Do physicians correctly rate permanent impairment in chronic low back pain patients? How accurate and consistent are permanent impairment ratings for low back problems? Very few articles in the medical literature deal with this problem.

Clark and Haldeman's 1993 article describes a study on workers' compensation patients with low back pain. This study was done in California, a state that does not use the Guides, but has its own rating system. The article's introduction states, “Two or more examiners consulting on the same injured worker would often submit grossly different findings and conclusions.”

Their California study considered 200 consecutive low back pain patient disability rating reports. The authors picked the 42 best (most complete) reports. Multiple physicians reviewed each report and rated each individual's disability. An average of 14 physicians rated each case, with the ratings differing...

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