Impairment and Disability: A Journey of Understanding
Christopher R. Brigham
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The inaugural issue of the American Medical Association's (AMA's) Guides Newsletter in 1996 ignited a conversation about the concepts of impairment and disability. Although the AMA Guides to the Evaluation of Permanent Impairment has evolved significantly with evidence-based medicine from the third edition (1990) to the current 2023 version of the sixth edition, conflating impairment and disability ratings continues. Impairment and disability are distinct terms. The extent of an injury does not necessarily predict the effects on activities of daily living, including work, given other clinical factors, comorbidities, motivation, technology, and accommodations. Patients with disabilities are best understood by embracing a biopsychosocial-spiritual model that reflects a humanistic and holistic view because disability is a multifaceted concept that is influenced by evolving physical, psychological, and psychosocial factors. Evaluating impairment is a challenging undertaking and physicians tasked with impairment evaluations must be trained to use the AMA Guides appropriately.

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