Erroneous Impairment Ratings

2006 ◽  
Vol 11 (3) ◽  
pp. 1-5, 9-11
Author(s):  
Christopher R. Brigham
Keyword(s):  
Scientific Evidence ◽  
Error Rates ◽  
The Body ◽  
Explanatory Variables ◽  
Reasonable Degree ◽  
Whole Person ◽  
Self Reports ◽  
Impairment Ratings ◽  
Time Frames ◽  
Original Rating

Abstract A nationwide study in 2005 of 2100 cases referred for impairment rating review found 80% to be erroneous, and 89% of these erroneous ratings were higher than appropriate. Among whole person erroneous ratings (839 of 1037 cases critiqued), the original physician's rating averaged 15.5% whole person permanent impairment, but following rerating by physician experts, the corrected rating averaged 5.6%; only 7% of the cases were underrated. All ratings were based on the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition. Tables and figures show error rates according to portion of the body affected, expert vs original rating, and other explanatory variables. Two physicians who use the AMA Guides should arrive at similar conclusions about impairment ratings, but most physicians have not received instruction about assessing impairment, disability, or causation and lack an adequate ability to assess these issues. Causation requires a given cause and a given effect that are associated with a reasonable degree of medical probability and also requires documentation with appropriate scientific evidence (not self-reports or historical time frames). Those who prepare and review assessments of impairment should ensure that clinical causation assessments were accurate, that the rating was performed at maximal medical improvement, that examination findings were consistent, and that the individual's normal state was determined.

Quick Reference: Motion at the Wrist, Elbow, and Shoulder

2005 ◽  
Vol 10 (2) ◽  
pp. 6-6
Keyword(s):  
Daily Living ◽  
Patient Advocacy ◽  
Body Part ◽  
Organ System ◽  
The Body ◽  
Organ Function ◽  
Reference Motion ◽  
Whole Person ◽  
Body Organ ◽  
Impairment Ratings

Abstract When they assess impairment, examiners must determine what “loss, loss of use, or derangement of any body part, organ system, or organ function,” occurred, according to the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides), Fifth Edition. At the same time, the AMA Guides cautions examiners to avoid “double dipping,” or rating the same impairment twice: “Related but separate conditions are rated separately[,] and impairment ratings are combined unless criteria for the second impairment are included in the primary impairment.” For example, it is not appropriate for an examiner who is rating spinal impairment using a Diagnosis-related estimate (DRE) category to award an additional 3% whole person impairment (WPI) beyond the baseline rating for the category because of limitation in activities of daily living (ADLs), presumably at least in part because of residual pain, and then to award a further impairment rating for pain based on Chapter 18. Rather, the AMA Guides notes that “the impairment ratings in the body organ system chapters make allowance for any accompanying pain.” Duplicative and, therefore, erroneously inflated ratings sometimes are performed by physicians who are less experienced in using the AMAGuides or those who, due to patient advocacy or other reason, want to maximize ratings.

Pain, Impairment, and Disability in the AMA Guides

2004 ◽  
Vol 9 (6) ◽  
pp. 1-19
Author(s):  
James P. Robinson ◽  
Dennis C. Turk ◽  
John D. Loeser
Keyword(s):  
Pain Assessment ◽  
Assessment Methods ◽  
First Person ◽  
Objective Data ◽  
Person Perspective ◽  
Contradictory Information ◽  
Whole Person ◽  
Self Reports ◽  
Impairment Ratings ◽  
First Person Perspective

Abstract This article clarifies important conceptual issues associated with the assessment of pain and considers reasons why pain should be considered in impairment and disability ratings. The authors address conceptual issues rather than specific pain assessment methods and limit the discussion to the musculoskeletal and neurologic injuries seen most frequently during impairment disability evaluations. Several groups of experts worked on the AMA Guides, and little is known about which elements of the AMA system are well substantiated and which need revision. In addition, the AMA Guides, as actually used, often differ from the guides as written. Self-reports that disability applicants provide about their experiences provide a first-person perspective that, in principle, may be important to assessors. Pain and “unbearable” sensations cannot be incorporated into impairment evaluations in the AMA Guides because pain is inherently subjective and because pain and its effects must be analyzed at the level of the whole person. In summary, although the AMA Guides, Fifth Edition, seems to support including pain in impairment ratings, this support is vitiated by inconsistencies in the conceptualization of impairment, contradictory information about how examiners should interpret pain, and inadequate guidance about how examiners should combine subjective and objective data.

