A critical review of the validity of the Credibility Assessment Tool (CAT) and its application to the screening of suspected malingering

[摘要] ENGLISH ABSTRACT: Malingering, the intentional simulation or exaggeration of symptoms for secondary gain, has asignificant financial impact on disability insurance given its prevalence. Multidisciplinaryprofessionals involved in disability determination therefore require a tool which would assist in thescreening of suspected malingerers.AIM: The Credibility Assessment Tool (CAT), a tool which was developed as part of thePerformance APGAR, was reviewed in terms of its validity and application to the screening ofmalingering. Research objectives included the review of face and content validity through aliterature review and concept analysis, as well as the review of construct and concurrent validity bycomparing the results with the operationalised malingering construct and available malingeringprotocols. The adapted Slick criteria as proposed by Aronoff, applicable to chronic pain,neurocognitive, neurological and psychiatric symptoms, was identified as the most suitablecriterion standard for use of comparison.DESIGN: The research design was a descriptive analytical design, which was performedretrospectively with a report review from insurance referrals to the researcher. Informed consentwas obtained from insurers who legally own the reports. A saturated sample of convenience of184 cases with depression and pain as predominant symptoms were analysed. Recall bias wereminimised through omission of personal identifiers and the use of a peer check of 20 randomcases. Results in the peer check were suggestive of poor inter-rater reliability, rather than recallbias.METHOD: Cases were analysed according to the guidelines from the respective authors of theCAT and adapted Slick criteria, however this was further defined to ensure that the study could bereplicated.RESULTS: Face validity was adequate in terms of purpose, item selection and associationbetween consistency criteria, however require improvement in terms of standardised instructionand weighting of the scale. Content validity was rated as adequate to excellent, given that itsupports criteria linked to the malingering construct. Construct validity was adequate asdemonstrated by association between concepts obtained through concept analysis. Correlationbetween the CAT and adapted Slick was strong (r>0.5) however caution is expressed that thisrequires further research.CONCLUSION: Recommendations for further research included the review of content validity withsubject experts, criterion and predictive valid through a case-control study of known-groups, aswell as the reliability of the CAT, and the use of specialised ADL indices for malingering detection.Adaptation to the CAT was depicted in the proposed Consistency Assessment Tool.

[发布机构] Stellenbosch University