Polatin P B, Cox B, Gatchel R J, Mayer T G
PRIDF, Research Foundation, Dallas, Texas, USA.
Spine (Phila Pa 1976). 1997 Jul 15;22(14):1618-21. doi: 10.1097/00007632-199707150-00019.
Analysis of the treatment-outcome predictive power of Waddell signs by evaluating them before and after functional restoration, with assessment of 1-year socioeconomic outcomes.
To evaluate the presence of Waddell nonorganic signs in a group of patients with chronic low back pain presenting for functional restoration, and to determine whether they were predictive of treatment success of failure.
Waddell has described "nonorganic" physical signs in patients with chronic low back pain indicative of somatization. Other researchers have correlated high Waddell scores with psychosocial barriers that required additional consultation, and have suggested that diminution of a Waddell score during physical rehabilitation is predictive of subsequent therapeutic success.
Total positive Waddell signs score and individual sign scores were assessed at initial presentation for functional restoration treatment and at discharge in a group of 50 patients with chronic low back pain (average length of disability = 17.9 months; average age = 38.5 years). Patients were then tracked and assessed with a 1-year follow-up structured interview to evaluate outcome variables such as return to work, work retention, re-injury rate, health utilization, and subsequent surgery.
Statistical analyses of these data revealed no significant associations between Waddell total positive score or changes in score and therapeutic success as measured by any of the behavioral outcomes such as return to work. Also, no predictive value was found for the individual positive signs of their changes and therapeutic success.
Although positive Waddell signs have been found to be predictive in patients with short-term chronic low back pain, the current results suggest that, in patients who have longer duration of pain and who undergo a comprehensive functional restoration program, these signs are not significantly prognostic. Because functional restoration is an interdiscipilinary approach that effectively manages somatization complaints in a consistent manner by all treatment personnel, such complaints do not create any major barriers to recovery. Therefore, although Waddell signs may be predictive of treatment outcome in less intensive rehabilitation programs, they do not provide any predictive power in a comprehensive functional restoration program, which has a basic goal of managing barriers to recovery in a clinically efficacious manner.
通过在功能恢复前后评估瓦德尔征的治疗结果预测能力，并评估1年的社会经济结果。
评估一组因功能恢复前来就诊的慢性下腰痛患者中瓦德尔非器质性体征的存在情况，并确定这些体征是否能预测治疗成功或失败。
瓦德尔描述了慢性下腰痛患者中提示躯体化的“非器质性”体征。其他研究人员将高瓦德尔评分与需要额外咨询的心理社会障碍相关联，并提出在身体康复过程中瓦德尔评分的降低可预测随后的治疗成功。
对50例慢性下腰痛患者（平均残疾时长 = 17.9个月；平均年龄 = 38.5岁）在初次就诊接受功能恢复治疗时以及出院时评估瓦德尔征总阳性评分和各个体征评分。然后对患者进行跟踪，并通过1年的随访结构化访谈进行评估，以评估诸如重返工作、工作保留、再受伤率、医疗利用情况以及后续手术等结果变量。
对这些数据的统计分析显示，瓦德尔总阳性评分或评分变化与任何行为结果（如重返工作）所衡量的治疗成功之间无显著关联。此外，各个阳性体征的变化及其与治疗成功之间也未发现预测价值。
尽管已发现阳性瓦德尔征在短期慢性下腰痛患者中具有预测性，但目前的结果表明，对于疼痛持续时间较长且接受全面功能恢复计划的患者，这些体征并无显著的预后价值。由于功能恢复是一种跨学科方法，所有治疗人员均以一致的方式有效处理躯体化主诉，此类主诉不会对康复造成任何重大障碍。因此，尽管瓦德尔征可能在强度较低的康复计划中对治疗结果具有预测性，但在以临床有效方式管理康复障碍为基本目标的全面功能恢复计划中，它们并无任何预测能力。
