Evidence map›Paper›PMID 40561085›Full record

SynthesisPloS one2025

Prevalence of symptom exaggeration among North American independent medical evaluation examinees: A systematic review of observational studies.

Andrea J Darzi, Li Wang, John J Riva, Rami Z Morsi, Rana Charide, Rachel J Couban, Samer G Karam, Kian Torabiardakani, Annie Lok, Shanil Ebrahim and 4 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. The stigmatization of patients with chronic pain due to assessed exaggeration of symptoms.Canadian journal of pain = Revue canadienne de la douleur · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Andrea J DarziDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.ORCID 0000-0002-2498-1697
Li WangMichael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada.
John J RivaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Rami Z MorsiDepartment of Neurology, University of Chicago, Chicago, Illinois, United States of America.
Rana CharideDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Rachel J CoubanMichael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada.ORCID 0000-0001-8672-2845
Samer G KaramDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Kian TorabiardakaniMichael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada.ORCID 0009-0001-3520-245X
Annie LokDepartment of Anesthesia, McMaster University, Hamilton, ON, Canada.
Shanil EbrahimDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Sheena BanceCentre for Addiction and Mental Health, Toronto, ON, Canada.
Regina KunzDivision of Clinical Epidemiology, Evidence-based Insurance Medicine, University Hospital Basel, Basel, Switzerland.ORCID 0000-0003-0931-8990
Gordon H GuyattDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Jason W BusseDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.ORCID 0000-0002-0178-8712

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIndependent medical evaluations (IMEs) are commonly acquired to provide an assessment of impairment; however, these assessments show poor inter-rater reliability. One potential contributor is symptom exaggeration by patients, who may feel pressure to emphasize their level of impairment to qualify for incentives. This study explored the prevalence of symptom exaggeration among IME examinees in North America, which if common may represent an important consideration for improving the reliability of IMEs.

methodsWe searched CINAHL, EMBASE, MEDLINE and PsycINFO from inception to July 08, 2024. We included observational studies that used a known-group design or multi-modal determination method. Paired reviewers independently assessed risk of bias and extracted data. We performed a random-effects model meta-analysis to estimate the overall prevalence of symptom exaggeration and explored potential subgroup effects for sex, age, education, clinical condition, and confidence in the reference standard. We used the GRADE approach to assess the certainty of evidence.

resultsWe included 44 studies with 46 cohorts and 9,794 patients. The median of the mean age was 40 (interquartile range [IQR] 38-42). Most cohorts included patients with traumatic brain injuries (n = 31, 67%) or chronic pain (n = 11, 24%). Prevalence of symptom exaggeration across studies ranged from 17% to 67%. We found low certainty evidence suggesting that studies with a greater proportion of women (≥40%) may be associated with higher rates of exaggeration (47%, 95%CI 36-58) vs. studies with a lower proportion of women (<40%) (31%, 95%CI 28-35; test of interaction p = 0.02). Possible explanations include biological differences, greater bodily awareness, or higher rates of negative affectivity. We found no significant subgroup effects for type of clinical condition, confidence in the reference standard, age, or education.

conclusionSymptom exaggeration may occur in almost 50% of women and in approximately a third of men undergoing IMEs. The high prevalence of symptom exaggeration among IME attendees provides a compelling rationale for clinical evaluators to formally explore this issue. Future research should establish the reliability and validity of evaluation criteria for symptom exaggeration and develop a structured IME assessment approach.

Indexed as

AdultFemaleHumansMaleNorth AmericaObservational Studies as TopicPrevalenceReproducibility of Results

Identifiers

PMID40561085
PMCPMC12193048

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.