The predictive utility of the orthopedic examination in identifying the low back pain patient with hysterical personality features.

Physical examination of the patient with low back pain routinely includes a number of tests which are useful clinically to the orthopedist as suggestive of the presence of hysteria or malingering. These include tests of light touch differences medially and laterally in the same foot or leg, vibratory sensation in the lower extremities, forward flexion, straight-leg raising differences between the supine and sitting positions, and the Burns' bench test. The present study examined the specific predictive utility of these tests individually and as a composite battery in identifying low back pain patients with hysterical personality features. Twenty-five postoperative lumbar laminectomy and diskectomy patients were administered the MMPI and evaluated by physical examination. Silight to moderate correlations were found for each of the subtests with a Composite Hysteria Index derived from the MMPI. The predictability was improved by the use of a weighted combination of the individual tests obtained by multiple regression analysis. The results lend empirical support to: the predictive value of these clinical tests in definitively identifying 60% of those low back pain patients with hysterical personality features; decision rules for use in clinical practice were also developed.