AMA Guides® Newsletter - Issue Archive

Articles

1. Determining Normal for Upper and Lower Limb Motions

   Charles N. Brooks, Christopher R. Brigham

   Pages 1–3

   DOI: 10.1001/amaguidesnewsletters.2012.MarApr01

   Abstract

   Normal joint motions vary from one person to another and depend on multiple factors, which raises issues when evaluators attempt to address issues of causation and apportionment. Although the causation and apportionment of joint motion deficits were not addressed in the fourth and earlier editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), the fifth and sixth editions took three possibilities into consideration when they provided instructions about how to evaluate impairment due to diminished mobility of upper and lower limb joints. Evaluating physicians must consider whether: 1) the motion deficit existed before the injury or illness in question or if the deficit was caused by individual variation, aging, disease, trauma, and/or other cause; 2) the motion deficit was caused by the injury or illness that is at issue or is in question; and 3) a lesser, pre-existing motion deficit existed before the current injury or illness was aggravated (permanently increased). Because of variations in normal joint motions among individuals, examiners should measure the motions of the uninvolved as well as the involved joints, using the former to define normal. Any motion impairment of the uninvolved joint is subtracted from that for the involved joint to determine the net impairment. Examples from the fifth and sixth editions show applications of the AMA Guides to two sample cases.
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2. Subjective, Objective, or Both?

   Charles N. Brooks, James B. Talmage, Kathryn Mueller

   Pages 4–6

   DOI: 10.1001/amaguidesnewsletters.2012.MarApr02

   Abstract

   The terms subjective and objective often appear in health care records, and one commonly hears about “subjective symptoms” and “objective complaints”—yet the former is redundant and the latter an oxymoron. Objectively verifiable pathology may explain a patient's symptoms, but complaints themselves are never objective but rather, by definition, subjective. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines the terminology: Subjective information is more open to interpretation, but objective data are factual, reproducible, and often measurable or quantifiable. Objective findings generally have much higher inter-examiner reliability than subjective findings. Symptoms and most findings on physical (particularly neuromusculoskeletal) examination are subjective. Diagnostic study results and a minority of physical findings are objective. Some physical findings, such as strength and range of motion measurements, are both subjective and objective. Repeat testing, assessment of plausibility, and use of confirmatory physical findings can be used to validate or “objectify” subjective findings (eg, by determining if a weakness is corroborated by other neurologic or physical findings, imaging study results, and/or electrodiagnostic testing). The use of objective, or at least less subjective, findings in impairment rating should improve interrater reliability. Thus, evaluating physicians should not regard subjective complaints and findings, and they should lend greater weight to objective findings.
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3. Combining Values Chart

   Christopher R. Brigham

   Pages 7–9

   DOI: 10.1001/amaguidesnewsletters.2012.MarApr03

   Abstract

   Evaluating physicians may need to account for the effects of multiple impairments using a summary value. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, the Combined Values Chart provides a method to combine two or more impairment percentages based on the formula A + B(1 – A) = the combined value of A and B. Using the Combined Values Chart and this formula, physicians can combine multiple impairments so that the whole person impairment is equal to or less than the sum of all the individual impairment values. The AMA Guides, Sixth Edition, specifies that “impairments are successively combined by first combining the largest number with the next largest remaining number, and then further combining it with the next largest remaining number … until all given impairment numbers are combined.” Impairment values within a region generally are combined and converted to whole person permanent impairment before being combined with values from other regions. The article reviews the AMA Guides, Sixth Edition, approach to combining upper extremity impairments, lower extremity impairments, and combining spinal impairments.
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4. Questions and Answers

   Pages 10–10

   DOI: 10.1001/amaguidesnewsletters.2012.MarApr04

5. Correction to the January/February 2012 AMA Guides Newsletter

   Pages 10–10

   DOI: 10.1001/amaguidesnewsletters.2012.MarApr05