whiplash, malingering - interesting abstracts found on PUBMED - (see bolded text)

[Guest guest]

Oregon DC's:

Pasted below are some cites from Janabeth Fleming , RN, who does medical research and is involved in the medicolegal aspects of cases. I thought you might be interested because I know some of you deal with tort and workers comp injury cases where malingering and embellishment are routine accusations against claimants.

Enjoy!

Chris

520 S.W. Sixth Avenue, Suite 1250Portland, OR 97204Tel: (503) 227-4330Fax: (503) 227-3230chill@...www.cthlaw.com

1: Neurosci Lett. 2003 May 15;342(1-2):53-6. A brief and unobtrusive instrument to detect simulation and exaggeration in

patients with whiplash syndrome.

Sartori G, Forti S, Birbaumer N, Flor H.

Department of General Psychology, University of Padua, Padua, Italy.

giuseppe.sartori@...

The objective of this study was to develop and test a brief and unobtrusive

instrument to detect exaggeration and simulation in whiplash syndrome. The

instrument consists of eight scenarios with ten response options that have to be

ordered according to how easy a behavior is to perform. Twenty-five simulating

and 25 non-simulating patients with whiplash syndrome of grades 2 and 3

according to the Quebec Task Force classification as well as 25 simulating and

25 non-simulating controls completed the instrument. In a cross-validation study

20 controls and 20 patients participated. Malingering and exaggeration scores

were determined for each subject and patient. The scores were summed up and

compared across malingering and exaggerating subjects and controls and cut-off

values were determined to classify the patients. T-tests and a discriminant

analysis were used to determine classification accuracy. The instrument

correctly identified 94% of the simulators and 84% of the exaggerators in both

samples. This brief and unobtrusive instrument can detect exaggeration and

simulation in whiplash syndrome.

Publication Types:

Clinical Trial

Controlled Clinical Trial

PMID: 12727316 [PubMed - indexed for MEDLINE]

2: Spine. 2002 Feb 1;27(3):327-8. Comment on:

Spine. 2001 Jun 15;26(12):E268-73.

Effect of monetary gain on the treatment of zygapophysial joint pain in cervical

whiplash.

Ferrari R.

Publication Types:

Comment

Letter

PMID: 11805701 [PubMed - indexed for MEDLINE]

3: Spine. 2001 Jun 15;26(12):E268-73. Comment in:

Spine. 2002 Feb 1;27(3):327-8.

Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with

cervical whiplash: a prospective study.

Sapir DA, Gorup JM.

Indiana Pain Institute, Lafayette, Indiana 47905, USA. sapirmd@...

STUDY DESIGN: The efficacy of radiofrequency medial branch neurotomy to treat

cervical zygapophysial joint pain from whiplash was compared prospectively in

litigants and nonlitigants. OBJECTIVES: 1) To assess the effect of monetary gain

on treatment of zygapophysial joint pain in cervical whiplash. 2) To determine

whether radiofrequency medial branch neurotomy is effective treatment for

whiplash. SUMMARY OF BACKGROUND DATA: The influence of litigation on treatment

outcome is a subject of controversy in both the medical and legal professions.

This is the first study to examine this issue in a prospective manner using a

previously proven diagnostic and therapeutic method. METHODS: Sixty patients

with cervical whiplash who remained symptomatic after 20 weeks of conservative

management were referred for radiofrequency cervical medial neurotomy. The

patients were classified as litigant or nonlitigant based on whether the

potential for monetary gain via litigation existed. Each group underwent

identical evaluation and treatment. Patients were observed for 1 year. Visual

analogue scores and self-reported improvement were obtained before, immediately

after, and 1 year after radiofrequency cervical medial neurotomy. RESULTS:

Forty-six patients completed the study. The overall reduction in cervical

whiplash symptoms and visual analogue pain scores were significant immediately

after treatment (nonlitigants vs. litigants: 2.0 vs. 2.5, P = 0.36) and at 1

year (nonlitigants vs. litigants: 2.9 vs. 4.0, P = 0.05). One-year follow-up

scores were higher than immediate post-treatment scores (nonlitigants vs.

litigants: 2.5 vs. 3.6). The difference between litigants and nonlitigants in

the degree of symptomatology or response to treatment did not reach

significance. CONCLUSIONS: These results demonstrate that the potential for

secondary gain in patients who have cervical facet arthropathy as a result of a

whiplash injury does not influence response to treatment. These data contradict

the common notion that litigation promotes malingering. This study also confirms

the efficacy of radiofrequency medial branch neurotomy in the treatment of

traumatic cervical facet arthropathy.

Publication Types:

Clinical Trial

PMID: 11426167 [PubMed - indexed for MEDLINE]

4: J Int Neuropsychol Soc. 2000 Mar;6(3):271-8. Cognitive functioning after whiplash injury: a meta-analysis.

Kessels RP, Aleman A, Verhagen WI, van Luijtelaar EL.

Department of Psychonomics, Utrecht University, The Netherlands.

r.kessels@...

Complaints on cognitive functioning are often reported in patients suffering

from whiplash syndrome, although objective neuropsychological test results do

not always support these. In addition, radiological abnormalities and anatomical

lesions are found only in a minority of these patients. This has led to a

controversy about its existence in the literature. In this systematic review,

the results of 22 neuropsychological studies on whiplash were quantitatively

analyzed, focusing on working memory, attention, immediate and delayed recall,

visuomotor tracking, and cognitive flexibility. Our findings suggest that a

consistent overall pattern of cognitive dysfunction can be demonstrated after

whiplash injury through neuropsychological testing, both compared to healthy and

to asymptomatic controls. Six months after the accident, improvement is found in

working memory, attention, immediate recall, and visuomotor tracking. The

results are discussed in the light of recent findings on the effect of cerebral

dysfunction, malingering, pain-related factors, and the role of coping

strategies and posttraumatic stress on neuropsychological test performance.

