This article provides an overview of the conceptual foundations of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. Impairment assessment in the sixth edition underwent a “paradigm shift” compared to the AMA Guides, Fifth Edition, in which its impairment rating methodology is based on the World Health Organization's (WHO's) International Classification of Functioning, Disability and Health (ICF) framework. Impairment rating is but one of several determinants of disability, and the one most amenable to physician assessment.

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