AMA Guides® Newsletter - Issue Archive

Articles

1. Part I: Psychological Factors in Delayed and Failed Recovery and Unnecessary Disability

   Garson Caruso, Les Kertay

   Pages 3–9

   DOI: 10.1001/amaguidesnewsletters.2019.MayJun01

   Abstract

   The first part of this two-part series discusses psychological influences in delayed and failed recovery and resulting unnecessary work disability; the second part discusses theoretical and practical aspects of the issue, including evaluation and treatment. Delayed and failed recovery and unnecessary disability (DFRUD) refers to a lag in, or lack of, expected recovery from a medical condition and/or unnecessary resultant disability. Causation is complex, and we are not doing well at managing this group of workers using a biomedical model. The traditional biomedical model posits that disease or injury produces symptoms and signs that cause impairment and result in disability. This approach too strictly separates mental phenomena and bodily function (Cartesian dualism) and leads to scientific reductionism when actually six domains are active in worker disability: medical, personal, psychological, sociocultural, systematic (including compensation and insurance), and workplace elements. Medically unexplained physical symptoms (MUPS) should be understood as a disturbance of normal neurological and/or psychological processes underlying symptom production, perception, and experience and cannot be better explained by another physical or psychiatric illness. Within this system of evaluation, administrative and medical iatrogenicity are associated with unnecessary medical care and poor outcomes for individuals. In addition to determining industrial causality and apportionment, if evaluators accept some psychological factors, MUPS, and central sensitization, they must explain to what extent these are compensable. Part two of this article will discuss theoretical and practical approaches, including specific evaluation and treatment methods.
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2. Spinal Alteration of Motion Segment Integrity Using the Sixth Edition

   Patrick R. Luers

   Pages 10–13

   DOI: 10.1001/amaguidesnewsletters.2019.MayJun02

   Abstract

   Spinal impairment evaluation includes determination of the presence or absence of alteration of motion segment integrity (AOMSI). The diagnosis-related estimate (DRE) method is the principal methodology used to evaluate spinal AOMSI impairment in the fourth and fifth editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In the AMA Guides, Sixth Edition, impairment ratings are calculated using the diagnosis-based impairment (DBI) method that uses five impairment classes determined by diagnoses and specific criteria, adjusted by consideration of non-key factors and grade modifiers. This article includes a correction of numbers in the AMA Guides, Sixth Edition, Figure 17-6. The following factors must be considered to determine if AOMSI is present: 1) flexion/extension radiographs are performed when the individual is at maximum medical improvement and are technically adequate; 2) the proper methodology is used in obtaining measurements of translation and angular motion; 3) normal translation and angular-motion thresholds consistent with the literature are used in determining AOMSI. Imaging modalities such as videofluoroscopy, digital fluoroscopy, and upright/motion magnetic resonance imaging cannot be used to establish an AOMSI permanent impairment using the AMA Guides. A number of technical factors can affect the image quality associated with measurements of AOMSI, including film centering, artifacts, poor edge resolution, endplate normal variations and spurring, and use of analog rather than digital radiography.
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3. Range of Motion Extremity Evaluation: Sixth Edition Approaches

   Jay Blaisdell, James B. Talmage

   Pages 14–16

   DOI: 10.1001/amaguidesnewsletters.2019.MayJun03

   Abstract

   Examiners use range-of-motion (ROM) testing to help calculate the physical examination modifier when they use the diagnosis-based impairment (DBI) method in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition. DBI is the preferred method for calculating upper and lower extremity ratings, but, in instances specified by the regional grid, the evaluator may choose to use the ROM method, typically because it yields a higher impairment rating relative to the DBI method. In rare lower-limb cases when the injury is not fully articulated by the regional grid (eg, severe crushes, burns, and scarring), ROM may be used instead of diagnosis. In cases of amputation, ROM may be used for the remaining portion of the limb and combined with amputation rating as explained in sections of Chapter 15. Note that, in the AMA Guides, the extended anatomic position is 0° rather than 180°, and evaluators can consult the detailed diagrams of the planes of the thumbs, fingers, wrists, elbows, and shoulders. Invalid results are declared if, after three consecutive efforts, the three measurements for a given plane of motion vary more than 10° from the mean (average) of these three measurements. The article also discusses adjustments for functional history when the ROM method does not adequately capture the full impairment.
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