SPINE UPDATE - BEHAVIORAL-RESPONSES TO EXAMINATION - A REAPPRAISAL OFTHE INTERPRETATION OF NONORGANIC SIGNS

Waddell et al in 1980 developed a standardized assessment of behaviora l responses to examination. The signs were associated with other clini cal measures of illness behavior and distress, and are not simply a fe ature of medicolegal presentations. Despite clear caveats about the in terpretation of the signs, they have been and misused both clinically and medicolegally. Behavioral responses to examination provide useful clinical information, but need to be interpreted with care and underst anding. isolated signs should not be overinterpreted. Multiple signs s uggest that the patient does not have a straightforward physical probl em, but that psychological factors also need to be considered. Some pa tients may require both physical management of their physical patholog y and more careful management of the psychosocial and behavioral aspec ts of their illness. Behavioral signs should be understood as response s affected by fear in the context of recovery from injury and the deve lopment of chronic incapacity. They offer only a psychological ''yello w-flag'' and not a complete psychological assessment. Behavioral signs are not on their own a test of credibility or faking.