AMA Guides® Newsletter - Issue Archive

Articles

1. Measuring Hip Motion

   Charles N. Brooks

   Pages 2–3

   DOI: 10.1001/amaguidesnewsletters.2010.NovDec01

   Abstract

   Accurate measurement of hip motion is important in initial diagnosis, assessing progression over time, evaluating treatment outcomes, and rating impairments of this joint. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, range-of-motion (ROM) measurements are still a factor because the physical examination and other adjustment tables are used to select the grade and final rating. Further, ROM deficits may be used to derive a stand-alone rating when other tables refer the rater to motion impairment or if no diagnosis-based section is applicable for impairment rating. Hip motions generally are measured using a large goniometer, although an electronic inclinometer also may be used. Examiners must conduct tests in accordance with measurement instructions in the AMA Guides. From the standpoint of impairment rating, hip extension, at least beyond neutral, is irrelevant; if a patient does not have a flexion contracture of at least 10°, there is no extension impairment. Examiners should compare both extremities; active or voluntary motion is performed by the active contraction of the governing muscles and should be evaluated first. During this and other measurements, patients may have a tendency to extend or guard, thus producing an erroneously inflated measurement. Examiners must ensure that such behaviors do not occur and should record only the correct measurement.
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2. Measuring Shoulder Motion

   Christopher R. Brigham

   Pages 3–4

   DOI: 10.1001/amaguidesnewsletters.2010.NovDec02

   Abstract

   Measuring and documenting shoulder motion is important for many reasons, including diagnosis, determining the severity and progression of a disorder, assessing the results of treatment, and evaluating impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition provides guidance for the process of assessing abnormal motion of the shoulder, specifically Section 15.7a, Clinical Measurements of Motion, and Section 15.7g, Shoulder Motion. The shoulder has greater mobility than any other joint of the body, and movement there usually is composite rather than in a single plane; as a result, single movements are difficult to isolate. In the AMA Guides, universal goniometers with long arms are used to measure shoulder range of motion (ROM). Measurements of joint motion must be performed and recorded consistently because interrater reliability is reduced if instruments are incorrectly placed or if overlying soft tissue distorts the measurement. Active motion is obtained with full muscle force and cooperation after warm-up, and the ROM examination is performed by recording the active measurements from three separate ROM efforts. Patients may self-limit during the assessment of active range of motion or exert submaximal effort on manual strength testing because of pain and/or apprehension, so all measurements should fall within 10° of the mean and both sides should be tested.
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3. Comparative Analysis of Impairment Evaluations by the 1996 Florida Uniform Permanent Impairment Rating Schedule (FUPIRS) and the AMA Guides™ Fourth, Fifth, and Sixth Editions

   Christopher R. Brigham, Aimee McEntire, Craig Uejo

   Pages 5–7

   DOI: 10.1001/amaguidesnewsletters.2010.NovDec03

   Abstract

   The Florida workers’ compensation system uses the 1996 Florida Uniform Permanent Impairment Rating Schedule (FUPIRS), that was based in part on the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Third Revised and Fourth Editions (the latter published in 1993). The authors ask if changes in the AMA Guides resulted in different impairment ratings and different awards. To these ends, the authors examined seventy-five cases that were randomly selected from a cohort of two hundred cases that was studied previously [see The Guides Newsletter, January/February 2010]. The average whole person impairment (WPI) per case was 5.3% WPI according to FUPIRS; 5.3% WPI according to the AMA Guides, Fourth Edition; 5.8% WPI according to the fifth edition; and 4.6% WPI according to the sixth edition. The difference between the WPIs was tested using a paired sample t test (alpha = .05), and results showed that the difference in WPI between FUPIRS and the sixth edition (0.7% WPI) was not statistically significant. The authors acknowledge that the limited range of impairment values in this study may have contributed to the lack of statistical significance when group means are compared because 84% of the cases were rated 10% WPI or less. The authors call for an expanded study to determine if meaningful differences exist between rating methodologies in a more diverse, less skewed sample.
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