AMA Guides® Newsletter - Issue Archive

Articles

1. Objectifying the Spinal Impairment Examination: Fifth Edition Approaches

   Robert H. Haralson, Christopher R. Brigham

   Pages 1–4, 14

   DOI: 10.1001/amaguidesnewsletters.2001.NovDec01

   Abstract

   A careful and thorough physical examination is a critical component of the spinal impairment evaluation. Two methods have been used for this evaluation, the Diagnosis-related estimates (DRE) method and the Range of Motion (ROM) method, but the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, states that “the DRE method is the principal methodology used to evaluate an individual who has had a distinct injury.” The DRE rating is based on objective findings at the time of evaluation and includes the following clinical findings: muscle spasm; muscle guarding; asymmetric spinal motion (previously called dysmetria); nonverifiable radicular pain; reflexes, neurological changes such as weakness or loss of sensation, atrophy, radiculopathy, and electrodiagnostic changes; alteration of motion segment integrity; cauda equina–like syndrome; and urodynamic tests. This article examines the definitions of the findings and discusses their use in the DRE method. For example, the AMA Guides, Fifth Edition, defines muscle spasm as a sudden, involuntary contraction of a muscle or group of muscles, and muscle spasm must be present at the time of a DRE-based evaluation; in the Fourth Edition, examiners used only a history of spasm. The AMA Guides, Fifth Edition also has different parameters, compared with the Fourth Edition, for determining atrophy.
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2. Legal Update: State-Specific Use of the AMA Guides

   Christopher R. Brigham

   Pages 11–14

   DOI: 10.1001/amaguidesnewsletters.2001.NovDec02

   Abstract

   Many states require use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in their workers’ compensation systems; state statutes may or may not specify which edition of the AMA Guides to use and how to use them. Thirty-five states make use of the AMA Guides, and 60% (21) of them use the Fifth Edition. Eleven states use the Fourth Edition (Alabama, Arkansas, Delaware, Kansas, Maine, Maryland, Nevada, Ohio, South Dakota, Texas, and West Virginia). One state uses the Third Edition–Revised (Colorado), and one state uses the Second Edition (Louisiana). Some states use their own guidelines for specific issues and use the AMA Guides for other issues (eg, Washington State rates spinal impairment using the state's own guidelines but rates extremity disorders using the AMA Guides). Many states use a statutory schedule to assess amputations, hearing loss, visual loss, hernias, and disfigurement; some states may use a statutory schedule and use the AMA Guides for nonscheduled injuries. Physicians who practice in a state that does not make use of the AMA Guides in state workers’ compensation cases may need to assess impairment using the “latest edition” of the AMA Guides. The article includes a tabular summary of state statutes that deal with rating impairment in workers’ compensation cases.
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3. Questions and Answers

   Pages 11–14

   DOI: 10.1001/amaguidesnewsletters.2001.NovDec03