• J U Yoo, T C McIver, J Hiratzka, H Carlson, N Carlson, S S Radoslovich, T Gernhart, E Boshears, and M S Kane.
• Oregon Health & Science University, 3181 South West Sam Jackson Park Road, Portland, Oregon 97239, USA.
• Bone Joint J. 2018 Feb 1; 100-B (2): 219-225.

AimsThe aim of this study was to determine if positive Waddell signs were related to patients' demographics or to perception of their quality of life.Patients And MethodsThis prospective cross-sectional study included 479 adult patients with back pain from a university spine centre. Each completed SF-12 and Oswestry Disability Index (ODI) questionnaires and underwent standard spinal examinations to elicit Waddell signs. The relationship between Waddell signs and age, gender, ODI, Mental Component Score (MCS), and Physical Component Score (PCS) scores was determined.ResultsOf the 479 patients, 128 (27%) had at least one positive Waddell sign. There were significantly more women with two or more Waddell signs than men. The proportion of patients with at least one positive Waddell sign increased with age until 55 years, and then declined rapidly; none had a positive sign over the age of 75 years. Functional outcome scores were significantly worse in those with a single Waddell sign (p < 0.01). With one or more Waddell signs, patients' PCS and ODI scores indicated a perception of severe disability; with three or more Waddell signs, patients' MCS scores indicated severe disability. With five Waddell signs, ODI scores indicated that patients perceived themselves as crippled.ConclusionPositive Waddell signs, a potential indicator of central sensitization, indicated a likelihood of having functional limitations and an impaired quality of life, particularly in young women. Cite this article: Bone Joint J 2018;100-B:219-25.©2018 The British Editorial Society of Bone & Joint Surgery.

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