Been a while since I saw a reference along the lines of "Waddells signs positive" in a DLA emp report.

I thought the fact that the detailed assessment required to essentially establish whether the back pain was "non-oganic" in origin - distract them and their funtion is better than they percieve - was well beyond the scope of any non-specialist and certainly took longer than the average visit had laid this all to rest! (The EMP involved was chronologically challenged i believe!)

Or have I just been lucky - and this is still an issue for IB?

Anyhoo - can't find all the arguments about this - sure there was a commissioners decision - can anyone help? In my research on t'iternet found a photo of Gordon (Waddell) who strangely looks like the average backpain IB claimant who used to walk into the CAB where i had my first paid job...

Joy - will be getting functional overlay next! It's like gypsy skirts being back in fashion...

The following article is a useful one if a few years old now:
http://www.gelmans.com/Articles/Waddell97.html



Though relating to Industrial Injuries Jacob's decision CI/1756/02 is worth a quote.

"7. The first expression, voluntary restriction, is clear in its meaning. The medically qualified panel members found that the claimant did not move his back as much as he could and that, this is the important point, that the restriction was under his voluntary control. In other words, to the extent that the movements were restricted voluntary, they did not form part of his disablement.

8. The other expressions, inappropriate signs and illness behaviour, are less clear in their meaning. They may mean the same as voluntary restriction. They may also mean that the claimant is demonstrating a disablement that is not attributable to the normal process of injury or disease, but is a result of the claimant’s mental reaction. In this latter sense, the behaviour is not within the claimant’s conscious control. The same confusion arises with references to Waddell signs. These signs are often misunderstood both by tribunals and even by doctors who examine for the purposes of benefit entitlement. They are not signs of deliberate misrepresentation of disablement."



To quote the American Journal of Medical Science in October 2002:

"Various approaches have been made to describe and quantify symptom magnification, with the most prevalent approach being Waddell nonorganic signs in the evaluation of low back pain. These approaches are limited, however, in that formal study of the techniques of evaluating symptom magnification has not been done. As Waddell put it in a retrospect of the nonorganic signs bearing his name:“Multiple signs suggest that the patient does not have a straightforward physical problem, but that psychological factors also need to be considered. Some patients may require both physical management of their physical pathology and more careful management of the psychosocial and behavioral aspects of their illness. Behavioral signs should be understood as response affected by fear in the context of recovery from injury and the development of chronic incapacity. They offer only a psychological “yellow-flag” and not a complete psychological assessment. Behavioral signs are not on their own a test of credibility or faking."
Volume 324(4) October 2002 pp 220-226 ]

here's an old rightsnet thread .....

http://www.rightsnet.org.uk/forum/disability/786.html

Using key word search for 'waddell' in rightsnet briefcase section, came up with a Commissioner Fellner decision, CIB/2767/2004, with a 'less positive spin'-

'... I am asked to comment on 'Waddell’s signs' – 'inappropriate' physical responses to examination that should not produce such responses, such as expressions of pain on axial loading or on simulated spinal rotation. The representative quotes Mr Commissioner Jacobs in CI/1756/2002, who in paragraph 8 opined that these are not signs of deliberate misrepresentation of disablement but are the result of a mental reaction not within the claimant’s conscious control. That may well often be so. But the learned commissioner in his next paragraph envisages that such signs may also stem from a claimant’s deliberate invention or misrepresentation, and so, it seems to me, they may. And a claimant, not necessarily from deliberate wickedness, may consider that to show pain whatever takes place during a formal examination must help his or her case. The rehearing tribunal must make up its own mind in the light of all the evidence what is to be taken from the presence of Waddell’s signs, and explain its finding.'

summary in briefcase @

http://www.rightsnet.org.uk/cgi-bin/sub_client/search.cgi?template1=briefcase/detail.htm&briefcase.ID_option=1&briefcase.ID=51816422062

Thanks all for your input - I tried searching for Waddells in just the forum area - hence my lack of success!

Really looking for the sort of stuff that Mike-rob's Gelman article flagged up - basically asking the questions that demonstrate the lack of knowledge in the EMP/GP at tribunal to justify the throw away comment that can do so much damage - unfortunately am concerned it would also demonstrate my lack of knowledge too - I'm gonna end up buying Gordon's book aren't I - might just get it out of the library!

Thanks again!

I've just got some more stuff through from the DWP - training materials for "disability analysts". Almost everything on low back pain is devoted to how to spot "illness behaviour" which includes: grimacing, sighing, guarding, bracing and rubbing. Not to mention pain at the tip of the coccyx, the use of aids in daily life and assistance with personal care in daily life.

Doctors are also told that "Waddell's signs are highly suggestive of abnormal illness behaviour. (Widespread tenderness; simulation of strain; Distraction; Regional neurological features; Over-reaction)."

Couple this with the statistics given that 90% of low back pain sufferers are back at work within 6 weeks and another 5% between 6 and 12 weeks and you begin to get the flavour of the training.

Surgery is apparently not effective "when a patient suffers from severe subjective complaints without any objective neurological signs" and "when the patient is involved in active litigation".

Treatment apparently best consist of "continuation of normal activity" plus "altering back pain health beliefs in the population (advice to stay active at work) - in the form of educational booklets and television commercial campaigns".

Hmm ... two adverts to be taken daily with a glass of water and a large pinch of salt.

And, as if all that wasn't bad enough, it seems gypsy skirts may no longer be fashionable.

Steve

I know Steve - they're so last week....keep up - it's white cropped trousers this week...

Any scope in the argument that the remaining 5% are the ones where the condition is permanantly disabling - if it was a temporary discomfort they would be back at work by now anyway!

Interesting that Waddell appears to have written a follow up in response to a concern that his signs were being used out of context - and it was really so much more complicated than that...

Isn't that what they call capri pants - or some similar spelling anyway?

Years ago I requested Waddell's signs via the local hospital (you now have to do this via NHS Direct and wait for someone to call you back or some such nonsense)and got this guide called 'the 5 minute orthopaedic assessment', and used it in a far too long and convoluted submisison, but by that point the case had got so protracted and bitter it had to be that way.

I think you ought to go back to the Commissioners on this one Jo and let them put Steve's stuff in their pipe and taste how that lot smokes. If the bad EMPs don't put it all in explicitly in general these days it's all there implicitly.

What a nostalgia trip going back to that 2002 thread - they're just not the same any more are they? I really miss Wheelchairwarrior and Rob Brown.

Matt Brown, even (sorry for going on Jo).