A new set of criteria for evaluating malingering in work-related vestibular injury.

OBJECTIVE

To develop and use a set of criteria using computerized dynamic posturography results to detect aphysiologic behavior in patients with complaints of imbalance, and to compare the efficacy of this system with present quantitative techniques and with subjective methods of evaluating malingerers.

STUDY DESIGN

Prospective study of two groups of sequentially referred patients complaining of dizziness and/or imbalance.

SETTING

A tertiary and quaternary care ambulatory referral center.

PATIENTS

Two groups of patients were studied. One was a group of patients who had suffered work-related head trauma and had subsequent complaints of dizziness and/or imbalance. The other was a group of patients referred for dizziness and/or imbalance who had no history of head trauma, work-related injury, or litigation procedures.

INTERVENTIONS

Standard vestibular assessment including computerized dynamic posturography was carried out on all patients.

MAIN OUTCOME MEASURES

All patients in both groups were scored for aphysiologic behavior using a quantified formula that has been used to detect malingerers, an analysis criterion using different aspects of computerized dynamic posturography performance that has been used for some time, and our newly developed nine-point scoring method. Results of all three methods were compared to determine the effectiveness of each one in detecting malingering behavior.

RESULTS

Our nine-point protocol was effective in assessing patients in a consistent manner. Assessment using the quantitative formula in the literature raised suspicions of malingering in many patients with no known ulterior motives, some of whom had documented vestibular disease. Our criteria also evaluate other aspects of performance not evaluated by the presently used techniques.

CONCLUSION

Our newly developed criteria are effective at evaluating the medicolegal patients from both the quantitative and qualitative viewpoints, and provide a more thorough assessment than has previously been available.