Posturographic performance in patients with the potential for secondary gain

OBJECTIVES: To determine the incidence of nonorganic sway patterns on compu terized dynamic posturography (CDP) among patients with potential secondary gain compared with patients without any obvious secondary gain. METHODS: A retrospective chart review of 100 patients who underwent clinica l evaluation, audiometry, electronystagmography, and CDP was undertaken, Gr oup 1 consisted of 50 patients who were randomly selected from a group who had pending lawsuits, worker's compensation claims, or disability claims. G roup 2 consisted of 50 randomly selected patients who had no pending legal status, worker's compensation claims, or disability claims, Previously publ ished criteria for nonorganic sway patterns were then applied to each group . Statistical analysis was performed. RESULTS: The average age of group 1 patients was 43.8 years compared with 6 3.2 years for group 2 patients (P < 0.0001). Among group 1 patients 50% had normal audiovestibular evaluations compared with only 4% of group 2 patien ts (P < 0.0001). Nonorganic sway patterns were found in 76% of group 1 pati ents, but only in 8% of group 2 patients (P < 0.0001). CONCLUSION: Patients who have the potential for secondary gain are generall y younger and have a much higher prevalence of normal audiovestibular evalu ations and a much higher prevalence of nonorganic sway patterns on CDP. A h igh degree of clinical suspicion should be maintained when evaluating the d izzy patient who has a pending lawsuit.