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'''Waddell's signs''' are a group of physical signs, first described in a 1980 article in ''[[Spine (journal)|Spine]]'', and named for the article's principal author, [[Gordon Waddell]].<ref name="pmid6446157">{{cite journal|last=Waddell|first=Gordon|coauthors=John McCulloch, Ed Kummel, Robert Venner|title=Nonorganic Physical Signs in Low-Back Pain|journal=[[Spine (journal)|Spine]]|year=1980|month=March/April|volume=5|issue=2|pages=117–125|pmid=6446157|doi=10.1097/00007632-198003000-00005|issn=0362-2436|oclc=2589719}}</ref> Waddell's signs may indicate non-organic or [[psychological]] component to chronic [[low back pain]]. Historically they have also been used to detect [[malingering]] in patients with back pain. While testing takes less than one minute,<ref name="pmid6446157" /> it has been described as time-consuming and alternatives have been proposed.<ref name="pmid12398129">{{cite journal|doi=10.1308/003588402760452682|last=Blom|first=Ashley|coauthors=Adrian Taylor, Sarah Whitehouse, Bill Orr, Evert Smith|title=A new sign of inappropriate lower back pain|journal=[[Annals of the Royal College of Surgeons of England]]|publisher=[[Royal College of Surgeons of England]]|month=September|year=2002|volume=84|issue=5|pages=342–343|url=http://www.ingentaconnect.com/search/download?pub=infobike%3a%2f%2frcse%2farcs%2f2002%2f00000084%2f00000005%2fart00013&mimetype=application%2fpdf|format=pdf|pmid=12398129|pmc=2504150|issn=0035-8843|oclc=2832178}}</ref>

==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.<ref name="pmid6446157" /> However, assessing the patient on the basis of overreaction has raised concerns regarding [[Observer-expectancy effect|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.<ref>{{cite book|title=Occupational Medicine Practice Guidelines|editor=Kurt Hegmann|publisher=[[American College of Occupational and Environmental Medicine]]|year=2007|edition=2|pages=43–44|chapter=Low Back Disorders (revised)}}</ref>

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 [[clinical depression|depression]], [[hysteria]] and [[hypochondria]]sis on the [[Minnesota Multiphasic Personality Inventory]].

==Criticism==
Although Waddell's signs can detect a non-organic component to pain, they do not exclude an organic cause. Clinically-significant Waddell scores are considered indicative only of symptom magnification or pain behavior, and have been misused in medical and medico-legal contexts. Waddell's signs are not considered a ''de facto'' indicator of deception for the purpose of financial gain.<ref name="pmid9820920">{{cite journal|last=Main|first=Chris|coauthors=Gordon Waddell|title=Behavioral Responses to Examination: A Reappraisal of the Interpretation of 'Nonorganic Signs'|journal=[[Spine (journal)|Spine]]|year=1998|month=November|volume=23|issue=21|pages=2367–2371|doi=10.1097/00007632-199811010-00025|pmid=9820920|issn=0362-2436|oclc=2589719}}</ref>

In a 2003 review, Fishbain, ''et al''. stated that Waddell's signs do not reliably distinguish organic from psychological pain but instead tend to underestimate the amount of pain that is actually experienced.<ref name="pmid12911018">{{cite journal|last=Fishbain|first=David|coauthors=Brandly Cole, R. B. Cutler, John Lewis, H. L. Rosomoff, R. Steele Rosomoff|date=5 June 2003|title=A Structured Evidence-Based Review on the Meaning of Nonorganic Physical Signs: Waddell Signs|journal=[[Pain Medicine (journal)|Pain Medicine]]|publisher=[[American Academy of Pain Medicine]]|volume=4|issue=2|pages=141–181|pmid=12911018|doi=10.1046/j.1526-4637.2003.03015.x|issn=1526-2375|oclc=42267277}}</ref> In a 2004 review, Fishbain, ''et al''. concluded, "there was little evidence for the claims of an association between Waddell signs and secondary gain and malingering. The preponderance of the evidence points to the opposite: no association".<ref name="pmid15502683">{{cite journal|last=Fishbain|first=David|coauthors=R. B. Cutler, H. L. Rosomoff, R. Steele Rosomoff|title=Is There a Relationship Between Nonorganic Physical Findings (Waddell Signs) and Secondary Gain/Malingering?|journal=[[Clinical Journal of Pain]]|publisher=[[American Academy of Pain Medicine]]|year=2004|month=November/December|volume=20|issue=6|pages=399–408|doi=10.1097/00002508-200411000-00004|pmid=15502683|issn=0749-8047|oclc=11198567}}</ref>

==References==
{{Reflist|2}}

==External links==
*[http://neuroland.com/spine/lbp_nonorganic_sign.htm Neuroland, Signs suggestive of non-organic back pain]

{{Eponymous medical signs for integumentary and musculoskeletal systems}}

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[[Category:Medical signs]]

[[pl:Oznaki Waddella]]
[[Category:2Fix]]