Carleton R N, Kachur S S, Abrams M P, Asmundson G J G
Anxiety and Illness Behaviours Laboratory, University of Regina, Regina, SK, S4S 0A2, Canada.
J Occup Rehabil. 2009 Mar;19(1):41-8. doi: 10.1007/s10926-009-9165-4. Epub 2009 Feb 10.
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.
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.
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.
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.
瓦德尔征和症状被描述为不符合损伤病理通常解剖模式的患者表现。瓦德尔征被认为表明心理困扰，被称为“非器质性发现”；同样，瓦德尔症状被描述为不适当的，且归因于心理特征。人们认为认可超过两种瓦德尔症状与心理困扰、残疾和治疗效果不佳有关；然而，这尚未得到实证评估。
本研究使用了参与第三方保险公司提供的多学科工作强化计划的患者样本（n = 108；30%为女性）。将认可超过两种瓦德尔症状的患者与未认可的患者在人口统计学变量以及心理困扰、残疾和治疗效果的自我报告测量方面进行比较。
认可超过两种瓦德尔症状的患者报告的心理困扰、感知到的残疾、疼痛强度和疼痛持续时间水平更高。此外，与先前关于瓦德尔症状的研究一致，认可超过两种症状的患者重返工作岗位的可能性也较小。
瓦德尔症状与感知到的残疾增加和普遍的疼痛干扰有关。认可超过两种症状的患者比认可零种、一种或两种症状的患者重返工作岗位的可能性显著更小。认可超过两种症状的患者可能确实受到组织病理学之外因素的影响，尽管如此，这些因素仍值得临床关注。瓦德尔症状似乎有望作为治疗复杂性和结果的快速指标。
