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The American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment (Guides) has become the most commonly used source for assessing and rating an individual's permanent impairment in the United States and, increasingly, abroad. Balancing the tradition of the Guides with the need for a scientific update, the fifth edition of the Guides has retained the focus of earlier editions, while incorporating updates in diagnostic criteria, clarifying key definitions and applications of the Guides, and enhancing readability, accessibility, and consistency. The updated scientific criteria are a blend of evidence-based medicine and specialty society consensus recommendations.

Although this preface cannot describe all of the updates to the fifth edition, we would like to emphasize certain features. Chapters have been reorganized, when possible, to follow a consistent format. Features include:

  • Chapter Outlines—an outline of main chapter headings precedes each chapter for quick reference

  • Boldface Glossary Terms—key impairment terms that are defined in the Glossary are boldface on first significant text occurrence

  • Principles of Assessment—an overview of impairment assessment for each body system

  • Interpretation of Symptoms and Signs—a description and interpretation of common signs and symptoms present for body system disorders

  • Description of Clinical Procedures—a summary of common clinical procedures used to investigate system-specific impairment

  • Criteria for Rating Permanent Impairment—clinical criteria used to determine impairment ratings

  • Case Studies—expanded from earlier editions; succinct format; clinically relevant

  • Impairment Evaluation Summary—summary of key conditions and their clinical assessment, with references to the main tables in the chapter

  • Bibliography and Key References—some with annotations

The updates in content and diagnostic criteria reflect recommendations from members of leading specialty societies. Many specialty societies recommended members of their society who subsequently became chapter chairs, contributors, and reviewers. These members often served as liaisons and interpreters, applying guidelines from their specialty society to the clinical assessment of permanent impairment.

The AMA is grateful for the valued input and content recommendations from the American Medical Association Federation Members, including input from members of the following:

  • American Academy of Dermatology

  • American Academy of Gastroenterology

  • American Academy of Hand Surgery

  • American Academy of Neurology

  • American Academy of Occupational and Environmental Medicine

  • American Academy of Orthopaedic Surgeons

  • American Academy of Otolaryngology-Head and Neck Surgery

  • American Academy of Pain Medicine

  • American Academy of Physical Medicine and Rehabilitation

  • American Academy of Respiratory Diseases

  • American Association for Hand Surgery

  • American Association for Thoracic Surgery

  • American Association of Clinical Endocrinologists

  • American Cardiology Society

  • American College of Obstetricians and Gynecologists

  • American College of Occupational and Environmental Medicine

  • American College of Physicians/American Society of Internal Medicine

  • American College of Rheumatology

  • p. iiiAmerican Opthalmology Society

  • American Orthopaedic Association

  • American Psychiatric Association

  • American Society for Surgery of the Hand

  • American Society of Hand Therapists

  • American Thoracic Society

  • International Federation of Societies for Surgery of the Hand

  • North American Spine Society

Input from other non-AMA member associations was also essential, including the International Association of Industrial Boards and Commissioners, American Academy of Disability Evaluating Physicians, American Pain Society, American Thoracic Association, and International Society for Low Vision Research and Rehabilitation (ISLRR). Staff from the Journal of the American Medical Association (JAMA) provided guidance and perspective concerning content and editorial issues.

The editors wish to thank B. J. Anderson, JD, of the AMA legal group and Donald R. Bennett, MD, PhD, for their guidance, as well as the executive, steering, and senior advisory committees who participated in the early planning stages of the revision for their input. A list of those individuals is available from the AMA on request. The editors also wish to thank the editorial, production, and marketing staff members at the AMA, the Think Design Group, and the freelance editors who developed and edited the manuscript, designed this edition, shepherded the book through production and manufacturing, and planned and executed the marketing program: Mary Lou White, Barry Bowlus, Jean Roberts, Reg Schmidt, Robert Miller, Rosalyn Carlton, Mary Ann Albanese, Ronnie Summers, Cindi Anderson, Linda Woodard, Robin Husayko, Ryan Bergin, David Arispe, Coralee Montes, Steve Straus, Nicole Netter, and Gerry van Raavensway. The editors are grateful for the integral administrative and secretarial support of Nancy Pabon and Gloria Roebuck at Rush-Presbyterian-St Luke's Medical Center.

The editors acknowledge and appreciate the prior hard work, dedication, and foundation provided by the editors of the prior edition, Theodore C. Doege and Alan Engelberg, and the many users of the Guides who submitted recommendations concerning the revision. Their input was essential to creating this edition of the Guides and ensuring subsequent revisions will meet the needs of the population this book serves.

Linda Cocchiarella, MD, MSc, AMA Medical Editor

Gunnar B. J. Andersson, MD, PhD, Senior Medical Editor

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