Mallinson A I, Longridge N S
Neuro-otology Unit, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Otol Neurotol. 2005 Jul;26(4):686-90. doi: 10.1097/01.mao.0000169639.48193.fb.
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.
Prospective study of two groups of sequentially referred patients complaining of dizziness and/or imbalance.
A tertiary and quaternary care ambulatory referral center.
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.
Standard vestibular assessment including computerized dynamic posturography was carried out on all patients.
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.
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.
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.
利用计算机化动态姿势描记术的结果制定并应用一套标准，以检测有平衡失调主诉患者的非生理性表现，并将该系统的效能与现有的定量技术以及评估诈病者的主观方法进行比较。
对两组先后转诊的主诉头晕和/或平衡失调的患者进行前瞻性研究。
一家三级和四级医疗门诊转诊中心。
对两组患者进行了研究。一组是曾遭受与工作相关的头部创伤，随后出现头晕和/或平衡失调主诉的患者。另一组是因头晕和/或平衡失调而转诊、无头部创伤史、与工作相关的损伤史或诉讼程序的患者。
对所有患者进行包括计算机化动态姿势描记术在内的标准前庭评估。
使用一种已用于检测诈病者的量化公式、一种长期以来使用的利用计算机化动态姿势描记术不同方面表现的分析标准以及我们新开发的九点评分法，对两组所有患者的非生理性表现进行评分。比较这三种方法的结果，以确定每种方法在检测诈病行为方面的有效性。
我们的九点方案能够以一致的方式有效地评估患者。使用文献中的定量公式进行评估，使许多无明显不良动机的患者被怀疑诈病，其中一些患者有前庭疾病的记录。我们的标准还评估了目前使用的技术未评估的其他表现方面。
我们新制定的标准从定量和定性角度对法医学患者进行评估时均有效，并且比以前的评估更为全面。
