Waddell's Signs - Use of Waddell's Signs

Use of Waddell's Signs

Waddell, et al. (1980) described five categories of signs:

• Tenderness tests: superficial and diffuse tenderness and/or nonanatomic tenderness
• Simulation tests: these are based on movements which produce pain, without actually causing that movement, such as axial loading and pain on simulated rotation
• Distraction tests: positive tests are rechecked when the patient's attention is distracted, such as a straight leg raise test
• Regional disturbances: regional weakness or sensory changes which deviate from accepted neuroanatomy
• Overreaction: subjective signs regarding the patient's demeanor and reaction to testing

Any individual sign marks its category as positive. When three or more categories were positive, the finding was considered clinically significant. However, assessing the patient on the basis of overreaction has raised concerns regarding observer bias and idiosyncrasies related to the patient's culture. Consequently, a practitioner may assess the patient on the remaining four categories, with two or more positive categories being considered clinically significant.

One or two Waddell's signs can often be found even when there is not a strong non-organic component to pain. Three or more are positively correlated with high scores for depression, hysteria and hypochondriasis on the Minnesota Multiphasic Personality Inventory.