Reliability and validity of American Medical Association's guide to ratings of permanent impairment
TL;DR: The guide's ratings showed both substantial reliability and accuracy with the various tests of hand function, and the injured hand, psychomotor test scores were highly correlated with the rating of permanent impairment in all cases.
Abstract: We examined the American Medical Association'sGuides to the Evaluation of Permanent Impairmentrating schedule to determine whether this guide provided a reliable and valid assessment of hand impairment. A sample of 118 patients with permanent hand impairment was assessed using the guide. In addition, each patient underwent tests of finger dexterity, hand strength, hand-eye coordination, and the rate of manipulation. The reliability, based on the correlation between the two raters, was 0.75. For the injured hand, psychomotor test scores were highly correlated with the rating of permanent impairment in all cases. These differences were statistically significant for approximately two thirds of the cases. The guide's ratings showed both substantial reliability and accuracy with the various tests of hand function. (JAMA1982;248:2292-2296)
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TL;DR: To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.
Abstract: The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition, is the most commonly used tool in the United States for rating permanent impairments for disability systems. The Guides, currently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability. To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.
75 citations
TL;DR: It is concluded that impairment percentages in RSD patients treated with PT or OT did not differ significantly from those treated with CT at 12 months after inclusion, and there were no significant differences between the groups.
Abstract: Reflex sympathetic dystrophy (RSD) is a disorder that can potentially result in permanent impairment. Because there are no adequate comparative studies regarding the additional value of physical therapy (PT) or occupational therapy (OT) for reducing the severity of permanent impairment in RSD, we prospectively investigated their effectiveness. At two university hospitals, we randomly assigned 135 patients with RSD of one upper limb, existing for <1 yr, to PT, OT, or control therapy (CT). One year after inclusion, impairment percentages were calculated according to the general method of the American Medical Association's Guides to the Evaluation of Permanent Impairment. For statistical evaluation, the Wilcoxon's signed-rank test (two-sided; alpha = 0.05) was used. The mean whole body impairments were as follows: PT, 21.6% and 19.1%; OT, 22.8% and 22.1%; CT, 22.0% and 22.1% (intention-to-treat and per protocol analysis, respectively). There were no significant differences between the groups. We conclude that impairment percentages in RSD patients treated with PT or OT did not differ significantly from those treated with CT at 12 months after inclusion.
63 citations
TL;DR: Applications of the Neutral-Zero Measuring Method and SFTR documentation and Recording System are focused on, and the advantages of this system when compared to more conventional approaches are highlighted.
61 citations
TL;DR: It is shown that, for mild-to-moderate clinical impairments, the associated impairment rating is a poor estimator of functional loss at the hand and should be used cautiously, if at all, as a criterion for disability determination.
47 citations
TL;DR: The anatomical approach of evaluation based on muscle strength that was described in the Guides to the Evaluation of Permanent Impairment was the most sensitive measure of impairment compared with the anatomical measure based on range of motion andCompared with the functional and diagnostic methods for the rating of impairment.
Abstract: We performed a prospective study of 302 patients who had a fracture of the lower extremity. Our purpose was to determine whether there was any association between impairment ratings of the lower extremity, derived with use of the Guides to the Evaluation of Permanent Impairment by the American Medical Association, and measurements of task performance based on direct observation as well as the patient's own assessment of activity limitation and disability as recorded on the Sickness Impact Profile. The mean residual impairment of the lower extremity according to the Guides was 27 per cent one year after the injury. Only 130 subjects (43 per cent) could perform all five functional tasks without difficulty. Eighty-four subjects (28 per cent) reported functional limitations that resulted in a score on the Sickness Impact Profile that was more than one standard deviation from the preinjury norm for the sample. Impairment ratings according to a modification of the system of the American Medical Association correlated strongly with the performance of functional tasks (r = 0.57) as well as the patients' reported activity limitations as recorded on the Sickness Impact Profile (r = 0.55). Correlations were highest when measures of impairment were based on strength rather than on range of motion. The relationship between the impairment rating and function (as observed by an examiner and as reported by the patient) was not influenced by the location of the fracture or the receipt of disability compensation. Our results suggest that the American Medical Association developed a valid approach for the measurement of physical impairment after a fracture of the lower extremity. In our study, the anatomical approach of evaluation based on muscle strength that was described in the Guides to the Evaluation of Permanent Impairment was the most sensitive measure of impairment compared with the anatomical measure based on range of motion and compared with the functional and diagnostic methods for the rating of impairment. Until the diagnostic and functional approaches for the measurement of musculoskeletal impairment are refined, we recommend use of the anatomical approach when evaluating impairment after a fracture of the lower extremity.
44 citations
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