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, future efforts can be directed toward determining its appropriateness when there is no evidence of organ or body part derangement (e.g., fibromyalgia syndrome, migraine), or when patients' pain reports appear to be determined primarily by psychological factors (somatoform disorders). Any attempt to clarify issues related to the assessment of pain in the AMA system is confounded by the conceptual ambiguities, inconsistencies in usage, and lack of scientific validation that pervade the entire system. 5 The paucity of research on the AMA system is striking, given the
member, such as a physical therapist or nurse, obtain measurements, rather obtaining these directly. Another common error is lack of consideration of normal for the individual (opposite uninvolved extremity or baseline, pre-injury status). It is necessary to distinguish between impairment related to the alleged injury and impairment that may be due to other injury, degenerative disease, or illness. 9 Causation must be based on scientific evidence, not merely on self-reports or historical time frames. Impairment may be related to multiple causes, and therefore
syndrome?” Model: ChatGPT-4 (OpenAI) Note: ChatGPT asked for additional information. Response (Unedited): “Certainly. Given the provided case of a 52-year-old woman with multiple underlying medical conditions, it is crucial to evaluate her condition through a multi-dimensional lens. Causation analysis should integrate individual medical history, co-morbidities, occupational environment, and the current state of scientific literature. Below, I'll go through the elements that contribute to her carpal tunnel syndrome. Medical History and Co
view, it would be exceedingly difficult to attribute carpal tunnel syndrome (CTS) to the work activities of a secretary, since there are no empirical scientific studies that have demonstrated that the usual functional demands of this employment are associated with the development of CTS. Studies have demonstrated that keyboards are not an occupational risk for CTS; rather that the development of CTS is commonly associated with risk factors of female gender, obesity and age (41 to 60 years), genetics and with certain medical conditions. 3 , 4 , 5 , 6 , 7 , 8 , 9
ed, 24) 2-1, Fundamental Principles of the Guides , explains in that Rule 6. Impairment evaluation requires medical knowledge. Physicians duly recognized by an appropriate jurisdiction should perform such assessments within their applicable scope of practice and field of expertise. Rule 8. The evaluating physician must use knowledge, skill, and ability generally accepted by the medical scientific community when evaluating an individual, to arrive at the correct impairment rating according to the Guides. (6th ed, 20) The Fifth Edition specifies in
discussion will alert researchers and writers in other areas of healthcare so that similar problems can be avoided in the development of any other diagnostic concepts. Part 2 of a 2-part series The first article in this series 3 referenced the alternative to the IASP's protocol, which was published in Chapter 16 of the Guides Fifth Edition, and it reviewed some of the reasons why the IASP protocol was not adopted for that Fifth Edition discussion. In addition, the first article reviewed the scientific and professional literature in regard to the reliability and
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desired outcome. Defensiveness can be encountered in circumstances such as evaluations for security clearance or in child custody disputes. Certain forms of defensiveness are also extremely common in impairment evaluations. Specifically, examinees are often extremely defensive in regard to pre-existing conditions and in regard to non-injury related issues that could account for their claims of impairment. For example, non-injury-related psychopathology has been scientifically established as a dominant factor in the development of chronic pain complaints, but such
nature and source of the referral, patient's complaints, and/or the reported etiology of the patient's problems. Objective data collection is consistent with the empirical scientific approach to neuropsychological assessment. Thus, the ability to utilize a technician is not a shortcoming, but rather an advantage provided that the person is well trained, supervised, and sensitive to the patient's behavior in the testing situation. The authors state that “the diagnosis of mild traumatic brain injury should be based on the patient and chart history; the temporal
applied the 10% upper extremity impairment rating for a distal clavicular resection listed in Table 16-27 to acromioplasty, presumably equating partial resection of the acromion with partial resection of the adjacent clavicle. However, while an impairment rating for resection arthroplasty of acromioclavicular joint may be scientifically warranted given increasing knowledge about the biomechanical importance of the clavicle, there has been no corresponding evidence regarding the anterior-inferior acromion. Hence transposition of the rating for distal clavicular resection
