What’s New to AMA Guides Sixth Edition 2022

Summary of Updates

• Language describing the new evidence-based editorial process explains why the latest edition of the AMA Guides is rooted in science and best evidence.
• Encourages documenting evidence and the standard used to determine the impairment rating in reports.
• No changes to impairment ratings or methodology.

Conceptual Foundations and Philosophy (Chapter 1)

• Section 1.1 History of the AMA Guides
  • Description of changes: Insertion of paragraph to describe the evolution of the sixth edition of the AMA Guides, including the new evidence-based editorial process and panel.
• Section 1.2a Previous Criticisms of the AMA Guides
  • Insertion: “New editions of the AMA Guides were unable to be published quickly enough to reflect emergent improvements in science and evidence-based medicine.”
• Section 1.3b Applications of ICF Model to the AMA Guides, International Appeal and Applications
  • Insertion: “The concept of impairment evaluation as it relates to the ICF model continues to evolve. Incorporation of the biopsychosocial model of health will provide a platform for further research and exploration of these concepts into the future.”
• Section 1.6 The Case for Simplification and Ease of Application
  • New Section title: Evidence Requirements
  • Description of changes: details the evidence requirements for updating the sixth edition.
• Section 1.8e History of Clinical Presentation
  • Removed: “…those with minimal or intermittent moderate symptoms, in impairment class 1; and those with constant symptoms that persist despite treatment, in impairment class 4.”
  • Inserted: “...those with mild symptoms will be in class 1; and those with very severe constant symptoms that persist despite treatment will be in impairment class 4.”
• 1.8g Objective Test Results
  • Insertion: “Each chapter will delineate the key factor of the impairment class within a given grid.”
  • Insertion: “Typically, a combination of the key factor and non-key factors will be used to determine a place within a class and grade, and the key factor may vary within chapters or between chapters.”
• 1.9 AMA Guides Editorial Process and Digital Delivery (New Section)
  • Description of changes: additional information about the mission and goals of the AMA Guides Editorial Panel and the importance of using the most current evidence-based medicine to complete impairment ratings.
  • Sixth edition methodology will serve as the foundation for all changes to the AMA Guides moving forward.
  • Figure 1.3, AMA Guides Editorial Process is also provided.
• Minor editorial updates throughout the chapter have been made to improve readability and for clarity.

Practical Application of the AMA Guides (Chapter 2)

• Introduction
  • Description of changes: revised to reflect the evidence-based editorial process and AMA H-365.976
  • Deletion: The Guides is written by medical doctors for medical doctors and others permitted to do impairment evaluations. 
  • Insertion: The AMA Guides is written by physicians for conducting impairment evaluations. Physician is defined as an individual who has received a Doctor of Medicine or a Doctor of Osteopathic Medicine degree or a recognized equivalent physician degree and who would be eligible for an Accreditation Council for Graduate Medical Education (ACGME) residency.
• Table 2-1 Fundamental Principles of the AMA Guides (#6)
  • Deletion: “Impairment evaluation requires medical knowledge. Physicians duly recognized by an appropriate jurisdiction should perform such assessments within their applicable scope of practice and field of expertise.”
  • Insertion: “Impairment evaluation requires medical knowledge. Physicians, chiropractors, and others permitted to do impairment evaluations recognized by the relevant jurisdiction perform impairment evaluations within their applicable scope of practice and field of expertise and calculate impairment ratings utilizing the AMA Guides.”
• Section 2.3a Who Performs Impairment Ratings?
  • Deletion: Impairment evaluation requires medical knowledge; therefore, mostly doctors who are qualified in allo pathic or osteopathic medicine or chiropractic medicine use the Guides to evaluate permanent impairment. For the purpose of determining impairment, the appropriate health regulatory agency in a given jurisdiction is the best-suited authority to determine the definition of doctor in regard to who uses the Guides to rate impairment in that jurisdiction.

    It must be emphasized, however, that even though the Guides is mainly written by medical doctors for medical doctors and others permitted to do impairment evaluations, nonphysician evaluators may analyze an impairment evaluation to determine if it was performed in accordance with the Guides.

  • Insertion: Impairment evaluation requires medical knowledge. Physicians, chiropractors, and others recognized by the relevant jurisdiction perform impairment evaluations within their applicable scope of practice and field of expertise and calculate impairment ratings utilizing the AMA Guides. For the purpose of determining impairment, the appropriate health regulatory agency in a given jurisdiction is the best-suited authority to determine who may submit an impairment rating in that jurisdiction.

    It must be emphasized, however, that even though the AMA Guides is mainly written by physicians for conducting impairment evaluations, non-physician evaluators may analyze an impairment evaluation to determine if it was performed in accordance with the AMA Guides.

• Section 2.6 Impairment Evaluation and the Law
  • Description of changes: inserted language elaborates on the concept that content updates in AMA Guides Sixth 2022 and future editions of the AMA Guides are supported by an evidence-based foundation, upholding the AMA’s commitment to providing information for physicians and patients based on the most current, evidence-based medicine
• 2.7dConcluding the Report: Use of Evidence-Based Medicine
  • Description of changes: encourages users to acknowledge the standard (eg, edition of the AMA Guides) used to perform the evaluation and impairment rating and the science/evidence used to support recommendations I the report. Specimen language is also offered for consideration for raters to insert into their reports to describe this process.
• Impairment report template: Standard(s) Used to Determine the Impairment Rating is Offered for Consideration.
• Minor editorial updates throughout the chapter have been made to improve readability and for clarity.