If you’re not aware of it, if you’re gonna discuss Waddell’s signs, his primary article, the first one was 1980, 1981. But the second article, he and Chris Main say, “The reason we’re writing this is, you all have misinterpreted what we’re doing here. These are not proof of malingering. These indicate that there is more than a straightforward medical problem. There’s probably psychosocial distress present that can color outcome, and may need a separate evaluation and separate treatment. But please, malingering is uncommon. Psychological stress distress is quite common. Don’t misinterpret these as evidence of malingering.”
So, if you’re asked that question, you can say, “Well, Gordon himself wrote an article and said the whole point of the article is, this is not necessarily malingering.”There is this, that if you see Waddell signs present at the very first treatment visit, some docs do them every time they see every back pain patient. And so, you will see records, “Hurt today, in the doctor’s office tomorrow, already has Waddell’s signs.” That is a poor prognostic sign. This is Will Gaines when he was in Arch Med practice before he became the Assistant Medical Director of for Liberty Mutuals work comp system. But if you have Waddell’s signs the first visit, prognostically, that is not good. Those people are slow to recover.
Here’s the most recent. You were asking at lunch, here’s the most recent review on Waddell’s signs. If you want this article, email me I’ll send it to you. But published in 2008, it says they really are something that’s pretty well established. Again, overreaction, we should cross off the list. But here’s our campus. Here, they measured them for…Can I agree with myself, or two day for physical therapists three weeks apart, can they agree? And they’re not as good as we would like.
So, they ended up saying, “If we take the overall score, how many categories have a positive response that does much better than any single of them?”
Excerpted from SEAK’s stream on-demand course, "IME Skills For Physicians: The Masters Program"