bluuebunny/crossref_metadata_2025_split huggingface dataset:
Special Feature: Use of the AMA Guides–2006 Update
Authors: Brigham Christopher R. , Walker Jenny 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition, is the most widely used basis for determining impairment and is used in state workers’ compensation systems, federal systems, automobile casualty cases, and personal injury cases. The AMA Guides is used in most state workers’ compensation jurisdictions: 25 states use the fifth edition; 10 use the fourth edition, 1 state uses a hybrid of the fourth and fifth editions, and 2 states use the third edition, revised; 6 states use their own state-specific guidelines, and 6 do not indicate a specific guideline. Statutes may or may not specify which edition of the AMA Guides to use nor how to use them. In addition, many states use a statutory schedule for amputations, hearing loss, visual loss, hernias, and disfigurement, and other states use the AMA Guides for nonscheduled injuries. The AMA Guides often is used to quantify the extent of injuries resulting from an automobile casualty or personal injury. Insurers may use an impairment rating as a factor in setting reserves and determining the settlement value of a claim, and attorneys may use this information to quantify the effects of an injury. A four-page table displays uses of the AMA Guides in state workers’ compensation plans, including the edition most commonly used, the statute/code, comments, and relevant websites.
Impairment Tutorial: Rating Tears of the Acetabular Labrum
Authors: Brooks Charles N. , Strain Richard E. , Talmage James B. 
Published: December 2020

Abstract
The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).
Case Exercise: Toxic Exposure-Related Illness: Causation, Diagnosis, and Permanent Impairment
Authors: Fung Frederick 
Published: December 2020

Abstract
A diagnosis of toxic-related injury/illness requires a consideration of the illness related to the toxic exposure, including diagnosis, causation, and permanent impairment; these are best performed by a physician who is certified by a specialty board certified by the American Board of Preventive Medicine. The patient must have a history of symptoms consistent with the exposure and disease at issue. In order to diagnose the presence of a specific disease, the examiner must find subjective complaints that are consistent with the objective findings, and both the subjective complaints and objective findings must be consistent with the disease that is postulated. Exposure to a specific potentially causative agent at a defined concentration level must be documented and must be sufficient to induce a particular pathology in order to establish a diagnosis. Differential diagnoses must be entertained in order to rule out other potential causes, including psychological etiology. Furthermore, the identified exposure at the defined concentration level must be capable of causing the diagnosis being postulated before the examiner can conclude that there has been a cause-and-effect relationship between the exposure and the disease (dose-response relationship). The evaluator's opinion should make biological and epidemiological sense. The treatment plan and prognosis should be consistent with evidence-based medicine, and the rating of impairment must be based on objective findings in involved systems.
Impairment Evaluation: Use of the Guides in Ontario for Defining “Catastrophic Impairment”: Challenges and Controversies
Authors: Ameis Arthur , Brigham Christopher , Barth Robert J. , Leclair Norma , Leclair Steven 
Published: December 2020

Abstract
Several Canadian provinces use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) to adjudicate workers’ compensation claims, and the Province of Ontario uses the AMA Guides, Fourth Edition, to adjudicate motor vehicle accident personal injury claims. This article focuses on controversies that have arisen in Ontario regarding how the AMA Guides is applied and shows some of the challenges that occur in quantifying psychological impairment. In 2004, the Ontario Superior Court found in the Desbiens v. Mordini trial that the AMA Guides did not provide any direct methodology for estimating percentage impairment in this unique circumstance that involved pre-existing paraplegia and subsequent dramatic loss of residual functions. The judge found that, using the information available, a whole person impairment (WPI) score of 40% could be derived, but Ontario requires a minimum 55% WPI before an individual qualifies for catastrophic impairment benefits. In view of the individual's circumstances and a psychologist's recommendation, the judge awarded an additional 25% WPI. The Ontario model has been interpreted to allow subjective complaints (symptoms) to be included in the impairment evaluation process, but this approach eliminates any expectation of objectivity. If a judicial system aims to force impairment percentages onto a situation that in fact does not warrant such ratings, it should not do so by an inappropriate application of the AMA Guides.
Sixth Edition: the New Standard
Authors: Brigham Christopher R. , Rondinelli Robert D. , Genovese Elizabeth , Uejo Craig , Eskay-Auerbach Marjorie 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, was published in December 2007 and is the result of efforts to enhance the relevance of impairment ratings, improve internal consistency, promote precision, and simplify the rating process. The revision process was designed to address shortcomings and issues in previous editions and featured an open, well-defined, and tiered peer review process. The principles underlying the AMA Guides have not changed, but the sixth edition uses a modified conceptual framework based on the International Classification of Functioning, Disability, and Health (ICF), a comprehensive model of disablement developed by the World Health Organization. The ICF classifies domains that describe body functions and structures, activities, and participation; because an individual's functioning and disability occur in a context, the ICF includes a list of environmental factors to consider. The ICF classification uses five impairment classes that, in the sixth edition, were developed into diagnosis-based grids for each organ system. The grids use commonly accepted consensus-based criteria to classify most diagnoses into five classes of impairment severity (normal to very severe). A figure presents the structure of a typical diagnosis-based grid, which includes ranges of impairment ratings and greater clarity about choosing a discreet numerical value that reflects the impairment.
Evaluating the Difficult Pain Patient
Authors: Katz Richard T. , Smith Stacey Lee 
Published: December 2020

