Vocational rehabilitative decisions after symptoms and findings consistent with hand-arm vibration syndrome in the Swedish surveillance system - a mixed-method design.

Background: EU workers exposed to hand-arm vibration should be offered health surveillance to detect early symptoms, and findings, of Hand-Arm Vibration Syndrome (HAVS). To execute the mandatory vocational rehabilitation, the employer needs to be aware of injuries found in the medical check-up. We aimed to analyse: 1) How physicians graded the neurosensory component of HAVS on the Stockholm Workshop Scale (SWS), compared to semi-objective findings. 2) What vocational rehabilitative decisions (VRD) were taken by physicians after examinations. 3) Whether the VRDs differed in relation to the SWS-grading.

Methods: Data came from 660 medical records - all examinations performed during twelve consecutive months in one large Swedish occupational healthcare company. 572 individuals had data on the SWS from the physician. For the qualitative analysis, we used the inductive-iterative immersion-crystallization method.

Results: 60% of the examined workers had symptoms and 32% had semi-objective findings consistent with HAVS. The physicians' SWS gradings were underestimated in 59% of the cases with semi-objective findings. The VRDs were classified, relative to communication with the employer, as: "Adequate" (57%), when no injury was present, communication had already taken place, was planned, or was no longer needed in the absence of further exposure, "Semi-adequate" (18%), if no plan for communication was yet established or only communicated through a document with a shorter time until next check-up, and "Inadequate"(25%), when patients refused (20%), or physicians failed to communicate with the employer, despite findings (80%). Underestimated SWS-gradings of HAVS were significantly associated with more "Inadequate" VRDs in the group with semi-objective findings.

Conclusions: Occupational physicians underestimate the number of individuals with SWS 2-3 compared with semi-objective findings and regularly fail to communicate to the employer despite findings of HAVS. The underestimation of SWS-grading, followed by inadequate VRDs, excludes many workers from the employer's mandatory protective measures which may lead to aggravation of an untreatable injury in the affected individual and development of HAVS in their similarly exposed colleagues.