Publication Types:

Meta-Analysis

PMID: 10824499 [PubMed - indexed for MEDLINE]

5: J Neurol Neurosurg Psychiatry. 1999 Dec;67(6):831-2. Comment on:

J Neurol Neurosurg Psychiatry. 1999 Apr;66(4):485-9.

Relation between neuropsychological and neuroimaging findings in patients with

late whiplash syndrome.

Ferrari R.

Publication Types:

Comment

Letter

PMID: 10617387 [PubMed - indexed for MEDLINE]

6: J Neurol Neurosurg Psychiatry. 1998 Mar;64(3):339-43. Cognitive complaints in patients after whiplash injury: the impact of

malingering.

Schmand B, Lindeboom J, Schagen S, Heijt R, Koene T, Hamburger HL.

Department of Psychology, Slotervaartziekenhuis, Amsterdam, The Netherlands.

b.schmand@...

OBJECTIVES: The validity of memory and concentration complaints that are often

reported after a whiplash trauma is controversial. The prevalence of malingering

or underperformance in post-whiplash patients, and its impact on their cognitive

test results were studied. METHODS: The Amsterdam short term memory (ASTM) test,

a recently developed malingering test, was used as well as a series of

conventional memory and concentration tests. The study sample was a highly

selected group of patients, who were examined either as part of a litigation

procedure (n=36) or in the normal routine of an outpatient clinic (n=72).

RESULTS: The prevalence of underperformance, as defined by a positive score on

the malingering test, was 61% (95% CI: 45-77) in the context of litigation, and

29% (95% CI: 18-40) in the outpatient clinic (p=0.003). Furthermore, the scores

on the memory and concentration test of malingering post-whiplash patients

(n=43) and non-malingering post-whiplash patients (n=65) were compared with the

scores of patients with closed head injury (n=20) and normal controls (n=46).

The malingering post-whiplash patients scored as low as the patients with closed

head injury on most tests. CONCLUSIONS: The prevalence of malingering or

cognitive underperformance in late post-whiplash patients is substantial,

particularly in litigation contexts. It is not warranted to explain the mild

cognitive disorders of whiplash patients in terms of brain damage, as some

authors have done. The cognitive complaints of non-malingering post-whiplash

patients are more likely a result of chronic pain, chronic fatigue, or

depression.

PMID: 9527145 [PubMed - indexed for MEDLINE]

7: Pain. 1996 Aug;66(2-3):223-7. Faking a profile: can naive subjects simulate whiplash responses?

Wallis BJ, Bogduk N.

Cervical Spine Research Unit, Faculty of Medicine, University of Newcastle,

Callaghan, NSW, Australia.

The psychological symptom checklist, the SCL-90-R (Derogatis 1983), has been

used to assess patients with a number of chronic pain syndromes. For whiplash

injury, a characteristic profile has been found (Wallis et al. 1995). However,

there is still a belief that patients with neck pain following whiplash injury

may be malingering, and therefore the utility of the SCL-90-R as a screen for

possible malingering is assessed here. Forty pain-free university students were

asked to simulate chronic pain 6 months after a motor vehicle accident in order

to ensure compensation. The SCL-90-R, McGill Pain Questionnaire and a visual

analogue pain scale were used. Students' scores were compared with those of a

group of 132 whiplash patients (Wallis et al. 1995). Differences between the two

groups were striking; the students scored significantly higher than patients on

all subscales of the SCL-90-R and on the visual analogue pain scale

(Mann-Whitney P-values all less than 0.001). However, pain scores for both

groups on the McGill Pain Questionnaire were similar. The conclusion was that it

is very difficult for an ingenuine individual to fake a psychological profile

typical of a whiplash patient.

Publication Types:

Clinical Trial

PMID: 8880844 [PubMed - indexed for MEDLINE]

8: Can Fam Physician. 1995 Jan;41:29-30. Comment on:

Can Fam Physician. 1994 Nov;40:1906-9.

Few whiplash patients are malingerers.

Zabrodski R.

Publication Types:

Comment

Letter

PMID: 7894276 [PubMed - indexed for MEDLINE]

9: Med Sci Law. 1993 Jul;33(3):231-42. Mild head injury is not always mild; implications for damage litigation.

Blakely TA Jr, Harrington DE.

The traditional view that mild head injury involves an essentially reversible

physiological process is examined and is found to be largely invalid. It is

concluded that long-term impairment following mild head injury is fairly common

and that the degree of impairment can be assessed clinically. Such an assessment

involves a combination of objective electrophysiological and psychometric

investigations as well as professional interpretation. With the use of this

approach the possibility of malingering can be ruled out in most cases and

significant impairment, when it exists, can be demonstrated beyond reasonable

doubt.

Publication Types:

Case Reports

PMID: 8366786 [PubMed - indexed for MEDLINE]

Janabeth Fleming , R.N., R.N.C.

Litigation Paralegal - ATLA Paralegal of the Year 2002 Attorney's Medical Services, Inc. - Corpus Christi

P.O. Box 181268

Corpus Christi, TX 78480-1268

Phone: 361-949-8880

Fax: 361-949-8886

jana@...

www.attorneysmedicalservices.com