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American Medical Association, 2011 Reviewed by David A. Fetter, MD, FAAOS, FAADEP, CEDIR Diplomate American Board of Orthopaedic Surgery Fellow American Academy of Orthopaedic Surgeons Fellow American Academy of Disability Evaluating Physicians Certification in Impairment and Disability Rating - American Academy of Disability Evaluating Physician The second edition of “ Return to Work,” in one word, is a masterpiece. The authors are to be congratulated for their scientific approach to a topic that at times has nonscientific contributing factors
the clinical data and the features of clinical data analysis, which can be helpful in identifying malingering and other validity problems during document and medical file reviews. Assessment of the validity of a clinical presentation can be challenging. Faust has commented on the vulnerability of physicians to overlooking malingering: “How easy it is to deceive sympathetic individuals … and how dangerous it is to be overly confident about our powers of detection.” 9 However, guidance on this issue is available from scientific findings and guidelines
paradoxical situation is reflective of directives provided by the editors that values remain the same (eg, “most impairment percentages in this fifth edition have been retained from the fourth edition because there are limited scientific data to support specific changes” [5th ed, 5]). In the spine chapter, the definition for Cervical Category IV (alteration of motion segment integrity or bilateral or multilevel radiculopathy) changed from that of the Fourth Edition for Cervicothoracic Category IV (loss of motion segment integrity or multilevel neurological compromise) due
as the Demeter textbook, 4 however, there were again some fresh perspectives. The major strength of the book lies in its updating of the methods of the NIOSH monograph of 1997. 1 Both works gather all the literature relating to musculoskeletal disorders in the workplace, devise methods of evaluating the scientific merit of each article, and then conclude that the causal evidence between a disorder and the workplace is either insufficient, moderate, strong, or very strong. On this basis a physician can step into an IME, deposition, or courtroom setting with the
individual's self-imposed limit on the ability to do the task in question.” The authors posit, “tolerance is not scientifically measurable or verifiable; it is an inherently subjective experience expressed as a symptom. Tolerance is frequently less than either capacity or current ability.” In light of these considerations, what is a HCP to do when a patient wants to be excused from work, but the HCP cannot ascertain any objective findings to justify such action? Surely, these are the hard cases. Here the authors provide a frank discussion – typical of the book's advice
be over-diagnosed and over-treated. 2 , 9 Such shortcomings in the utilization of a diagnosis are especially intolerable for a concept such as CRPS-1, because this concept is on very tenuous scientific ground in general. The general lack of scientific support for this concept has been documented elsewhere, 10 , 11 and is subsequently not reviewed in detail within this paper. But the lack of scientific credibility is noted because within such a context, diagnostic systems should minimize credibility problems rather than compound them. III. Challenges in the
impairment per Chapter 3, Pain-Related Impairment. While Chapter 3 has an example of postconcussive headache (page 42, Example 3-2), the instructions on rating headache in Chapter 13, The Central and Peripheral Nervous System (6th ed, 342), state, “… nonmigrainous headaches are not ratable using the AMA Guides. ” The diagnosis of “posttraumatic cephalgia” in this case is based solely on a subjective complaint of questionable validity. Scientific findings reveal that “posttraumatic” headache is best predicted by compensation and litigation and outside the medical
Osteoarthritis (OA), also known as degenerative arthritis or degenerative joint disease, is the most common type of arthritis. It affects the knee more often than any other joint. Hence physicians are often asked to rate impairment due to knee OA. However, in addition to accurately estimating any permanent impairment, it is important to determine what is or was normal for the individual prior to the subject injury or illness, ie, the premorbid baseline. “Medical or scientifically based causation requires a detailed analysis of whether the factor could have
recommendations for patients with low back pain. These two studies help explain the frequent disagreement between treating physicians and “second-opinion” physicians on issues other than impairment rating. Future outcome studies should help clarify the scientific basis for consensus as to surgical indications and activity recommendations. 1 Talmage J. . 3 articles on the consistency of impairment ratings. (Literature Review.) The Guides Newsletter . September/October 1997 .
