bluuebunny/crossref_metadata_2025_split huggingface dataset:
Knee Osteoarthritis
Authors: Brigham Christopher R. , Brooks Charles N. , Talmage James B. 
Published: December 2020

Abstract
More than 20 million Americans have osteoarthritis (OA), which affects the knee more often than any other joint and is the most common cause of long-term disability in persons older than 65 years. Knee OA is common, particularly in older patients and especially the obese. Knee injury, depending on the severity and type, can increase the risk of developing and the rate of progression of OA. In assessing impairment for knee OA, the evaluator must obtain a thorough history and physical examination and identify all potential risk factors. To opine that an injury caused OA, the evaluator should demonstrate that the traumatized knee shows significant arthritis but that the contralateral uninjured knee is radiographically normal; for an evaluator to suggest that pre-existing arthritis was aggravated, the involved knee should show significantly more advanced OA than the contralateral joint. Joint space widths (cartilage intervals) of both knees must be measured carefully on anteroposterior films obtained standing with a film-to-camera distance of 90 cm (36 in) and the beam at the level of and parallel to the joint surface. Taking into account all of the data (history, physical findings, and radiographic measurements from both the involved and contralateral joint), the rating physician can assess causation, estimate impairment, and apportion the latter to one or more etiologies.
Acromioclavicular Joint Arthritis
Authors: Brooks Charles N. , Brigham Christopher R. 
Published: December 2020

Abstract
Acromioclavicular joint (ACJ) arthritis is a common source of shoulder pain. Manifestations of the arthritis may include inferiorly projecting spurs that predispose an individual to impingement and rotator cuff tears and can result in permanent impairment due to shoulder weakness or motion loss. Rotator cuff tendinopathy generally is multifactorial, and tears usually result from a combination of intrinsic factors (loads transmitted, local blood supply, and age) and extrinsic factors (impingement, primarily). Surgery to eliminate impingement collectively is termed subacromial decompression. The AMA Guides to the Evaluation of Permanent Impairment provides no impairment rating for cheilectomy about acromioclavicular or other joints, and, because removal of this liability is beneficial, it results in no (and perhaps even negative) impairment. An individual whose job involves repetitive shoulder elevation and who develops impingement probably has a legitimate workers’ compensation claim, even if predisposed by preexisting bony prominences; in this scenario, the proximate cause was repetitive shoulder elevation. A case example demonstrates that if an individual with preexisting osteoarthritis of the ACJ is injured and disabled at work, the rotator cuff tear, although preexisting, was worsened during employment and probably will be covered under the claim. In legal terms, findings of disability associated with ACJ injuries may differ depending on the jurisdiction.
Special Feature: Complex Regional Pain Syndrome (CRPS): Unratable Through the Pain Chapter
Authors: Barth Robert J. 
Published: December 2020

Abstract
A sidebar titled “Rating Impairment for [complex regional pain syndrome] CRPS Type 1” in the March/April issue of The Guides Newsletter states: “Do NOT use the pain chapter to rate CRPS” because there is no well-defined pathophysiologic basis. That conclusion is contradicted by the pain chapter, which lists CRPS among conditions considered ratable, but accompanying text provides no explanation how this determination was made. This article attempts to resolve the conflict between the sidebar in The Guides Newsletter and the pain chapter. The lack of a well-defined pathophysiologic basis for CRPS is the reason for the position stated in the sidebar, and a review of the relevant professional literature confirms this reasoning. Further, the concept of CRPS itself is ambiguous and was intentionally designed to be “general” and “descriptive” and historically has been diagnosed using nonstandardized, idiosyncratic, or incompatible diagnostic systems. The AMA Guides to the Evaluation of Permanent Impairment is self-contradictory regarding diagnostic criteria and terminology (eg, is CRPS-1 synonymous with RSD, causalgia, or neither?). CRPS lacks any well-defined pathophysiology, is highly ambiguous and controversial, involves characteristics that compromise the credibility of any examinee making such a presentation, and is a good example of a condition that should be evaluated using the mental and behavioral disorders chapter.
Undiagnosed Mental Illness as the Cause of General Medical Disability Claims
Authors: Barth Robert J. 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) warns physicians against minimizing psychiatric impairments but does not elaborate on this warning against minimizing the contribution of psychological factors to general medical impairment. Claims regarding spinal impairment are a useful example because the AMA Guides cites a study showing there is no general medical explanation for 85% of low-back pain cases. The list of mental illnesses that are commonly associated with complaints of physical pain includes somatoform, mood, anxiety, personality, psychotic factitious, and substance-related disorders. In one study, anxiety disorders accounted for 54% of the variance in pain severity reports and associated claims of disability. Psychological dysfunction leads only to subjective complaints such as pain but also can lead to objective physiological signs, for example, mental illness such as panic disorder, which includes objectively verifiably physical signs such as heart palpitations, sweating, and tremor. Claims of disability also have been associated with hypertension, cardiac issues, concussion, multiple sclerosis, and psoriasis. To credibly assess the possibility of mental illness as the cause of a general medical impairment claim is extremely demanding, and evaluators should think of the evaluation process in terms of days rather than hours. The steps in an evaluation protocol should mirror those described in the March/April 2005 issue of The Guides Newsletter and are summarized in the present article.
Case Exercise: Biomechanics in Rearend Motor Vehicle Collisions
Authors: Brooks Charles N. , Brigham Christopher R. 
Published: December 2020

