure of responsiveness of the digital blood vessels to the cold stimulus. While there has been many variants of this test 1,2) , the procedure that has been recently used most widely in the UK involves immersion of the hands in 15°C water for 5 min and recording of finger skin tip temperature during recovery using thermocouples [3][4][5] . However, the diagnostic usefulness of this technique has been questioned 4,6,7) .…”

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Cold-Provocation Testing for the Vascular Component of Hand-Arm Vibration Syndrome in Health Surveillance

2006

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Abstract:The aim was to investigate whether the use of infra-red thermography (I-R) and measurement of temperature gradients along the finger could improve the diagnostic accuracy of cold-provocation testing (15°C for 5 min) in vascular hand-arm vibration syndrome (HAVS). Twentyone controls and 33 individuals with stages 2/3V HAVS were studied. The standard measurement of time to rewarm by 4°C (T4°C) and temperature gradients between the finger tip, base and middle (measured using I-R) were calculated. Receiver Operating Characteristics (ROC) analysis to distinguish between the two groups revealed that for T4°C the area under the ROC curve was not statistically significantly different from 0.5 (0.64 95% confidence interval 0.49-0.76). The difference between the tip and middle portion of the finger during the sixth minute of recovery was the most promising gradient with an area of 0.76 (95% confidence interval 0.62-0.87), and sensitivity and specificity of 57.6% and 85.7% respectively. However, this was not significantly different from that for the time to rewarm by 4°C. In conclusion, the cold-provocation test used in this study does not appear to discriminate between individuals with stage 2/3V HAVS and controls and this is not improved by the measurement of temperature gradients along the fingers using I-R.

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“…Though not intended to serve as a 'gold standard' test, the SWS is often used as a reference criterion for investigating the diagnostic utility of objective tests for HAVS [2,[5][6][7][8][9][10][11][12][13]. The subjective nature of the SWS makes it less than ideal for use as either a diagnostic tool or reference criterion.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the hand arm vibration syndrome: thermometry, plethysmography and the Stockholm Workshop Scale

Thompson

House

Manno

2007

Occupational Medicine

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Background The Stockholm Workshop Scale (SWS) provides a staging scheme for hand-arm vibration syndrome (HAVS) based on subjective history. Cold provocation finger thermometry and plethysmography are commonly used objective tests for the vascular component of HAVS. AimTo examine the correlation between the cold provocation tests and SWS vascular stage. A secondary goal was to evaluate the correlation between cold provocation finger plethysmography and thermometry testing. MethodsPatients investigated for HAVS at St Michael's Hospital, Toronto, Ontario, were subjected to the same protocol including a questionnaire, clinical assessment and objective testing. Spearman correlation coefficients were calculated for the vascular tests with the SWS and for the vascular tests themselves. Logistic regression models controlled for age, smoking, use of vasoactive medications and time since last vibration exposure. ResultsOne hundred and thirty-nine patients investigated for HAVS consented to participate in the study. The correlation coefficients for plethysmography (r 5 0.14) and thermometry (r 5 0.18) with the SWS were not statistically significant. Plethysmography and thermometry results were significantly correlated (r 5 0.47, P , 0.001). Logistic regression showed plethysmography and thermometry to weakly predict SWS vascular stage (OR 1.5 and 1.3, respectively). None of the potential confounders had a significant effect in the models. ConclusionThe results of plethysmography and thermometry did not significantly correlate with SWS vascular stage in this study. The objective tests did correlate with each other, suggesting that they are reliable measures of similar phenomena likely related to underlying vascular pathology.

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A medical assessment process for a large volume of medico-legal compensation claims for hand-arm vibration syndrome

Abstract: It is concluded that the MAP is a practical and time-efficient tool for assessing a large volume of claimants with suspected HAVS. Further analysis of the process and staging is required to confirm its validity as a medico-legal examination.

Cited by 42 publications

References 12 publications

Diagnostic Criteria and Staging of Hand-Arm Vibration Syndrome in the United Kingdom

Diagnostic Criteria and Staging of Hand-Arm Vibration Syndrome in the United Kingdom

Cold-Provocation Testing for the Vascular Component of Hand-Arm Vibration Syndrome in Health Surveillance

Assessment of the hand arm vibration syndrome: thermometry, plethysmography and the Stockholm Workshop Scale

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