The Waddell Sign is an objective measure used to help treatment providers establish a metric for distress associated with the experience of chronic pain and to identify predictors of secondary pain through exaggerated pain report. This measure describes five nonorganic (i.e., physical or behavioral) signs indicating that a patient with pain is trying to purposefully communicate seriousness about his or her pain experience to others. These five signs include superficial tenderness, pain response elicited from activity that should not induce pain, difference in pain report when distracted, regional weakness or sensory variations, and exaggerated response during physical examination.
Measures Registry
Waddell Sign
Description
Purpose
The Waddell Sign measure detects nonorganic (i.e., physical or behavioral) signs of lower back pain in order to determine distress associated with chronic pain in patients.
Population
Adults with low back pain
Year of Publication
1980
Reference
Waddell, G., McCulloch, J. A., Kummel, E., & Venner, R. M. (1980). Nonorganic physical signs in low-back pain. Spine, 5(2), 117-125. https://doi.org/10.1097/00007632-198003000-00005
Number of Items
5
Scale Types (Likert=Likert Type; MC=Multiple Choice; T/F=True/False; OR=Open Response)
Open Response
Subscales
Tenderness
Simulation
Distraction
Regional
Overreaction
Scoring
Any individual nonorganic sign (i.e., physical or behavioral) counts as a positive sign for that type. A finding of three or more positive types represents clinical significance. Individual positive signs are ignored.
Administration
Self-Administered
Readability/ Literacy Level
N/A
Reliability
Reliability of the Waddell Sign measure was assessed by having two independent observers examine 50 patients. The reproducibility percentage agreement between the two independent observers ranged from 78% to 86%. Additional information is available in Table 3 of the source article.
Validity
Validity of the Waddell Sign measure was assessed by comparing participant scores on the Waddell Sign measure to their scores on the Minnesota Multiphasic Personality Inventory (MMPI) and forms of nonorganic (i.e., physical or behavioral) signs (e.g., inappropriate symptoms, somatic symptoms). Pearson's correlation coefficients between the Waddell Sign measure and the MMPI ranged from 0.18 to 0.29, demonstrating that these measures assessed distinct constructs. Additional information is available in Table 4 of the source article.
In contrast, Pearson's correlation coefficients between the Waddell Sign measure and various forms of nonorganic physical signs ranged from 0.27 to 0.73, demonstrating stronger validity of the measure to assess pain via nonorganic signs. Additional information is available in Table 5 of the source article.
Limitations
N/A
Availability
Publicly Available
Cost
Free
Other Considerations
N/A