Comparative Analysis: The State of Colorado Study, Part III

2004 ◽  
Vol 9 (3) ◽  
pp. 1-12
Author(s):  
Christopher R. Brigham ◽  
Kathryn Mueller ◽  
Douglas Van Zet ◽  
Debra J. Northrup ◽  
Edward B. Whitney ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Lower Extremity ◽  
Range Of Motion ◽  
Scientific Evidence ◽  
Functional Limitations ◽  
The State ◽  
Fourth Edition ◽  
Functional Loss ◽  
Whole Person ◽  
Impairment Ratings

Abstract This article concludes the three-part discussion of differences among the editions of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides): Third Edition Revised, Fourth, and Fifth Editions. The discussion begins with a comparison of different editions of the AMA Guides for evaluating lower extremity impairment and spinal impairment. The AMA Guides, Fourth Edition, introduced the Diagnosis related estimates (DRE) model, and in this edition the range-of-motion (ROM) model has only a limited role (ie, primarily as a differentiator). A table summarizes the criteria of spinal impairment criteria by edition of the AMA Guides. The authors summarize differences in the impairment ratings of various body systems based on the use of different editions of the AMA Guides, including differences in ratings of the cardiovascular, pulmonary, digestive, and other systems. Critiquing the AMA Guides, the authors call for improvements, including the following: add a system to rate permanent impairments, including functional limitations; base impairment ratings on scientific evidence and a valid whole person impairment scale; make the AMA Guides reliable, comprehensive, internally consistent, comprehensible, accessible (ie, the AMA Guides are complex and difficult to use, and not all physicians are capable of rating impairment), and acceptable. Despite the shortcomings, no other widely accepted basis to assess impairment is available, and future editions of the AMA Guides will improve the process of providing fair assessments of functional loss.

Combining Values

2002 ◽  
Vol 7 (2) ◽  
pp. 1-4, 12 ◽  
Author(s):  
Christopher R. Brigham
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Evaluation Method ◽  
Proximal Phalanx ◽  
Common Error ◽  
The Third ◽  
Whole Person ◽  
Impairment Ratings ◽  
Upper Extremity Impairment ◽  
The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

Spine Impairment Evaluation: Sixth Edition Approaches

2009 ◽  
Vol 14 (1) ◽  
pp. 1-5
Author(s):  
Craig Uejo ◽  
Marjorie Eskay-Auerbach ◽  
Christopher R. Brigham
Keyword(s):  
Functional Status ◽  
Spinal Injury ◽  
Current Medical ◽  
Clinical Testing ◽  
Medical Evidence ◽  
Sixth Edition ◽  
Whole Person ◽  
Rating Process ◽  
Impairment Ratings ◽  
Class Assignment

Abstract Evaluators who use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, should understand the significant changes that have occurred (as well as the Clarifications and Corrections) in impairment ratings for disorders of the cervical spine, thoracic spine, lumbar spine, and pelvis. The new methodology is an expansion of the Diagnosis-related estimates (DRE) method used in the fifth edition, but the criteria for defining impairment are revised, and the impairment value within a class is refined by information related to functional status, physical examination findings, and the results of clinical testing. Because current medical evidence does not support range-of-motion (ROM) measurements of the spine as a reliable indicator of specific pathology or permanent functional status, ROM is no longer used as a basis for defining impairment. The DRE method should standardize and simplify the rating process, improve validity, and provide a more uniform methodology. Table 1 shows examples of spinal injury impairment rating (according to region of the spine and category, with comments about the diagnosis and the resulting class assignment); Table 2 shows examples of spine impairment by region of the spine, class, diagnosis, and associated whole person impairment ratings form the sixth and fifth editions of the AMA Guides.