Abstract
Multiple factors determine the likelihood, type, and severity of bodily injury following a motor vehicle collision and, in turn, influence the need for treatment, extent of disability, and likelihood of permanent impairment. Among the most important factors is the change in velocity due to an impact (Δv). Other factors include the individual's strength and elasticity, body position at the time of impact, awareness of the impending impact (ie, opportunity to brace, guard, or contract muscles before an impact), and effects of braking. Because Δv is the area under the acceleration vs time curve, it combines force and duration and is a useful way to quantify impact severity. The article includes a table showing the results of a literature review that concluded, “the consensus of human subject research conducted to date is that a single exposure to a rear-end impact with a Δv of 5 mph or less is unlikely to result in injury” in most healthy, restrained occupants. Because velocity incorporates direction as well as speed, a vehicular occupant is less likely to be injured in a rear impact than when struck from the side. Evaluators must consider multiple factors, including the occupant's pre-existing physical and psychosocial status, the mechanism and magnitude of the collision, and a variety of biomechanical variables. Recommendations based solely on patient history and physical findings (and, perhaps, imaging studies) may be ill-informed.
Global Assessment of Functioning
Authors: Leclair Norma , Leclair Steven , Barth Robert 
Published: December 2020

Abstract
The Global Assessment of Functioning (GAF) is part five of the multiaxial diagnostic system for mental disorders outlined in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition–Text Revised (DSM-IV-TR). The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) notes the use of DSM-IV-TR in rating an individual's global functional capacity, which, like disability, is related directly to the effects of impairments. The AMA Guides, Fourth and Fifth Editions, do not provide numeric psychiatric impairment, and shortcomings plague the use of GAF to define disability—but even so, authorities ranging from the State of California to the Veterans Administration rely on GAF scores. A table shows the 100-point scale Global Assessment Scale in which higher scores indicate better functioning. The GAF has been modified to address deficiencies; a decision tree has been added and is summarized; and the editor of DSM-IV-TR has developed a computerized version that reportedly improves reliability and validity. Evaluators should bear in mind that the GAF helps evaluate the individual's functioning in three areas: psychological, social, and occupational (including the activities of daily living). The resulting score facilitates the creation of a treatment plan, evaluates its effectiveness, and predicts outcomes, but evaluators should be aware of its significant limitations.
Case Study: Cervical Spine Apportionment
Authors: Brigham Christopher R. , McEntire Aimee 
Published: December 2020

Abstract
Impairment apportionment refers to the distribution or allotment of impairment to different factors such as pre-existing injury, illness, or impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) provides instructions about calculating impairment ratings and advises concurrent consultation of specific state laws (eg, the state of California apportions disability differently than does the Longshore and Harbor Workers Act. A case example highlights some of the complexities of cervical spine apportionment. A 55-year-old man sustained a work-related cervical spine injury that aggravated pre-existing cervical pathology. The patient underwent anterior cervical discectomy and decompression, foraminotomies, C3-4 and C4-5, and a two-level anterior cervical interbody arthrodesis; the postoperative diagnosis was two level disc herniation, stenosis, and disc degeneration. The article discusses the Diagnosis-related estimate (DRE) vs the range-of-motion method (ROM). The DRE method is most widely used in the AMA Guides, but in certain specified situations, including a multilevel fusion such as that in the clinical example, the ROM method must be used. Because of the significant difference in values derived from the DRE and ROM methods, evaluators must be careful to apportion impairment in accordance with the method that served as the basis for the final rating (ie, the ROM method in this example). Apportionment becomes more complex when one considers the etiology of the underlying disease.
Upper Extremities Impairment Evaluation: Overview of Sixth Edition Approaches
Authors: Brigham Christopher R. , Uejo Craig , Melhorn J. Mark , Talmage James B. 
Published: December 2020

