Young J Christopher, Roper Brad L, Arentsen Timothy J
a Siskin Hospital for Physical Rehabilitation , Chattanooga , TN , USA.
b Memphis Veterans Affairs Medical Center , Memphis , TN , USA.
Clin Neuropsychol. 2016 May;30(4):497-514. doi: 10.1080/13854046.2016.1159730. Epub 2016 Apr 1.
A survey of neuropsychologists in the Veterans Health Administration examined symptom/performance validity test (SPVT) practices and estimated base rates for patient response bias.
Invitations were emailed to 387 psychologists employed within the Veterans Affairs (VA), identified as likely practicing neuropsychologists, resulting in 172 respondents (44.4% response rate). Practice areas varied, with 72% at least partially practicing in general neuropsychology clinics and 43% conducting VA disability exams.
Mean estimated failure rates were 23.0% for clinical outpatient, 12.9% for inpatient, and 39.4% for disability exams. Failure rates were the highest for mTBI and PTSD referrals. Failure rates were positively correlated with the number of cases seen and frequency and number of SPVT use. Respondents disagreed regarding whether one (45%) or two (47%) failures are required to establish patient response bias, with those administering more measures employing the more stringent criterion. Frequency of the use of specific SPVTs is reported.
Base rate estimates for SPVT failure in VA disability exams are comparable to those in other medicolegal settings. However, failure in routine clinical exams is much higher in the VA than in other settings, possibly reflecting the hybrid nature of the VA's role in both healthcare and disability determination. Generally speaking, VA neuropsychologists use SPVTs frequently and eschew pejorative terms to describe their failure. Practitioners who require only one SPVT failure to establish response bias may overclassify patients. Those who use few or no SPVTs may fail to identify response bias. Additional clinical and theoretical implications are discussed.
对退伍军人健康管理局的神经心理学家进行的一项调查，考察了症状/表现效度测试（SPVT）的应用情况，并估计了患者反应偏差的基础比率。
通过电子邮件向387名受雇于退伍军人事务部（VA）、被认定可能从事神经心理学工作的心理学家发出邀请，共收到172份回复（回复率为44.4%）。实践领域各不相同，72%的人至少部分时间在普通神经心理学诊所工作，43%的人进行VA残疾评估。
临床门诊患者的平均估计失败率为23.0%，住院患者为12.9%，残疾评估为39.4%。mTBI和PTSD转诊患者的失败率最高。失败率与所处理的病例数量、SPVT的使用频率和数量呈正相关。对于确定患者反应偏差需要一次（45%）还是两次（47%）失败，受访者存在分歧，使用更多测量方法的人采用更严格的标准。报告了特定SPVT的使用频率。
VA残疾评估中SPVT失败的基础比率估计与其他法医学环境中的相当。然而，VA常规临床检查中的失败率远高于其他环境，这可能反映了VA在医疗保健和残疾判定中角色的混合性质。一般来说，VA神经心理学家经常使用SPVT，并且避免使用贬义词来描述测试失败情况。仅需一次SPVT失败就确定反应偏差的从业者可能会对患者进行过度分类。很少或不使用SPVT的从业者可能无法识别反应偏差。还讨论了其他临床和理论意义。
