Objectives: To compare the results of questionnaire screening with those of objective testing in the identification of vibration white finger (VWF) in a high risk population.
Methods: Three groups of men (79 riveters, 52 healthy controls and 79 compensation claimants) were assessed for VWF by a detailed questionnaire covering occupational and general medical history and incorporating specific questions related to the presence or absence of relevant symptoms in their hands. Each then underwent provocative cold testing under controlled conditions using established protocols. The presence or absence of digital vasospasm following cooling was determined by finger systolic pressure measurements using laser Doppler flowmetry. The test protocols used have been evaluated in patients with a clear clinical diagnosis of non-occupational Raynaud's syndrome.
Results: 6.3% of the riveters and 83.5% of the claimants reported specific Raynaud's syndrome symptoms but 30.4% of the riveters and only 19% of the claimants tested positive for vasospasm after middle phalangeal cooling to 10 degrees C for 5 min. Using a more severe cooling protocol provoked vasospasm in 46.8% of the claimants. Lack of sensitivity or specificity of the objective testing could not explain the large discrepancies between the findings in the riveters and in the claimants.
Conclusions: Questionnaire responses concerning VWF symptoms can be influenced by the context in which they are recorded. It is important to employ more objective methods in assessing all workers at risk of developing VWF.