AMA Guides® Newsletter - Issue Archive

Articles

1. Spinal Impairment Evaluation: Process Improvement

   Christopher R. Brigham, James B. Talmage, Marjorie Eskay-Auerbach

   Pages 1–9

   DOI: 10.1001/amaguidesnewsletters.2013.NovDec01

   Abstract

   Impairment evaluation of the spine has evolved notably since the 1958 publication by the American Medical Association of an article titled A Guide to the Evaluation of Permanent Impairment of the Extremities and Back. Significant differences exist among the editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) currently in use, including the third edition, revised (1988), fourth (1993), fifth (2000), and sixth (2008) editions. This article reviews exemplary cases according to the instructions and methods of each edition, beginning with a table that summarizes spinal impairment criteria by edition of the AMA Guides. Another extensive table presents seven exemplar cases that demonstrate the differences in impairment ratings between the fourth, fifth, and sixth editions; each example is discussed in terms of different approaches taken in each of these editions. In the AMA Guides, Sixth Edition, the process of rating impairment was simplified by the elimination of the range of motion method. In the examples presented, the impairment values calculated using the sixth edition fall between those obtained using the fourth and fifth editions. Evaluating physicians must know the appropriate edition of the AMA Guides to use in each case and must understand the differences between them, particularly the changes included in the sixth edition.
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2. To Combine or Not to Combine

   Mohammed I Ranavaya, Robert Rondinelli

   Pages 9–9

   DOI: 10.1001/amaguidesnewsletters.2013.NovDec02

   Abstract

   Physicians must account for the effects of multiple impairments using a summary value. Sometimes, when dealing with multiple impairments in a single case, the evaluating physician may be confused about whether specific impairments are added or combined, particularly during the assessment of hand or limb injuries. Combining is accomplished by using the Combined Values Chart presented in the Appendix of each edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). With a few exceptions, the general rule is that all impairments should be combined. The combining must occur at the same hierarchal level (eg, upper extremity impairment can be combined only with another upper extremity impairment from the same limb), and whole person impairment (WPI) can be combined only with another WPI impairment. In case of impairments from a different limb (either from both upper or lower limbs) even though they may be expressed at the same hierarchal limb (eg, upper extremity or lower extremity), they should be combined at the WPI level only after the individual limb is fully rated and the final impairment for that limb is expressed at the WPI level. Evaluators should remember that impairing factors (sensory, motor, vascular, and so on) are combined at the smallest common unit (ie, digit < hand < upper extremity < whole person).
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3. Question and Answer: Foot and Toe Fractures

   Christopher R. Brigham, James B. Talmage, Naomi Shields, Glenn Pfeffer, Charles N. Brooks

   Pages 10–11

   DOI: 10.1001/amaguidesnewsletters.2013.NovDec03