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symptoms and chronic pain; the work relevance of even non-workrelated conditions; the considerable effects of administrative and clinical iatrogenicity; and the plethora of complex factors potentially affecting the course of conditions treated in WC systems. Once claims are established in WC, administrative and medical management of both identifiable pathologic conditions and unexplained symptoms are fragmented, not based on available scientific evidence, and adherent to a biomedical care approach which is not appropriate for a significant number of cases. These
the Guides ”? The American Academy of Disability Evaluating Physicians is a non-profit professional organization of physicians with an interest or specialization in impairment and disability evaluation issues. Over 1,400 physicians from diverse specialties and from six different countries are now fellows. The Academy formed three committees to evaluate the scientific literature on these conditions and to assess how the Guides might be used to rate impairment in these conditions. Each paper went through multiple revisions and each was finally approved by the
Person Impairment Percent Due to Specific Spine Disorders to Be Used as Part of the ROM Method) awards some impairment for developmental conditions (e.g., spondylolisthesis) and degenerative changes that may not be related to the injury being rated. On the other hand, the ROM is easy to perform and, though it is difficult to correlate loss of motion with impairment, loss of motion may be a surrogate for impairment. Further scientific study is needed to elucidate this theory. Robert H. Haralson, III, MD, MBA Chair, Chapter 15, The Spine Question I
(>32°C), then the study is clearly abnormal. However, if the limb was cold and not rewarmed for testing, the study could be that of a normal individual with a cold limb. Thus, the AMA Guides , 6th Edition, requirement that nerve conduction reports must state limb temperature to be used in impairment rating is both scientifically logical and supported by the American Association of Neuromuscular and Electrodiagnostic Medicine standards. Physicians rating impairment should provide feedback to the physicians who do nerve conduction testing that the absence of
symptoms is frequently, but inappropriately, the basis for “restrictions,” and this is not scientific. 2 Doctors may disagree about “restrictions” based on symptom tolerance, and they have no way to determine this other than to ask the injured worker to self-report, because tolerance cannot be measured or compared to objective studies the way risk and capacity can. It is important to recognize that the Guides states, “Impairment ratings are not intended for use as direct determinants of work disability” (5th ed, 5). It is also incorrect to use an inverse approach of
, limitations (capabilities) are much easier to evaluate than restrictions (risk). This series of articles is a valuable resource for physicians asked to cite the scientific rationale behind activity recommendations for individuals with cardiovascular disorders. James B. Talmage, MD 1. Reprints: American College of Cardiology . Attention: ACCEL Department , 9111 Old Georgetown Road, Bethesda, MD 20814-1699. (XBC26-BC#26) 2. Maron BJ , Mitchell JH . Revised eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Colt
. Identify the design of each study. Assess the methods of each study. Ascertain statistical significance and the degree to which change may have produced the results. Assess the studies using the Updated Hill Criteria. Form a conclusion about the degree to which a causal association is or is not present. Causation analysis must be based on both scientific evidence (in this case the medical literature) and the facts of the individual case. To conclude that an occupational exposure and an effect are etiologically associated with a reasonable degree of medical
subject 7 states CRPS lacks a defining mechanism, calls for research directed toward understanding CRPS, and cites the lack of scientific data to support current speculation regarding pathophysiology. 8 , 9 This situation is succinctly summarized in the following quote from that text: “Knowledge about CRPS is in its infancy. There are many unanswered questions about all aspects of the condition.” 10 Consistent with the above, this most recent IASP text characterizes CRPS as a “functional disorder.” 9 There are many relevant definitions of “functional disorder,” and
, peer-reviewed scientific literature has had substantial publications describing clinical applications of the CPET. The use of the CPET in obese individuals, its role in prognosticating mortality in heart failure patients, and its utility in patients with pulmonary hypertension have been studied. Other articles have addressed the utility of CPET in the pre-operative evaluation of individuals with or without severe pulmonary or cardiac disease, assessing the safety of lobectomies in patients with cancer, and in many other areas. Proper identification of input variables
demonstrate understanding of the impairment evaluation process, Failure to specify when and how to rebut an AMA Guides rating, and Failure to specify standards for reasonable alternatives to an AMA Guides rating, leaving open the possibility that individual medical opinion might be allowed as “evidence” for use in rebuttal. The need for alternative approaches to ratings has not been supported by scientific studies. In a 2012 study of 21,663 California cases, the relationship between impairment ratings based on the Fifth Edition and earnings losses using
