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- Author or Editor: Douglas Van Zet x
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Abstract
In 2002, the Department of Labor and Employment, the State of Colorado, performed a study to identify changes among the Third Edition, Revised (December 1990); the Fourth Edition (June 1993); and the Fifth Edition (November 2000) of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). This three-part article summarizes the differences found. The study was based on a random sample of 250 cases identified by the Division of Workers’ Compensation of the State of Colorado and stratified into three broad categories: 40 upper extremity cases, 60 lower extremity cases, and 150 whole person cases. Only case records with adequate documented evidence to enable rating among all three editions of the AMA Guides were included. The average age of the examinee was 42.9 years (SD, 11.1 years, range, 18 to 71 years, 171 [68%] male); equal percentages of men and women were present in the upper extremity impairment ratings (20 men, 20 women), but lower extremity and whole person impairments occurred primarily among males (73% and 71% men, respectively). Interrater reliability was obtained from an independent expert medical review of 20% of the cases. Three figures show percentages of upper extremity, lower extremity, and whole person impairment according to the edition used; ratings generally are lower with more recent editions.
Abstract
This article concludes the three-part discussion of differences among the editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): Third Edition Revised, Fourth, and Fifth Editions. The discussion begins with a comparison of different editions of the AMA Guides for evaluating lower extremity impairment and spinal impairment. The AMA Guides, Fourth Edition, introduced the Diagnosis related estimates (DRE) model, and in this edition the range-of-motion (ROM) model has only a limited role (ie, primarily as a differentiator). A table summarizes the criteria of spinal impairment criteria by edition of the AMA Guides. The authors summarize differences in the impairment ratings of various body systems based on the use of different editions of the AMA Guides, including differences in ratings of the cardiovascular, pulmonary, digestive, and other systems. Critiquing the AMA Guides, the authors call for improvements, including the following: add a system to rate permanent impairments, including functional limitations; base impairment ratings on scientific evidence and a valid whole person impairment scale; make the AMA Guides reliable, comprehensive, internally consistent, comprehensible, accessible (ie, the AMA Guides are complex and difficult to use, and not all physicians are capable of rating impairment), and acceptable. Despite the shortcomings, no other widely accepted basis to assess impairment is available, and future editions of the AMA Guides will improve the process of providing fair assessments of functional loss.
Abstract
[Continued from the January/February 2004 issue of The Guides Newsletter.] To understand discrepancies in reviewers’ ratings of impairments based on different editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), users can usefully study the history of the revisions as successive editions attempted to provide a comprehensive, valid, reliable, unbiased, and evidence-based system. Some shortcomings of earlier editions have been addressed in the AMA Guides, Fifth Edition, but problems remain with each edition, largely because of the limited scientific evidence available. In the context of the history of the different editions of the AMA Guides and their development, the authors discuss and contextualize a number of key terms and principles including the following: definitions of impairment and normal; activities of daily living; maximum medical improvement; impairment percentages; conversion of regional impairments; combining impairments; pain and other subjective complaints; physician judgment; and causation analysis; finally, the authors note that impairment is not synonymous with disability or work interference. The AMA Guides, Fifth Edition, contrasts impairment evaluations and independent medical evaluations (this was not done in previous editions) and discusses impairment evaluations, rules for evaluations, and report standards. Upper extremity and lower extremity impairment evaluations are discussed in terms of clinical assessments and rating processes, analyzing important changes between editions and problematic areas (eg, complex regional pain syndrome).
