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Date of Award
Capstone Project (On-Campus Access Only)
Doctor of Physical Therapy (DPT)
John Medeiros, PhD, PT
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1. Clinical Bottom Line: Waddell’s signs and symptoms are not effective for predicting delay or non-return to work in patients with work restricting low back pain.
2. Clinical Scenario: In the outpatient orthopedic setting, clinicians play a large role in the treatment of patients with work-restricting low back pain. A majority of these patients experience chronic low back pain, enabling them from return to work in a timely fashion and increasing health care costs and compensation benefits dispersed. As a clinician, you hope to utilize specific tools that will validly predict the outcome of physical therapy treatment; and more specifically in this case, return to work. While working with a veteran clinician, we observed the use of Waddell signs as a predictive tool for patients with chronic work-restricting low back pain. A majority of the patients were taking part in a work hardening program where a clinical psychologist was available for consultation and intervention. Many others, not a part of the work hardening program, were receiving compensation benefits. There was a wide range of patients seen by this clinician, but every initial evaluation included a screening for Waddell signs. However, the use of these signs as a predictive tool for non-return to work is not a topic discussed readily amongst health professionals, and within the physical therapy school curriculum. Thus, to determine the validity and efficacy of these signs we established the following clinical question: Are Waddell Signs an effective predictive test for delayed or non-return to work in patients with low back pain?
3. Our Clinically Answerable Question: Population: Patients with low back pain, unable to perform full time work duties. Independent Variable: Physical examination for the presence of Waddell signs. Comparison: Return to full time work. Outcome Measure(s): Efficacy of Waddell signs measured by sensitivity, specificity, predictive values, and likelihood ratios.
Andrews, Jenelle R. and Lyttle, Thomas W., "The Efficacy of Waddell Signs to Predict Delayed Return to Work in Patients with Work-restricting Low Back Pain" (2007). School of Physical Therapy. 70.