Abstract
One of the most difficult aspects of performing independent medical examinations (IME) is the assessment of individuals with pain complaints (eg, neck or low back pain) for which no clear and objective basis can be determined. This two-part article critiques chronic pain models and presents a useful construct based on well-validated psychiatric diagnoses. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) attempts to evaluate pain in the context of the underlying, objectively defined impairment and considers pain to be of secondary importance. Physicians differ sharply concerning the contributions of neurophysiological vs behavioral/psychological factors when pain is present without general medical findings (eg, fibromyalgia). Chronic pain syndrome diagnosed by the “Eight Ds in Chronic Pain” is superficially attractive but seriously inadequate. Evaluators are challenged by poorly validated criteria for certain diagnoses and questions about the accuracy of patient self-reports. The AMA Guides, Sixth Edition, does not use range of motion to determine spinal impairment, and in most cases electrodiagnosis has little to add. Impairment and disability assessment of individuals with pain complaints is one of the greatest challenges encountered by IMEs, and future challenges will involve taking into account both the subjective factors and the difficulties inherent in evaluating another person's subjective experiences.
Degenerative Disc Disease: The Myth of Work-Related “Cumulative Trauma”
Authors: Brigham Christopher R. , Talmage James B. , Brooks Charles , Andersson Gunnar , Uejo Craig 
Published: December 2020

Abstract
The primary cause of degenerative disc disease (DDD) is nonoccupational factors such as genetics and aging, and attributing DDD to “cumulative trauma” at work is a myth that is not supported by current scientific evidence. Some authors have suggested that DDD is a misnomer because the condition is not a disease but rather an inevitable component of the aging process that occurs at variable rates in different persons. Causation analysis requires a link between a cause and an effect, and reference to “cumulative trauma” without identification of a specific accident is incomplete. Physicians appear sometimes to opine “to a reasonable degree of medical certainty” that certain work events caused or aggravated a condition solely on the basis of a temporal relationship. Further, DDD usually is not the cause of neck or back pain but rather is an incidental finding on x-rays or advanced imaging studies. A dominant view of disc degeneration has been that disc structures are damaged by occasional excessive forces and the cumulative effects of repeated loading—but modern science contradicts this view. The authors examine current publications regarding DDD (including four full abstracts from recent articles) and conclude that current scientific evidence does not support the premise that “cumulative trauma” results in or aggravates degenerative disc disease. “Repetitive strain injury” of the spine is a mythical medicolegal concept, not a clinical or pathologic reality.
Carpal tunnel syndrome – Occupationally Related or Not?
Authors: Uejo Craig 
Published: December 2020

Abstract
Carpal tunnel syndrome (CTS), the most common peripheral entrapment neuropathy, is caused by compression of the median nerve at the wrist, and annual costs of CTS treatment in the United States total $2 billion. Although CTS often is attributed to repetitive motions at work, recent reports have questioned the relationship of CTS and occupational activities. This article reviews recent publications and provides insights into the causation of this common problem. Despite ergonomic workplace modifications aimed at reducing perceived risk factors, rates of imputedly work-related musculoskeletal disorders such as CTS have not decreased during the past ten years. One study found a prevalence of electrodiagnostically confirmed CTS of 3.5% in frequent computer users, but the authors also note that affected and unaffected employees had similar occupations, years using a computer, and usage rates. Another group concluded that computer use does not pose a severe occupational hazard for developing symptoms of CTS. Recent publications have suggested other risk factors such as age, obesity, hand dominance, reduced physical fitness, lifetime alcohol intake, and smoking; others have correlated weight and body mass index with prolonged median nerve latency. A relatively small number of jobs may be associated with CTS, primarily those that involve high force and repetition. The etiology of CTS usually is multifactorial, and risk factors include genetics, age, female sex, and obesity; its relationship with occupational injury is questioned.
Examinee-Reported History Is Not a Credible Basis for Clinical or Administrative Decision Making
Authors: Barth Robert J. 
Published: December 2020