Abstract
In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, the chapter on the upper extremities is the longest and most complex, which reflects the complexities of the upper limb and the type of injuries encountered. This chapter incorporates the following changes: The International Classification of Functioning, Disability, and Health (ICF) Model of Functioning and Disability, developed by the World Health Organization, is used to provide a common basis for the description of human functioning and impairments. The principles of assessment have been simplified and clarified. Specific diagnosis-based rating tables for the most common injuries and diagnoses have been added, and an extensive discussion shows the definition of impairment classes and corresponding ranges of impairment for upper and lower extremities. A table and accompanying diagnosis-based impairment example provide examples of upper extremity diagnoses and associated class definitions and default impairment values. The physical examination has been simplified, and functional assessment is provided through focused history-taking, including information about activities of daily living and a functional assessment tool. The criteria for diagnosis of complex regional pain syndrome have been updated for consistency with current standards and other chapters. Among other modifications, the approach to entrapment neuropathy (eg, carpal tunnel syndrome) has changed, and only electrodiagnostically confirmed entrapment cases are ratable.
Assessing Mental and Behavioral Disorder Impairment: Overview of Sixth Edition Approaches
Authors: Leclair Norma , Leclair Steve , Barth Robert 
Published: December 2020

Abstract
Chapter 14, Mental and Behavioral Disorders, in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, defines a process for assessing permanent impairment, including providing numeric ratings, for persons with specific mental and behavioral disorders. These mental disorders are limited to mood disorders, anxiety disorders, and psychotic disorders, and this chapter focuses on the evaluation of brain functioning and its effects on behavior in the absence of evident traumatic or disease-related objective central nervous system damage. This article poses and answers questions about the sixth edition. For example, this is the first since the second edition (1984) that provides a numeric impairment rating, and this edition establishes a standard, uniform template to translate human trauma or disease into a percentage of whole person impairment. Persons who conduct independent mental and behavioral evaluation using this chapter should be trained in psychiatry or psychology; other users should be experienced in psychiatric or psychological evaluations and should have expertise in the diagnosis and treatment of mental and behavioral disorders. The critical first step in determining a mental or behavioral impairment rating is to document the existence of a definitive diagnosis based on the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The article also enumerates the psychiatric disorders that are considered ratable in the sixth edition, addresses use of the sixth edition during independent medical evaluations, and answers additional questions.
Use of the AMA Guides in State Workers' Compensation Systems: 2009 Update
Authors: Brigham Christopher R. , Walker Jenny 
Published: December 2020

Abstract
The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) is the most widely used basis for determining impairment and is used in state workers’ compensation systems, federal systems, automobile casualty, and personal injury, as well as by the majority of state workers’ compensation jurisdictions. Two tables summarize the edition of the AMA Guides used and provide information by state. The fifth edition (2000) is the most commonly used edition: California, Delaware, Georgia, Hawaii, Kentucky, New Hampshire, Idaho, Indiana, Iowa, Kentucky, Massachusetts, Nevada, North Dakota, Ohio, Vermont, and Washington. Eleven states use the sixth edition (2007): Alaska, Arizona, Louisiana, Mississippi, Montana, New Mexico, Oklahoma, Pennsylvania, Rhode Island, Tennessee, and Wyoming. Eight states still commonly make use of the fourth edition (1993): Alabama, Arkansas, Kansas, Maine, Maryland, South Dakota, Texas, and West Virginia. Two states use the Third Edition, Revised (1990): Colorado and Oregon. Connecticut does not stipulate which edition of the AMA Guides to use. Six states use their own state specific guidelines (Florida, Illinois, Minnesota, New York, North Carolina, and Wisconsin), and six states do not specify a specific guideline (Michigan, Missouri, Nebraska, New Jersey, South Carolina, and Virginia). Statutes may or may not specify which edition of the AMA Guides to use. Some states use their own guidelines for specific problems and use the Guides for other issues.
Sleep Impairment
Authors: Uejo Craig , Demeter Stephen 
Published: December 2020

Abstract
In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, distal clavicle resection (resection arthroplasty of the acromioclavicular joint [ACJ]) results in ratable impairment, but only a single diagnosis within a region may be rated. Therefore, if another impairing condition is present in the shoulder region (eg, impingement syndrome or rotator cuff disease) only that resulting in the greatest causally related impairment is rated. In the setting of an occupational or other compensable injury or illness, causation of the impairment often is a key issue because, typically, only impairment that is causally related to the injury can be rated. For example, assume that a lifting injury at work caused a tear in a rotator cuff tendon that was already attenuated by repetitive impingement on inferiorly projecting spurs from longstanding degenerative arthritis of the ACJ. If surgery was performed for a traumatic rotator cuff tear and the distal clavicle also was resected due to preexisting ACJ arthritis, the latter surgery is not considered to be related to the injury. In other words, because the ACJ arthritis was neither caused nor worsened by the injury, this condition is not rated. The distal clavicular resection may have been warranted to diminish pain due to ACJ arthritis and/or eliminate the distal clavicle as a source of impingement.
Comparative Analysis of AMA Guides Ratings by the Fourth, Fifth, and Sixth Editions*
Authors: Brigham Christopher R. , Uejo Craig , McEntire Aimee , Dilbeck Leslie 
Published: December 2020

