title: Waddell's symptoms as indicators of psychological distress, perceived disability, and treatment outcome.
abstract: BACKGROUND
  Waddell's signs and symptoms have been described as patient presentations not within usual anatomic patterns of injury pathology. Waddell's signs were thought to indicate psychological distress and were termed "non-organic findings"; similarly, Waddell's symptoms were described as inappropriate and attributable to psychological features. Endorsement of more than two of Waddell's symptoms is thought to be associated with psychological distress, disability, and poor treatment outcomes; however, this has not been empirically assessed.
  
  
  METHODS
  The current study used a sample of patients (n = 108; 30% women) involved in a multi-disciplinary work hardening program provided by a third-party insurer. Patients who endorsed more than two of Waddell's symptoms were compared with those who did not on demographic variables as well as self-report measures of psychological distress, disability, and treatment outcome.
  
  
  RESULTS
  Patients who endorsed more than two of Waddell's symptoms reported higher levels of psychological distress, perceived disability, pain intensity, and pain durations. Moreover, consistent with previous research on Waddell's symptoms, patients endorsing more than two symptoms were also less likely to return to work.
  
  
  CONCLUSIONS
  Waddell's symptoms were associated with increased perceived disability and pervasive pain interference. Patients who endorsed more than two symptoms were significantly less likely to return to work than those who endorsed zero, one, or two symptoms. Patients who endorsed more than two symptoms may indeed be affected by factors beyond tissue pathology that nonetheless warrant clinical attention. Waddell's symptoms appear to have promise as a quick indicator of treatment complexity and outcome.
authors.affiliation: Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, SK, S4S 0A2, Canada. carletor@uregina.ca
authors.forename: R N
authors.initials: RN
authors.lastname: Carleton
authors.forename: S S
authors.initials: SS
authors.lastname: Kachur
authors.forename: M P
authors.initials: MP
authors.lastname: Abrams
authors.forename: G J G
authors.initials: GJ
authors.lastname: Asmundson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000523:psychology* / Q000534:rehabilitation*; D010147:Pain Measurement; D011379:Prognosis; D020127:Recovery of Function; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis*; D011795:Surveys and Questionnaires