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What’s New to AMA Guides Sixth Edition 2021


Summary of Updates

  • Content update provides clarification and updated terminology around mental and behavioral health concepts to improve interrater reliability. Overview of updates to Mental and Behavioral Health Content:
    • Change from DSM IV to DSM 5 terminology and methodology 
    • Newer editions of Assessment Tools and Tests
    • Descriptions of Malingering and Motivation 
    • Removal of summaries of psychiatric diagnoses and conditions from the Glossary to mitigate discrepancies in a forensic setting
  • Removal of GAF results in more accurate mental and behavioral health impairment ratings
  • Minor editorial corrections to Lower Extremities and Spine and Pelvis content


Significant Changes to Content and Methodology 

Changes to the AMA Guides Sixth 2021 which resulted in substantial changes of content, evidence, and impact to impairment ratings. 

Mental and Behavioral Health (Chapter 14)
  • Introduction and Sections 14-1, 14-2 and 14-3 rewritten to reflect updated thinking, specifically regarding the update from DSM-IV-TR to DSM-5 and definitions of motivation and malingering. 
  • Table 14-1 from AMA Guides Sixth 2008 has been eliminated as the Multiaxial System is no longer considered in DSM-5. 
  • Tables 14-2 and 14-3 from AMA Guides Sixth 2008 are now 14-1 and 14-2 and have been significantly revised to reflect updating testing tools. 
  • Global Assessment of Functioning (GAF) has been eliminated from impairment rating methods outlined in Section 14.5 and 14.6. 
  • Mental and Behavioral Disorder Examples (Section 14.7) have been revised to eliminate reference to the Axis’ and GAF in calculating impairment ratings. Impairment ratings reflected in these examples have been updated as applicable. 
  • References updated as applicable. 

Minor Editorial Enhancements

Editorial clarifications that have no substantiative impact on content, supporting evidence used, or impairment ratings. 

Lower Extremities (Chapter 16)
  • Functional History Modifier now has a box around it to promote consistency with the upper extremity Functional History Modifier. 
  • In all chapter tables, instances with ‘-‘ were replaced with ‘:’ to promote internal consistency. Example: Table 16-12, Peripheral Nerve impairment - Lower Extremity Impairments has been changed to Peripheral Nerve impairment : Lower Extremity Impairments.
  • Table 16-3: The word ‘meniscectomy’ was added within the Class 1 and 2 definition of meniscal injury.  
  • Example 16-10: subluxing was corrected to subluxating.
  • Example 16-11: The term ‘right knee’ is now bolded and returned on another line.
Spine and Pelvis (Chapter 17)
  • Table 17-3: ‘Soft tissue and nonspecific conditions’ subheading added to the top of table 17-3.
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