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, more probable, prior, or subsequent cause for the symptoms and signs. Risk assessment techniques such as the Bradford Hill requirements for an environmental disease are useful in causation analysis of occupational illness. In brief, the physician should examine existing scientific evidence and consider: the strength of association between the exposure and disease (relative risk of developing the illness) the consistency of results among studies with similar exposures whether studies were adequately controlled to ensure specificity of the results, if
presented. The premise that examinee reports are accurate has repeatedly failed scientific testing, as detailed in the September/October 2009 issue of the AMA Guides Newsletter. 1 Impairment evaluations are vulnerable to being influenced by the examinee's self-reported history. Studies have demonstrated that claimants tend to over-report symptoms and functional difficulties. Lacking other information, it is difficult to determine whether the reported symptoms with prolonged walking are valid. However, given the tear this is possible. Yet many athletes sustain tendon
sick or disabled to work. When people lose their jobs and do not find new ones, they barely get by on disability benefits and are vulnerable to other detrimental effects. How Can We Fix This Problem? Good scientific evidence exists about how unexpectedly poor outcomes are created, how to avoid them, and how health care and other services can protect jobs. 2 Health-related work disruption should be viewed as a life emergency. Productive activity should be a part of treatment regimens. When work disruption begins, it can be both effective and cost
QUESTION: A 65-year-old obese male heavy-equipment operator, who drives bulldozers at a landfill, was seen for neck pain. Imaging studies revealed cervical facet arthropathy. Does whole-body vibration (WBV) cause or aggravate cervical disc degeneration? ANSWER: Causation analysis must be based on facts and scientific evidence. The AMA Guides to the Evaluation of Disease and Injury Causation provides guidance on causation analysis and apportionment. The second edition, published in 2014, provides the following guidance in Chapter 32, Effects of Whole
defined as being a psychological phenomenon, 3 and scientific research classifies pain as a psychosocial variable rather than a general medical variable. 4 In contrast to this pervasiveness of psychological factors in pain, general medical factors are not essential to a presentation of pain. As is succinctly stated in Bonica's Management of Pain, 5 “Tissue damage and nociception are neither necessary nor sufficient for pain.” It can also be noted that Chapter 18 provides what appears to be all encompassing answers to its key question, before it even presents that
raised, “Is absence of objective findings an indicator of absence of pathology (impairment) or insufficient sensitivity of the measures used?” The scientist in each of us prods us to believe the scientifically verifiable and to worship at the altar of “evidence based” knowledge. However, the realist in us recognizes the limits of our current knowledge and ability to detect, let alone cure, all pathology. Succeeding editions of the AMA Guides have acknowledged examples of poorly defined conditions that warrant rating not recognized in prior editions. Table 49 of the
concept that physicians have frequently ignored but that has significant implications for treatment options. It should be recognized that while there are thousands of published studies on specific conditions such as low-back pain, the science and study of nociplastic pain are still preliminary. Science comes to conclusions slowly, with the publication of preliminary studies and criticism of those studies that leads to the subsequent publication of better studies. Eventually, enough evidence accumulates that a conclusion is accepted as being scientifically established
of the other changes in that edition. One change was the addition of the burden of treatment compliance (BOTC). Here, the origin, evolution, and use of this concept are described. BOTC: Where Did It Come From? The ideal impairment evaluation scientifically measures an individual's maximum capability and compares it with a normal value based on variables such as age, gender, and other anthropomorphic measures. The ideal system also would have linear scales that show the continuity from normalcy to severity. Thus, the results of an injury could be
by their training, experience, biases, and beliefs. It's important to realize that there is very little in the way of scientific studies or evidence-based guidance for most disability determinations. The second category was labeled a cued response. In this case, the patient guides the physician. For example, a patient may claim there are no possible accommodations at work or might indicate to the physician that he's ready to return to work. The consultative response involves a discussion or negotiation between the physician and the patient before coming to a
Chapter 16, The Upper Extremities, presents several changes from the Fourth Edition. Although these changes are minor compared to those in Chapter 15, The Spine, they are more significant than those in Chapter 17, The Lower Extremities. The primary approach to assessing upper extremity impairment continues to be anatomical, as opposed to functional. Some of the approaches have been modified. The stated revisions are: basic principles of assessment have been clarified, updates of the latest scientific information in assessment of upper extremity
