Performance Validity Test Failure in the Clinical Population: A Systematic Review and Meta-Analysis of Prevalence Rates

Jeroen J. Roor*, Maarten J.V. Peters, Brechje Dandachi-FitzGerald, Rudolf W.H.M. Ponds

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Performance validity tests (PVTs) are used to measure the validity of the obtained neuropsychological test data. However, when an individual fails a PVT, the likelihood that failure truly reflects invalid performance (i.e., the positive predictive value) depends on the base rate in the context in which the assessment takes place. Therefore, accurate base rate information is needed to guide interpretation of PVT performance. This systematic review and meta-analysis examined the base rate of PVT failure in the clinical population (PROSPERO number: CRD42020164128). PubMed/MEDLINE, Web of Science, and PsychINFO were searched to identify articles published up to November 5, 2021. Main eligibility criteria were a clinical evaluation context and utilization of stand-alone and well-validated PVTs. Of the 457 articles scrutinized for eligibility, 47 were selected for systematic review and meta-analyses. Pooled base rate of PVT failure for all included studies was 16%, 95% CI [14, 19]. High heterogeneity existed among these studies (Cochran's Q = 697.97, p <.001; I2 = 91%; τ2 = 0.08). Subgroup analysis indicated that pooled PVT failure rates varied across clinical context, presence of external incentives, clinical diagnosis, and utilized PVT. Our findings can be used for calculating clinically applied statistics (i.e., positive and negative predictive values, and likelihood ratios) to increase the diagnostic accuracy of performance validity determination in clinical evaluation. Future research is necessary with more detailed recruitment procedures and sample descriptions to further improve the accuracy of the base rate of PVT failure in clinical practice.

Original languageEnglish
Pages (from-to)299-319
Number of pages21
JournalNeuropsychology Review
Issue number1
Early online date6 Mar 2023
Publication statusPublished - Mar 2024


  • Base rate
  • Clinical assessments
  • Invalid performance
  • Meta-analysis
  • Performance validity test
  • Prevalence


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