Using the coefficient of variation to detect sincerity of effort of grip strength: a literature review.

Many clinicians use the coefficient of variation (CV) to assess sincerity of effort, without understanding the premise on which it is based or its physiological and mathematical bases. Clinicians who use computerized evaluation systems that calculate the CV may not even be aware of the formula used to derive it. The wide use of the CV in detecting sincerity of effort of grip strength is puzzling, since it lacks empirical support in the literature. This paper examines the physiological rationale for using measures of variability to detect sincerity of effort, the mathematical basis on which the CV is founded, and the reliability and validity of the CV. The conclusions based on this literature review are that the CV is not an appropriate method for determining whether an effort is sincere and that CV values may be inflated in injured patients with compromised hand strength.