Is there a relationship between nonorganic physical findings (Waddell signs) and secondary gain/malingering?

David A Fishbain, R. B. Cutler, H. L. Rosomoff, R. Steele Rosomoff

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

This is a structured evidence based review of all available studies addressing the concept of nonorganic findings (Waddell signs) and their potential relationship to secondary gain and malingering. The objective of this review is to determine what evidence, if any, exists for a relationship between Waddell signs and secondary gain and malingering. Waddell signs are a group of 8 physical findings divided into 5 categories, the presence of which has been alleged at times to indicate the presence of secondary gain and malingering. A computer and manual literature search produced 16 studies relating to Waddell signs and secondary gain or malingering. These references were reviewed in detail, sorted, and placed into tabular form according to topic areas, which historically have been linked with the alleged possibility of secondary gain and malingering: 1) Waddell sign correlation with worker compensation and medicolegal status; 2) Waddell sign improvement with treatment; 3) Waddell sign correlation with Minnesota Multiphasic Personality Inventory validity scores; and 4) Waddell sign correlation with physician dishonesty perception. Each report in each topic area was categorized for scientific quality according to guidelines developed by the Agency for Health Care Policy and Research. The strength and consistency of this evidence in each subject area was then also categorized according to Agency for Health Care Policy and Research guidelines. Conclusions of this review were based on these results. There was inconsistent evidence that Waddell signs were not associated with worker's compensation and medicolegal status; there was consistent evidence that Waddell signs improved with treatment; there was consistent evidence that Waddell signs were not associated with invalid paper-pencil test; and there was inconsistent evidence that Waddell signs were not associated with physician perception of effort exaggeration. Overall, 75% of these reports reported no association between Waddell signs and the 4 possible methods of identifying patients with secondary gain and/or malingering. Based on the above results, it was concluded that 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.

Original languageEnglish
Pages (from-to)399-408
Number of pages10
JournalClinical Journal of Pain
Volume20
Issue number6
DOIs
StatePublished - Nov 1 2004

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Malingering
United States Agency for Healthcare Research and Quality
Workers' Compensation
Guidelines
Physicians
MMPI
Therapeutics

Keywords

  • Chronic pain
  • Malingering
  • Nondermatomal sensory abnormalities
  • Nonorganic physical signs
  • Secondary gain
  • Waddell signs

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology

Cite this

Is there a relationship between nonorganic physical findings (Waddell signs) and secondary gain/malingering? / Fishbain, David A; Cutler, R. B.; Rosomoff, H. L.; Steele Rosomoff, R.

In: Clinical Journal of Pain, Vol. 20, No. 6, 01.11.2004, p. 399-408.

Research output: Contribution to journalArticle

Fishbain, David A ; Cutler, R. B. ; Rosomoff, H. L. ; Steele Rosomoff, R. / Is there a relationship between nonorganic physical findings (Waddell signs) and secondary gain/malingering?. In: Clinical Journal of Pain. 2004 ; Vol. 20, No. 6. pp. 399-408.
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