Dear All,
Is Waddell test the gold standard for checking spinal problem?
I observed a 70 yo male Spine consultant seeking his junior to perform the test and discharged the 47 yo male patient for falling from atop a double decker because he said there was no "visual proof" of any broken spines or ribs when the patient is debilitatingly pushed around on wheelchair by the staffs for living alone.
There was no attempt to perform scans. The consultant only used his bare sleepy eyes to "confirm" that the bones are all intact when the patient was painfully curling like a ball. Then he discharged him immediately.
What are any alternatives as follow-up instead of using the "scanner" sleepy eyes as gold standard?
Best regards - Mariam
Waddell test gives some insight about the non-organicity of a pain. It is useful as a part of the evaluation, but not the "gold standard". It cannot replace a neurological exam nor the basic radiological eval.
Dear Jacques,
Thank you for your kind input.
My sentiment exactly.
Best regards - Mariam
Dear Mariam
I read your query and the response thereto with interest. This is certainly a complex issue and presents many more dimensions than may be apparent at a glance. Firstly to make a reasonable comment about the given case we need to have a lot more details. How many days before seeing the Spine Consultant did the patient sustain the injury? What was the primary care given? Were any images deemed necessary by the primary care Physician? If yes what were the results? How long has he been in the present state of disability (wheel chair bound as described)? What was his neurological status, including bowel and bladder function?
Clearly failure to take a detailed history and perform a detailed clinical examination and imaging studies if indicated are not pardonable offences; None the less, it may be understood that disability does not necessarily imply disease; the former has a significant element of subjectivity attached to it. This is the very role of the Waddell's tests. Though they have not been described as the Gold standard they are perhaps the only clinical tests that can be performed rapidly and effectively to differentiate between organic spinal disease "non organic " disorders.
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