Waddell signs are a group of physical signs designed specifically to detect non-organic components to lower back pain. A non-organic problem or symptom is one that deviates from the usual presentation of a particular disease.
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When Dr. Gordon Waddell first developed these signs in the 1980s, physicians used them to detect malingering patients, especially those trying to fake injuries for workers’ compensation benefits. However, physicians today widely recognize that this brief examination serves simply as a preliminary step to help identify patients whose conditions may require a more detailed assessment.
Some employers misunderstand Waddell’s signs, thinking they are tests physicians can use to detect workers’ compensation fraud among employees with all types of injuries. In fact, Waddell developed these signs to apply exclusively to lower back injuries and did not intend for the five signs to be completely indicative of malingering. As an employer, it is important for you to understand how physicians use Waddell’s signs and why the presence of any of the signs may—or may not—indicate workers’ compensation fraud or impact the employee’s ability to return to work successfully.
The Five Signs
- Tenderness: The patient has skin surface tenderness that is not related to a particular skeletal or neuromuscular structure, meaning it occurs over a wide area or extends across several unrelated structures.
- Simulation Tests: The patient complains of pain in the lower back when the examiner presses down on top of the head or rotates the shoulders and pelvis together on the same plane, neither of which should produce this type of pain.
- Distraction Tests: The examiner does the same test twice, once while distracting the patient, and he/she only complains of pain in one test. The most common example is when a patient complains of pain on a straight leg raise, but not if the examiner extends the knee in the same motion while testing the reflexes.
- Regional Disturbances: This can either be a regional weakness or a regional sensory change. Either way, it involves dysfunction over a widespread area that cannot be explained based on anatomy or neurological patterns.
- Overreaction: This is an exaggerated pain response to a stimulus, which may include verbalization, facial expression, muscle tension and tremor. It also includes any response that the patient does not reproduce when the examiner gives the same stimulus later.
What They Mean
In short, a high Waddell score—meaning the presence of three or more of the signs explained above—indicates possible symptom magnification or illness behavior. One or two signs presented generally do not indicate non-organic symptoms, though if you are truly concerned, you could require the employee to go in for more conclusive, concrete tests.
Several researchers across medical disciplines have found that non-organic signs and positive Waddell tests occur more frequently in lower back pain patients who are anticipating or are already receiving financial compensation during the injury.
Also, there is a connection between Waddell’s signs and the ability—or desire—of employees to return to work. Several physicians have recently studied the impact of Waddell’s signs on the workplace. In one study, at least one non-organic sign was present in 47% of patients whose work status did not improve. Comparatively, a non-organic sign was only found in 12% of patients who demonstrated significant improvement. Another study found that of patients with non-organic symptoms whose physicians give a vague diagnosis or a nebulous treatment plan, less than 40% return to work.
The bottom line is that it is crucial for employers to communicate their intentions and efforts to physicians so they understand the importance of the employee returning to work. Rather than trying to nail employees for workers’ compensation fraud using Waddell’s test, which may not indicate malignance in many cases, funnel your efforts into a solid, comprehensive return to work program. Studies around Waddell’s test all indicate that the most important factor in avoiding fraud and getting employees healthy is requiring and enforcing return to work duties. Letting employees know that being injured is not a free ride is vital to your company’s cost containment strategy.
If you need assistance in creating or updating your Return to Work Program, contact us at 909.466.7876 today. TPG Insurance Services can ensure your employees stay healthy and that injured workers get back on track as quickly as possible. Don’t forget to also check out our practical Workers’ Compensation content today!