Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P71. The effects of insurance and employment on the presence of Waddell signs

Abstract

BACKGROUND CONTEXT Waddell signs were originally introduced as manifestations of “nonorganic” low back pain. Once thought to indicate malingering, positive Waddell signs are now understood to represent real pain, potentiated through mechanisms of central sensitization. This study examines the relationship between the presence of Waddell signs and patient social environments, specifically insurance and employment status. PURPOSE To examine the relationship between the presence of Waddell signs, insurance status, and employment status. STUDY DESIGN/SETTING Prospective cross-sectional study at a single academic institution. PATIENT SAMPLE Three orthopedic spinal surgeons, two spinal neurosurgeons, and two physiatrists participated in the study over a one-year period. All patients over age 16 with thoracic or lumbar back pain due to a degenerative condition, with or without radicular symptoms, were included in the analysis. Full-time students were excluded, identifying 462 eligible patients for detailed analysis. OUTCOME MEASURES The primary outcome measures were 1+ or 3+ Waddell signs. METHODS Patient medical records were extracted for age, sex, employment, and insurance status. Subjects over age 65 and not working were considered retired. At their initial appointment, all patients were given a standard spinal examination where Waddell signs were noted if present. Age, sex, insurance status, and employment status were compared between those with and without any (1+) Waddell signs or clinically significant (3+) Waddell signs. Frequency data comparisons were performed using contingency table analysis; comparisons of means were analyzed for continuous variables. A frequency co-analysis of employment and insurance status was performed. Statistical analysis was performed using SAS (SAS Institute Inc., Cary, NC). RESULTS Nonworking subjects under age 65 had a significantly higher prevalence of 1+ Waddell signs than employed subjects (43% vs. 24%; p CONCLUSIONS Working age patients that do not work have a significantly higher prevalence of Waddell signs than those working or retired. Medicaid patients also have higher prevalence, but this effect appears to be a function of employment status rather than public medical assistance.