Abstract
If a patient reports not having back pain before lifting an object at work but having chronic disabling pain thereafter, an examiner may conclude without further questioning that an injury took place when the object was lifted and therefore is work related. This article reviews relevant scientific findings and provides recommendations for making disability determinations in a manner that is more credible than basing conclusions on an examinee's reports. The author specifically recommends that future editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) should emphasize that clinical and forensic conclusions cannot be based on reports from an examinee and instead must be based on more credible sources of information. Research has shown that, among individuals who believe that a specific event (eg, an accident) caused the current complaints, the individual is likely to underreport their health history for the time preceding that event and to overstate the extent of their problems following the event. Other researchers found that claimants systematically underreported every preclaim health issue that might have provided a non–injury-related explanation for their complaints. Any basis for a conclusion of injury should be based on objective and scientifically credible findings that would have indicated that an injury had occurred even in the absence of any information having been reported by the patient.
Spine Ratings: Guides, Sixth Edition vs Guides, Fifth Edition
Authors: Eskay-Auerbach Marjorie 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, caused controversy with respect to changes in rating percentages. Impairment ratings in this edition are more specific than in previous editions and are intended to reflect lesser impairment in cases when symptomatology has improved with appropriate treatment. Grids in the AMA Guides, Sixth Edition, include impairment ratings for multiple-level conditions, so an alternative rating system (such as the range-of-motion method in the fifth edition) are not needed. The Diagnosis-related estimate (DRE) categories described in the fifth edition have been modified and expanded by the creation of regional grids that are used in the sixth edition to rate spinal impairments. The grids provide clearer categorization of many conditions and are consistent with clinical outcomes; ratings in the sixth edition reflect the results of treatment rather than the method of treatment. A significant difference in impairment ratings occurs between the fifth and sixth editions of the AMA Guides with respect to the classification of diagnoses of Alteration of Motion Segment Integrity, which includes fusion and, in the sixth edition, motion preserving technologies. A table compares the fifth and sixth editions for single-level spinal disease with or without radiculopathy and with or without surgery, including fusion.
Case Example: Rating Upper Extremity Injuries Involving Multiple Conditions in Same Extremity Using the AMA Guides, Sixth
Authors: Uejo Craig 
Published: December 2020

Abstract
Some injuries to the extremities can be associated with multiple injuries or diagnoses, and, in such cases, evaluators should recall that the functional history adjustment can be considered only for the single highest rated condition. This Case Example illustrates the proper rating methodology using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition section on The Upper Extremities. A 58-year-old male automotive mechanic fell at work on an oil-slickened floor and landed directly on his left outstretched hand and wrist, as well as the lateral part of his left elbow. At maximum medical improvement (MMI), the individual complained of moderate pain at rest and severe pain with repetitive forceful gripping and grasping. Radiographs taken at MMI showed a healed distal radius fracture in anatomic position with no posttraumatic arthritis and no carpal instability. The AMA Guides, Sixth Edition, allows use of only one of two methodologies: the Diagnosis-based impairment (DBI) methodology or the range-of-motion (ROM) method. Because ROM findings at the left elbow and wrist were recorded as normal and because the greater impairment that is causally related to the injury is used to rate the impairment, the DBI methodology is appropriate here. Only a single diagnosis is rated per region, and a case that involves more than a single region in the same extremity can be rated for separate impairments based on the separate regional conditions or diagnoses.
Rating Visual System Impairment using the Sixth Edition: Technical Aspects
Authors: Blais Bernard R. 
Published: December 2020

