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Chiropractic Research Review

"Nonorganic Signs": Behavioral Responses to Examination

Seemingly abnormal responses to examination procedures have been called "inappropriate signs, medically incongruent signs, Waddell signs and behavioral signs." Despite the publication of clear warnings regarding the interpretation of these responses, they have been misused in both the clinical and medicolegal areas.

This article, written by two sage veterans of the topic, offers a reconsideration of the use and interpretation of nonorganic signs.

The authors systematically examine behavioral signs, distinguishing them from purely physical signs, explaining how they have been misused or misinterpreted in clinical contexts. The authors provide readers sufficient information to clearly distinguish pain behavior from psychological responses to examination. They conclude that greater judgment and freedom from bias is required for objective and consistent assessment of back problems.

Clinicians are advised to distinguish between "pain behavior," which can be used to describe various aspects of the patient's response to pain, from "behavioral signs," which should be used only to describe specifically how the patient responds to examination. The authors warn that "behavioral signs are not on their own a test of credibility or veracity. Interpretation of the signs is only possible within the context of a broader clinical and psychosocial assessment."

Take note: Many doctors have observed and recorded these signs in clinical practice. Note, however, that differences may exist between what is in this article and what was published before. For example, "Yellow Flags" have replaced the "Red Flags" that many doctors are familiar with. Take a few moments to update your use of these signs with information from the authors who have led the field in this research.

Main CJ, Waddell G. Behavioral responses to examination: A reappraisal of the interpretation of "nonorganic signs." Spine, Nov. 1, 1998;23(21), pp2367-71.

Chiropractic Research Review

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