Insurance and Employment Status Are Correlated with the Presence of Waddell Signs

Stephanie S. Radoslovich, Spencer Smith, Carter Haag, Hans Carlson, Nels Carlson, Erik Ensrud, Jung U. Yoo

Research output: Contribution to journalArticlepeer-review


Objective The aim of the study was to determine whether employment or insurance status is associated with the presence and number of Waddell signs. Design In this cross-sectional study, adult low back pain patients were seen at a tertiary academic center for thoracic or lumbar back pain, due to a degenerative condition. Frequency data were compared with contingency table analysis, including χ2 and logistic regression. Results Of 462 patients, 26% had any Waddell signs and 10% had clinically significant Waddell signs. Nonemployed patients had a higher prevalence of Waddell signs than employed and retired patients (P = 0.0004 and P = 0.001, respectively). Subgroups of Medicaid participants as well as patients with secondary gain issues, including worker's compensation and motor vehicle accident, had a higher prevalence of 1+ Waddell signs than patients of other insurances (P < 0.0001 and P = 0.01, respectively). Medicaid participants had a higher prevalence of 3+ Waddell signs than other insurances (P = 0.002). Conclusions The presence of Waddell signs is associated with employment and insurance status. This suggests that social factors may affect patients' perceptions of their thoracic or low back pain. Clinicians aware of these factors can provide individualized care to their patients prone to poor outcomes.

Original languageEnglish (US)
Pages (from-to)746-752
Number of pages7
JournalAmerican Journal of Physical Medicine and Rehabilitation
Issue number8
StatePublished - Aug 1 2022


  • Employment
  • Insurance
  • Low Back Pain
  • Waddell Signs

ASJC Scopus subject areas

  • Medicine(all)


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