AMA Guides® Newsletter - Issue Archive

Articles

1. Spine Impairment Evaluation: Sixth Edition Approaches

   Craig Uejo, Marjorie Eskay-Auerbach, Christopher R. Brigham

   Pages 1–5

   DOI: 10.1001/amaguidesnewsletters.2009.JanFeb01

   Abstract

   Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.
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2. Case Exercises from Guides Sixth Impairment Training Workbook–Spine

   Pages 6–6

   DOI: 10.1001/amaguidesnewsletters.2009.JanFeb02

   Abstract

   Studying case exercises is an effective way to increase understanding of appropriate applications of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). This Case Exercise is one of more than seventy cases that are included in the new edition of the AMA Guides Casebook, and illustrates the process of assessing impairment for a mental and behavioral disorder using the fourth, fifth, and sixth editions of the AMA Guides. The patient is a fifty-year-old man who has worked twenty years at a high-end stationery and writing supply company. After a severe on-the-job back injury kept him from work for six months, he returned to work part-time but struggled with fatigue, depressed mood, irritability, and difficulty with concentration; he also reported financial and marital problems and was diagnosed with depression. Two years after the onset of depression, the patient reports feeling less depressed but also tense and anxious, particularly when tired. He is working 32 hours per week. According to the AMA Guides, Fourth Edition, the patient is rated Class 2, mild impairment, after a consideration of the patient's activities of daily living, social functioning, concentration, persistence and pace, and adaptation. Use of the fifth edition similarly results in Class 2, mild impairment. The AMA Guides, Sixth Edition, bases the rating on three psychological impairment rating scales and provides a numeric rating of 5% whole person impairment.
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3. Guides Case Exercise: Depression

   Robert Barth, Norma Leclair, Steve Leclair

   Pages 7–13

   DOI: 10.1001/amaguidesnewsletters.2009.JanFeb03

4. Questions and Answers: Rating Total Shoulder Arthroplasty by the Sixth Edition

   James T. Talmage

   Pages 14–14

   DOI: 10.1001/amaguidesnewsletters.2009.JanFeb04

5. Answer and Rational to Sample Questions 66, 76, 79 and 82

   Pages 15–15

   DOI: 10.1001/amaguidesnewsletters.2009.JanFeb05