Australian Centre for Economic Research on Health, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Spine (Phila Pa 1976). 2011 Dec 1;36(25 Suppl):S303-8. doi: 10.1097/BRS.0b013e3182388411.
Review article.
To explain why the evidence that compensation-related factors lead to worse health outcomes is not compelling, either in general, or in the specific case of whiplash.
There is a common view that compensation-related factors lead to worse health outcomes ("the compensation hypothesis"), despite the presence of important, and unresolved sources of bias. The empirical evidence on this question has ramifications for the design of compensation schemes.
Using studies on whiplash, this article outlines the methodological problems that impede attempts to confirm or refute the compensation hypothesis.
Compensation studies are prone to measurement bias, reverse causation bias, and selection bias. Errors in measurement are largely due to the latent nature of whiplash injuries and health itself, a lack of clarity over the unit of measurement (specific factors, or "compensation"), and a lack of appreciation for the heterogeneous qualities of compensation-related factors and schemes. There has been a failure to acknowledge and empirically address reverse causation bias, or the likelihood that poor health influences the decision to pursue compensation: it is unclear if compensation is a cause or a consequence of poor health, or both. Finally, unresolved selection bias (and hence, confounding) is evident in longitudinal studies and natural experiments. In both cases, between-group differences have not been addressed convincingly.
The nature of the relationship between compensation-related factors and health is unclear. Current approaches to testing the compensation hypothesis are prone to several important sources of bias, which compromise the validity of their results. Methods that explicitly test the hypothesis and establish whether or not a causal relationship exists between compensation factors and prolonged whiplash symptoms are needed in future studies.
综述文章。
解释为何补偿相关因素会导致更差的健康结果这一证据无论在总体上还是在特定的挥鞭样损伤案例中都不具有说服力。
有一种普遍观点认为，补偿相关因素会导致更差的健康结果（“补偿假说”），尽管存在重要且未解决的偏倚来源。关于这个问题的实证证据对补偿计划的设计有影响。
本文使用挥鞭样损伤研究，概述了妨碍确认或反驳补偿假说的方法学问题。
补偿研究容易受到测量偏倚、反向因果关系偏倚和选择偏倚的影响。测量误差主要归因于挥鞭样损伤和健康本身的潜在性质、测量单位（特定因素或“补偿”）不明确以及对补偿相关因素和方案的异质性缺乏认识。未能承认和从经验上解决反向因果关系偏倚或健康状况不佳影响寻求补偿的决策的可能性：不清楚补偿是健康状况不佳的原因还是结果，或者两者都是。最后，在纵向研究和自然实验中明显存在未解决的选择偏倚（因此存在混杂）。在这两种情况下，组间差异都没有得到令人信服的解决。
补偿相关因素与健康之间的关系性质尚不清楚。目前测试补偿假说的方法容易受到几种重要偏倚来源的影响，这损害了其结果的有效性。未来的研究需要采用明确检验假说并确定补偿因素与长期挥鞭样损伤症状之间是否存在因果关系的方法。