Abstract
Use of The Visual System section of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, requires knowledge and skills in ophthalmology and assessing impairment. Visual acuity usually is measured using symbols (letters, numbers, pictures, or other symbols) presented in a letter chart format. The Visual Acuity Scale (VAS) is a linear scale with fixed increments and provides a reasonable estimate of acuity-related visual abilities; the associated impairment rating is a reasonable estimate of acuity-related performance loss. This article shows how to perform visual acuity calculations and how to assess impairment of visual fields, including visual field test procedures and calculations. Additional factors can lead to a loss of functional vision and can limit the individual's ability to perform activities of daily living and include contrast sensitivity, glare sensitivity, color vision defects, and binocularity, stereopsis, suppression, and diplopia. If functional vision is affected and is not accounted for by visual acuity or visual field loss, the impairment rating of the visual system can be adjusted but should be limited to an increase of the impairment rating of the visual system by, at most, 15 points (ie, less severe than the total loss of one eye). The ability to rate visual impairment requires significant knowledge and education, and therefore a physician trained in ophthalmology should perform the visual examination and visual system impairment rating.
Thrombotic and Hemorrhagic Disorders
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
The fourth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) devoted only a single page to the rating of thrombotic and hemorrhagic disorders, based primarily on analogous impairments from other organ systems and impairments in the activities of daily living (ADLs). The AMA Guides, Fifth Edition, rated thrombotic disorders by the effects on the organ system; criteria for rating hemorrhagic and platelet disorders were based on the treatment required and interferences in ADLs. The sixth edition introduced significant changes, among which are the following: The ratings for hematological disorders were deliberately reduced, especially the highest ratings, because of the inevitable involvement of other organ systems. The goal is for evaluators to rate each organ system based on its defined criteria rather than combining multiple organ system difficulties into a single organ system rating. Also in the AMA Guides, Sixth Edition, separate tables are used to rate hemorrhagic conditions caused by platelet disorders, hemophilia, and clotting disorders. Further, major changes were required because of global methodological changes in this edition, including a significant expansion of the methodology used in rating clotting defects. Finally, the rating for the use of warfarin was altered, and thrombotic disorders are rated using the specific coagulation defect.
Carpometacarpal (CMC) Joint Subluxation: Causation Analysis and Impairment Evaluation
Authors: Melhorn J. Mark , Brigham Christopher R. , Talmage James B. 
Published: December 2020

Abstract
Carpometacarpal (CMC) joint subluxation refers to the changes that occur in the CMC joint as seen on x-rays and observed during physical examination. The CMC joint is the most commonly involved arthritic joint in the hand, and arthritis may appear in localized or systemic forms. A diagnosis of thumb-CMC arthritis is based on symptoms of localized pain, tenderness, and instability on physical examination and radiographic evaluation. The AMA Guides to the Evaluation of Disease and Injury Causation provides a protocol for assessing causation and requires that all three of the following criteria must be met: 1) the patient has an illness compatible with a disease-producing agent or an injury; 2) the worker's exposure in the occupational environment potentially caused the disease or is a plausible mechanism of injury of sufficient magnitude to cause the condition; and 3) the preponderance of evidence supports the disease or injury as occupational in origin. If any one of the three is possible but not probable, causation has not been established. The authors review several published articles and conclude that, based on the clinical facts and current science, CMC joint subluxation is unrelated to work and instead is reflective of aging. The article concludes with a comparison of impairment ratings of CMC-related disability using the fifth and sixth editions of the AMA Guides to the Evaluation of Permanent Impairment, both of which lead to identical impairment ratings but by different means.
The Historical Development of AMA Guides Impairment Ratings for Asthma
Authors: Demeter Stephen L. 
Published: December 2020

Abstract
In 1956, the Board of Trustees of the American Medical Association convened an ad hoc Committee on Medical Rating of Physical Impairment that published thirteen articles in JAMA between 1958 and 1970, including one on pulmonary impairment rating on November 22, 1965. That article rated pulmonary impairment by radiographic abnormalities, the historical description of the degree of shortness of breath, the results of at least two of three spirometric tests (forced vital capacity, forced expiratory flow in one second, and the maximal ventilatory volume), the maximal ventilatory volume, and oxygen saturation (if performed). Use of the examinee's history has come full circle from being part of the impairment rating process to being excluded to being reintroduced in the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition. The concept that asthma is not easily rated using methods applicable to other pulmonary diseases was introduced in the fifth edition and was modified for use in the sixth edition. Since the publication of the fifth edition, several medications have been approved for treatment of asthma. Future editions likely will refine the medication usage table to reflect medications in clinical use at the time and, one hopes, also will eliminate the clumsy reference to “beclomethasone equivalents” and are likely instead to reference low, medium, and high doses of the inhaled corticosteroids.