Abstract
In December 2007, the American Medical Association published the sixth edition of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), following previous editions published in 2000 (fifth edition) and 1993 (fourth edition). To assess the effects of changes in whole person impairment ratings across editions, the authors selected 200 cases of whole person impairment and reevaluated each according to criteria in the three editions. Interrater reliability was confirmed when an independent reviewer checked 15% of the cases and found agreement within 1% in all but one of the thirty cases checked. Tables and figures in the article compare average whole person impairment in terms of sixth edition chapters; by edition; and by category (nonsurgical vs surgical intervention) and edition. On the basis of the sample and their comparisons, the authors conclude that the effect for patients based on their diagnostic impairment is small, and greater difference is seen for results obtained using the fifth edition compared with the fourth edition. The observed changes were expected and result primarily from the following: surgery and therapy should improve function and thus should not routinely increase impairment; there are improved functional outcomes for carpal tunnel syndrome and total joint replacement; and certain common conditions that resulted in functional deficits but no ratable impairment in previous editions now should be ratable. The study showed excellent interrater reliability with sixth edition ratings, which was an important goal for the new edition.
Measuring Hip Motion
Authors: Brooks Charles N. 
Published: December 2020

Abstract
Accurate measurement of hip motion is important in initial diagnosis, assessing progression over time, evaluating treatment outcomes, and rating impairments of this joint. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, range-of-motion (ROM) measurements are still a factor because the physical examination and other adjustment tables are used to select the grade and final rating. Further, ROM deficits may be used to derive a stand-alone rating when other tables refer the rater to motion impairment or if no diagnosis-based section is applicable for impairment rating. Hip motions generally are measured using a large goniometer, although an electronic inclinometer also may be used. Examiners must conduct tests in accordance with measurement instructions in the AMA Guides. From the standpoint of impairment rating, hip extension, at least beyond neutral, is irrelevant; if a patient does not have a flexion contracture of at least 10°, there is no extension impairment. Examiners should compare both extremities; active or voluntary motion is performed by the active contraction of the governing muscles and should be evaluated first. During this and other measurements, patients may have a tendency to extend or guard, thus producing an erroneously inflated measurement. Examiners must ensure that such behaviors do not occur and should record only the correct measurement.
Measuring Shoulder Motion
Authors: Brigham Christopher R. 
Published: December 2020

Abstract
Measuring and documenting shoulder motion is important for many reasons, including diagnosis, determining the severity and progression of a disorder, assessing the results of treatment, and evaluating impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition provides guidance for the process of assessing abnormal motion of the shoulder, specifically Section 15.7a, Clinical Measurements of Motion, and Section 15.7g, Shoulder Motion. The shoulder has greater mobility than any other joint of the body, and movement there usually is composite rather than in a single plane; as a result, single movements are difficult to isolate. In the AMA Guides, universal goniometers with long arms are used to measure shoulder range of motion (ROM). Measurements of joint motion must be performed and recorded consistently because interrater reliability is reduced if instruments are incorrectly placed or if overlying soft tissue distorts the measurement. Active motion is obtained with full muscle force and cooperation after warm-up, and the ROM examination is performed by recording the active measurements from three separate ROM efforts. Patients may self-limit during the assessment of active range of motion or exert submaximal effort on manual strength testing because of pain and/or apprehension, so all measurements should fall within 10° of the mean and both sides should be tested.
Comparative Analysis of Impairment Evaluations by the 1996 Florida Uniform Permanent Impairment Rating Schedule (FUPIRS) and the AMA Guides™ Fourth, Fifth, and Sixth Editions
Authors: Brigham Christopher R. , McEntire Aimee , Uejo Craig 
Published: December 2020

Abstract
The Florida workers’ compensation system uses the 1996 Florida Uniform Permanent Impairment Rating Schedule (FUPIRS), that was based in part on the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Third Revised and Fourth Editions (the latter published in 1993). The authors ask if changes in the AMA Guides resulted in different impairment ratings and different awards. To these ends, the authors examined seventy-five cases that were randomly selected from a cohort of two hundred cases that was studied previously [see The Guides Newsletter, January/February 2010]. The average whole person impairment (WPI) per case was 5.3% WPI according to FUPIRS; 5.3% WPI according to the AMA Guides, Fourth Edition; 5.8% WPI according to the fifth edition; and 4.6% WPI according to the sixth edition. The difference between the WPIs was tested using a paired sample t test (alpha = .05), and results showed that the difference in WPI between FUPIRS and the sixth edition (0.7% WPI) was not statistically significant. The authors acknowledge that the limited range of impairment values in this study may have contributed to the lack of statistical significance when group means are compared because 84% of the cases were rated 10% WPI or less. The authors call for an expanded study to determine if meaningful differences exist between rating methodologies in a more diverse, less skewed sample.