A Structured Evidence-Based Review on the Meaning of Nonorganic Physical Signs: Waddell Signs
ABSTRACT Study Design. This is a structured, evidence‐based review of all available studies addressing the concept of nonorganic findings: Waddell signs (WSs). Objectives. To determine what evidence, if any, exists for the various interpretations for the presence of WSs on physical examination. Summ...
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Veröffentlicht in: | Pain medicine (Malden, Mass.) Mass.), 2003-06, Vol.4 (2), p.141-181 |
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Zusammenfassung: | ABSTRACT
Study Design. This is a structured, evidence‐based review of all available studies addressing the concept of nonorganic findings: Waddell signs (WSs).
Objectives. To determine what evidence, if any, exists for the various interpretations for the presence of WSs on physical examination.
Summary of Background Data. WSs are a group of eight physical findings divided into five categories, the presence of which has been alleged at times to have the following interpretations: Malingering/secondary gain, hysteria, psychological distress, magnified presentation, abnormal illness behavior, abnormal pain behavior, and somatic amplification. At the present time, there is, therefore, significant confusion as to what these findings mean.
Methods. A computer and manual literature search produced 61 studies and case series reports relating to WSs. These references were reviewed in detail, sorted, and placed into tabular form according to the following subject areas: 1) Reliability (test‐retest); 2) Reliability (inter‐rater); 3) Reliability (factor analysis); 4) Validity, psychological distress; 5) Validity, correlation Minnesota Multiphasic Pain Inventory (MMPI); 6) Validity, correlation abnormal illness behavior; 7) Validity, other behaviors; 8) Validity, as a nonorganic phenomenon; 9) Validity, correlation pain drawing; 10) Validity, functional performance; 11) Validity, treatment outcome; 12) Validity, predicting surgical treatment outcome; 13) Validity, return to work outcome; 14) Validity, secondary gain correlation; and 15) Validity, pain correlation. Each study in each topic area was classified according to the type of study it represented according to the type of evidence guidelines developed by the Agency for Health Care Policy and Research (AHCPR). In addition, a list of 14 study quality criteria was used to measure the quality of each study. Each study was categorized for each criterion as positive, (criterion filled), negative (criterion not filled), or not applicable independently by two of the authors. A percent quality score was obtained for each study by counting the total number of positives obtained, dividing by 14 minus the total number of not applicables, and multiplying by 100. Only studies having a quality score of 75% or greater were used to formulate the conclusions of this review. The strength and consistency of the evidence represented by the remaining studies in each topic area (above) was then categorized according to the strength and |
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ISSN: | 1526-2375 1526-4637 |
DOI: | 10.1046/j.1526-4637.2003.03015.x |