Detección de simulación de síntomas asociados al esguince cervical

Abstract

Whiplash injury is one of the most complex conditions to assess because several of the symptoms it presents are not objectively measurable with current diagnostic methods, and cannot be quantified or assessed correctly. Its diagnosis is usually made on the basis of patients' verbalisations and without objective evidence, which makes it susceptible to feigning. To date, there is no method available to assess the risk of feigning in this condition and the vast majority of tools validated in the context are too extensive, which makes their application difficult. Therefore, it is of particular interest to validate short scales that allow the professional to carry out a feigning assessment in the condition of interest. The aim of this doctoral thesis is to develop a protocol to assess the risk of feigning in patients diagnosed with cervical sprain. The protocol was composed of brief psychometric instruments, including the Brief Pain Inventory (BPI), the Cervical Disability Index (NDI), the SF-36 Health Questionnaire, the Beck Anxiety and Depression Inventories (BDI and BAI-II), the Brief Illness Perception Questionnaire (BIPQ) and the Structured Inventory for Malingered Symptomatology (SIMS). In addition, a checklist of feigning indicators was added. Firstly, to select the instruments to be included in the protocol, a systematic review of the literature on the subject was carried out and those that presented the best psychometric properties and were validated in the Spanish population were chosen. The protocol was structured following the biopsychosocial model, so that there was at least one instrument that measured a variable from each of the three dimensions. Secondly, and in parallel, an observational study was carried out to assess the diagnostic usefulness of the criteria for establishing the causal link of the Law 35/2015. Third and finally, a simulation design with a clinical reference group (quasi-experimental) was used to apply the protocol to participants recruited in a multidisciplinary medical centre in the Region of Murcia, Spain (clinical group, diagnosed with whiplash injury), and at the University of Murcia (healthy experimental malingerers). Our findings indicate that the biopsychosocial assessment of the whiplash injury can be useful for the evaluation of feigning. The results obtained indicate that the BPI, the NDI and the SF-36 have shown adequate discriminative ability and can be useful integrated into a system, methodology or battery for feigning screening. The BAI, BDI, BIPQ and SIMS have shown a lower capacity, with a high rate of false positives in the case of the BDI and SIMS and false negatives in the other two, so we believe that they are not appropriate for the intended purpose. Finally, most of the indicators included in the checklist may be useful in the forensic context, but we consider it necessary to replicate these results with a group of genuine simulators to ensure their validity