Actual and clinician-predicted IOP-29 scores in a clinical setting

Objective Clinicians often rely on judgement rather than validated tools to assess symptom credibility. Understanding how clinical judgement compares to objective measures is crucial, as self-reported symptoms can significantly influence diagnosis and treatment.Method Eleven clinicians from a group private practice were asked to predict the IOP-29 False Disorder Probability Score (FDS) for n = 154 non-litigants seen for neuropsychological assessment, based on their judgement of the examinee’s self-report credibility. These predictions were compared to actual IOP-29 FDS scores using different cut-offs. Test-operating characteristics of clinician-predicted versus actual IOP-29 FDS scores were calculated for the three cut-offs, and secondary analyses examined the effect of culturally and linguistically diverse (CALD) status on prediction accuracy.Results Cohen’s Kappa (.08, −.07 – .24) and intra-class correlation (ICC = .33, .18–.46) values showed poor agreement between clinician-predicted and actual IOP-29 FDS scores. Although the specificity was acceptable (90.7%, 83.6–95.5), sensitivity of the clinical judgement of symptom validity was low (19.6%, 9.4–33.9). CALD status had no bearing on FDS prediction accuracy.Conclusions Clinicians are unable to accurately judge the validity of symptom reporting relative to a validated symptom validity measure, highlighting the need to administer such measures routinely in clinical practice.