ISSN 1308-7649 | E-ISSN 2148-3817
Review
Defining Clinical-Posturographic and Intra- Posturographic Discordances: What Do These Two Concepts Mean?
1 Research Unit EA 3450 DevAH - Development, Adaptation and Handicap, University of Lorraine, Faculty of Medicine and UFR STAPS; Department of Pediatric Otolaryngology, University Hospital of Nancy, Nancy, France  
2 Unit of Neuro-Otology, Division of Otolaryngology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada  
3 Unit of Neuro-Ophthalmology, Erasme University Hospital, Bruxelles, Belgium  
4 Research Unit EA 3450 DevAH - Development, Adaptation and Handicap, University of Lorraine, Faculty of Medicine and UFR STAPS, Nancy, France  
5 Department of Otorhinolaryngology, Landspitali University Hospital, Reykjavik, Iceland  
6 Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Sciences, University Hospital of Lund, Lund, Sweden  
7 Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands; Tomsk Research State University, Faculty of Physics, Tomsk, Russia  
8 Clinic of Otolaryngology, Head and Neck Surgery, Neurotology Unit, Lausanne University Hospital, Lausanne, Switzerland  
J Int Adv Otol 2018; 14: 127-129
DOI: 10.5152/iao.2018.4349
Key Words: Balance, posturography, discordance
Abstract

The European Society for Clinical Evaluation of Balance Disorders - ESCEBD - Executive Committee meets yearly to identify and address clinical equilibrium problems that are not yet well understood. This particular discussion addressed “discordances” (defined as “lack of agreement”) in clinical assessment. Sometimes there is disagreement between a clinical assessment and measured abnormality (ies); sometimes the results within the assessment do not agree. This is sometimes thought of as “malingering” or an attempt to exaggerate what is wrong, but this is not always the case. The Committee discussed the clinical significance of unexpected findings in a patient’s assessment. For example intraposturographic discordances sometimes exhibit findings (eg performance on more difficult trials may sometimes be better than on simpler trials). This can be suggestive of malingering, but in some situations can be a legitimate finding. The extreme malingerer and the genuine patient are at opposite ends of a spectrum but there are many variations along this spectrum and clinicians need to be cautious, as a posturography assessment may or may not be diagnostically helpful. Sometimes there is poor correlation between symptom severity and test results. Interpretation of posturography performance can at times be difficult and a patient’s results must be correlated with clinical findings without stereotyping the patient. It is only in this situation that assessment in a diagnostic setting can be carried out in an accurate and unbiased manner.

 

Cite this article as: Perrin P, Mallinson A, Van Nechel C, Peultier-Celli L, Petersen H, Magnusson M, et al. Defining Clinical-Posturographic and Intra-Posturographic Discordances: What Do These Two Concepts Mean? J Int Adv Otol 2018; 14(1): 127-9.

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