Re: Waddell testing

[Guest guest]

Lori,

it has been a long time since I used to do PCEs, but at that time the Waddell

signs were often included to " prove " that someone was malingering. The Waddell

signs are not designed to test for malingering and have in my humble opinion no

place in PCE reports if used for that purpose. Waddell has commented many time

that his work has been misinterpreted and misused. He even stated that they are

not a test of credibility or faking. Waddell emphasized viewing low back pain

in a broader psychosocial I recommend reading

Ranney D: A proposed neuroanatomical basis of Waddell's nonorganic signs.

American journal of physical medicine & rehabilitation 89(12): 1036-42, 2010.

When considered within a broader psychosocial context, the Waddell signs may be

useful according to a recent publication:

Oesch P, Meyer K, Jansen B, Mowinckel P, Bachmann S, Hagen KB: What is the role

of " nonorganic somatic components " in functional capacity evaluations in

patients with chronic nonspecific low back pain undergoing fitness for work

evaluation? Spine 37(4): E243-50, 2012.

Some of the Waddell signs can easily be misinterpreted. Ranney describes for

example:

Superï¬cial tenderness— skin discomfort on light palpation. Four

possibilities exist:

i. This is a very serious injury ,e.g., an acute fracture. This will be obvious.

ii. This patient has a very low pain tolerance. This can be measured with a

dolorimeter.

iii. The client is pretending to be in more pain than he or she really is,i.e.,

faking.

iv. Allodynia is present—the result of CNS potentiation of real pain. CNS

sensitization results from prolonged stimulation of the spinal cord’s dorsal

horn by pain. It is a physical change in the structure and function of the

spinal cord

Hope that helps,

Jan Dommerholt

Bethesda Physiocare®, Inc.

7830 Old town Road, Suite C-15

Bethesda, MD 20814-2440

United States

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