ABSTRACT

Introduction: Research to date has supported the use of multiple performance validity tests (PVTs) for determining validity status in clinical settings. However, the implications of including versus excluding patients failing one PVT remains a source of debate, and methodological guidelines for PVT research are lacking. This study evaluated three validity classification approaches (i.e. 0 vs. ≥2, 0–1 vs. ≥2, and 0 vs. ≥1 PVT failures) using three reference standards (i.e. criterion PVT groupings) to recommend approaches best suited to establishing validity groups in PVT research methodology.

Method: A mixed clinical sample of 157 patients was administered freestanding (Medical Symptom Validity Test, Dot Counting Test, Test of Memory Malingering, Word Choice Test), and embedded PVTs (Reliable Digit Span, RAVLT Effort Score, Stroop Word Reading, BVMT-R Recognition Discrimination) during outpatient neuropsychological evaluation. Three reference standards (i.e. two freestanding and three embedded PVTs from the above list) were created. Rey 15-Item Test and RAVLT Forced Choice were used solely as outcome measures in addition to two freestanding PVTs not employed in the reference standard. Receiver operating characteristic curve analyses evaluated classification accuracy using the three validity classification approaches for each reference standard.

Results: When patients failing only one PVT were excluded or classified as valid, classification accuracy ranged from acceptable to excellent. However, classification accuracy was poor to acceptable when patients failing one PVT were classified as invalid. Sensitivity/specificity across two of the validity classification approaches (0 vs. ≥2; 0–1 vs. ≥2) remained reasonably stable.

Conclusions: These results reflect that both inclusion and exclusion of patients failing one PVT are acceptable approaches to PVT research methodology and the choice of method likely depends on the study rationale. However, including such patients in the invalid group yields unacceptably poor classification accuracy across a number of psychometrically robust outcome measures and therefore is not recommended.

摘要

简介：迄今为止的研究支持使用多项绩效有效性测试 (PVT) 来确定临床环境中的有效性状态。然而，包括与排除未能通过 PVT 的患者的影响仍然存在争议，并且缺乏 PVT 研究的方法学指南。本研究使用三个参考标准（即标准 PVT 分组）评估了三种有效性分类方法（即 0 对 ≥2、0-1 对 ≥2、0 对 ≥1 PVT 失败），以推荐最适合建立有效性的方法PVT 研究方法中的小组。

方法：对 157 名患者的混合临床样本进行独立（医学症状有效性测试、点计数测试、记忆伪装测试、单词选择测试）和嵌入式 PVT（可靠数字跨度、RAVLT 努力评分、Stroop 单词阅读、BVMT- R 识别歧视）在门诊神经心理评估期间。创建了三个参考标准（即上面列表中的两个独立式 PVT 和三个嵌入式 PVT）。除了参考标准中未使用的两个独立 PVT 之外，Rey 15 项测试和 RAVLT 强制选择仅用作结果测量。接受者操作特征曲线分析使用每个参考标准的三种有效性分类方法评估分类准确性。

结果：当仅一项 PVT 失败的患者被排除或归类为有效时，分类准确性从可接受到极好。然而，当一次 PVT 失败的患者被归类为无效时，分类准确性差到可以接受。两种有效性分类方法（0 对 ≥ 2；0-1 对 ≥ 2）的敏感性/特异性保持相当稳定。

结论：这些结果表明，纳入和排除一项 PVT 失败的患者都是 PVT 研究方法的可接受方法，方法的选择可能取决于研究的基本原理。然而，将这些患者包括在无效组中会在许多心理测量稳健的结果测量中产生令人无法接受的糟糕分类准确度，因此不推荐。