This paper deserves attention because it is a well-designed study in a prestigious, peer-reviewed journal. Meta-Analysis involves the statistical manipulation of data from all available quality studies which contain sufficient detail. By combining the populations studied by each writer, spurious and anomalous findings are eliminated, and trends which are not statistically significant in an individual study may prove to be valid. The authors reviewed seventeen reports of 18 study groups - a total of 2,353 subjects.
Patients with financial incentives who had sustained mild closed head-injury had greater abnormality and disability than more severely injured patients without financial incentives. Patients with less neurological abnormality were more likely to pursue financial compensation. Financial incentive had a more powerful effect on patients with mild than on those with more severe closed head-injury.
The authors go further than merely reporting an association. They contend that, absent monetary compensation, some patients would have fewer and milder deficits and others would have none.
They propose that patients with severe cognitive deficits many months after a mild head-injury undergo extensive neuropsychiatric evaluation to quantify the contribution of financial incentive.
The contribution of financial incentive is part of the medicolegal assessment of severely disabled Mild Traumatic Brain Injury litigants.
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