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. 2017 Jul 26;9(7):609–619. doi: 10.4330/wjc.v9.i7.609

Table 5.

Cold Intolerance symptoms severity Questionnaire

Questions Score
Which of the following symptoms of cold intolerance do you experience in your injured limb on exposure to cold?
Pain, numbness, stiffness, weakness, aching, skin colour change (white/bluish white/blue)
How often do you experience these symptoms? (Please tick)
Continuously/all the time
Several times a day
Once a day
Once a week
Once a month or less
Never
When you develop cold induced symptoms, on your return to a warm environment are the symptoms relieved? (Please tick)
Not applicably
Within a few minutes
Within 30 min
After more than 30 min
What do you do to ease or prevent your symptoms occurring? (Please tick)
Take no special action
Keep hand in pocket
Wear gloves in cold weather
Wear gloves all the time
Avoid cold weather/stay indoors
Other (please specify)
How much does cold bother your injured hand in the following situations? (Please score 0-10)
Holding a glass of ice water
Holding a frozen package from the freezer
Washing in cold water
When you get out of a hot bath/shower with air room temperature
During cold wintry weather
Please state how each of the following activities have been affected as a consequence of cold induced symptoms in your injured hand and score each (please score 0-4)
Domestic chores
Hobbies and interests
Dressing and undressing
Tying your