JHT READ FOR CREDIT ARTICLE #344. Scientific/Clinical Article Self-management strategies used by patients who are hypersensitive to cold following a hand injury. A prospective study with two years follow-up Tone Vaksvik OT, MSc a, b, * , Ingvild Kjeken OT, PhD b, c , Inger Holm PT, MHA, PhD b, d a Division of Surgery and Clinical Neuroscience, Department of Orthopaedics, Section of Rehabilitation, Oslo University Hospital, Norway b Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway c National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway d Division of Surgery and Clinical Neuroscience, Department of Orthopaedics, Section of Research, Oslo University Hospital, Norway article info Article history: Received 7 March 2014 Received in revised form 27 August 2014 Accepted 10 September 2014 Available online 5 October 2014 Keywords: Self-management strategies Compensatory strategies Heating aids Cold hypersensitivity Cold intolerance Cold sensitivity Hand injury abstract Study design: Prospective cohort study. Introduction: Knowledge of the strategies used by patients with injuries of the hand to manage cold hypersensitivity should guide information given by health-care workers. Purpose: To explore the use of cold-associated self-management strategies in patients with severe hand injuries. Methods: Seventy patients being cold hypersensitive following a hand injury, reported use of strategies to limit cold-induced symptoms in the injured hand(s) and the severity of cold-associated activity limita- tions one and two years after surgery. Results: The patients used several strategies, including clothing (100%), use of own body (movement/use of muscles to produce heat or massage of the fingers) (94%), and heating aids (48%), but were still limited in valued cold-associated activities two years after surgery. The number of patients staying indoors, using heating aids and hand wear indoors and during summer-time increased with severity of cold hyper- sensitivity. Patients both implemented and discontinued different strategies after the first year, but for most strategies, the proportions of users were quite stable. Conclusion: The most common strategies used to limit cold-induced symptoms in the injured hand(s) were clothing and use of own body. Many patients also seemed to benefit from using heating aids. After one year, a number of patients still experimented in finding the best strategies and were still limited in valued cold-associated activities. Level of evidence: 2b. Ó 2015 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. Introduction Cold hypersensitivity implies an abnormally low threshold to elicit cold-associated symptoms and signs and affects the majority of patients sustaining upper-extremity nerve injuries. 1e4 Typical symptoms are pain, aching, numbness, weakness, and stiffness and/or the feeling of coldness in the injured hand upon exposure to mildly cold temperatures and short cooling. 2,5,6 Exaggerated pe- ripheral vasoconstriction, leading to cold skin and a long time to re- warm fingers after cooling, is also common. 7,8 The symptoms impair hand function and may restrict participation in work and leisure activities. 9e11 The condition may arise after any tissue injury in the hand, but severe injuries are associated with more severe cold hypersensitivity. 3,9,12,13 Supporting patients in developing and maintaining effective self-management strategies is an important part of treatment. Self- management strategies can be defined as strategies individuals use “to manage the symptoms, treatments, physical and psychological The paper has not been adapted from a presentation at a meeting, but parts of the content have been presented at Norwegian meetings. This research was supported by 1) a grant from Sophies Minde Ortopedi A/S (8/ 2011), and by 2) Department of Orthopaedics, Section of Rehabilitation Oslo Uni- versity Hospital and 3) by Institute of Health and Society, Faculty of Medicine, University of Oslo. * Corresponding author. Oslo University Hospital, Division of Surgery and Clinical Neuroscience, Department of Orthopaedics, Section of Rehabilitation, 0372 Oslo, Norway. Tel.: þ47 452 40 401. E-mail address: tone.vaksvik@getmail.no (T. Vaksvik). Contents lists available at ScienceDirect Journal of Hand Therapy journal homepage: www.jhandtherapy.org 0894-1130/$ e see front matter Ó 2015 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jht.2014.09.006 Journal of Hand Therapy 28 (2015) 46e52