Medical and Legal Issues Raised by the Protz Decision Issued by the Pennsylvania Supreme Court

2017 ◽  
Vol 22 (4) ◽  
pp. 12-13
Author(s):  
LuAnn Haley ◽  
Marjorie Eskay-Auerbach
Keyword(s):  
Supreme Court ◽  
Scientific Evidence ◽  
Workers Compensation ◽  
Sixth Edition ◽  
Complex Concept ◽  
The Supreme Court ◽  
Compensation Claims ◽  
Recent Edition ◽  
Impairment Ratings ◽  
Definition Of

Abstract Pennsylvania adopted the impairment rating provisions described in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) in 1996 as an exposure cap for employers seeking predictability and cost control in workers’ compensation claims. In 2017, the Supreme Court of Pennsylvania handed down the Protz decision, which held that requiring physicians to apply the methodology set forth in the most recent edition of the AMA Guides reflected an unconstitutional delegation of legislative power to the American Medical Association. The decision eliminates the impairment-rating evaluation (IRE) mechanism under which claimants were assigned an impairment rating under the most recent edition of the AMA Guides. The AMA Guides periodically are revised to include the most recent scientific evidence regarding impairment ratings, and the AMA Guides, Sixth Edition, acknowledges that impairment is a complex concept that is not yet defined in a way that readily permits an evidence-based definition of assessment. The AMA Guides should not be considered standards frozen in time simply to withstand future scrutiny by the courts; instead, workers’ compensation acts could state that when a new edition of the AMA Guides is published, the legislature shall review and consider adopting the new edition. It appears unlikely that the Protz decision will be followed in other jurisdictions: Challenges to using the AMA Guides in assessing workers’ compensation claims have been attempted in three states, and all attempts failed.

scholarly journals Subcellular Localization and Vesicular Structures of Anthocyanin Pigmentation by Fluorescence Imaging of Black Rice (Oryza sativa L.) Stigma Protoplast

Plants ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 685
Author(s):  
Enerand Mackon ◽  
Yafei Ma ◽  
Guibeline Charlie Jeazet Dongho Epse Mackon ◽  
Qiufeng Li ◽  
Qiong Zhou ◽  
...  
Keyword(s):  
Oryza Sativa ◽  
Subcellular Localization ◽  
Oryza Sativa L ◽  
Scientific Evidence ◽  
Brown Rice ◽  
The Body ◽  
Central Vacuole ◽  
In Planta ◽  
Black Rice

Anthocyanins belong to the group of flavonoid compounds broadly distributed in plant species responsible for attractive colors. In black rice (Oryza sativa L.), they are present in the stems, leaves, stigmas, and caryopsis. However, there is still no scientific evidence supporting the existence of compartmentalization and trafficking of anthocyanin inside the cells. In the current study, we took advantage of autofluorescence with anthocyanin’s unique excitation/emission properties to elucidate the subcellular localization of anthocyanin and report on the in planta characterization of anthocyanin prevacuolar vesicles (APV) and anthocyanic vacuolar inclusion (AVI) structure. Protoplasts were isolated from the stigma of black and brown rice and imaging using a confocal microscope. Our result showed the fluorescence displaying magenta color in purple stigma and no fluorescence in white stigma when excitation was provided by a helium–neon 552 nm and emission long pass 610–670 nm laser. The fluorescence was distributed throughout the cell, mainly in the central vacuole. Fluorescent images revealed two pools of anthocyanin inside the cells. The diffuse pools were largely found inside the vacuole lumen, while the body structures could be observed mostly inside the cytoplasm (APV) and slightly inside the vacuole (AVI) with different shapes, sizes, and color intensity. Based on their sizes, AVI could be grouped into small (Ф < 0.5 um), middle (Ф between 0.5 and 1 um), and large size (Ф > 1 um). Together, these results provided evidence about the sequestration and trafficking of anthocyanin from the cytoplasm to the central vacuole and the existence of different transport mechanisms of anthocyanin. Our results suggest that stigma cells are an excellent system for in vivo studying of anthocyanin in rice and provide a good foundation for understanding anthocyanin metabolism in plants, sequestration, and trafficking in black rice.

Invariance of Wearing Location of Omron-BI Pedometers: A Validation Study

2010 ◽  
Vol 7 (6) ◽  
pp. 706-717 ◽  
Author(s):  
Weimo Zhu ◽  
Miyoung Lee
Keyword(s):  
Validation Study ◽  
Absolute Error ◽  
Activity Monitor ◽  
Error Rates ◽  
Living Conditions ◽  
The Body ◽  
Validity And Reliability ◽  
Free Living ◽  
Climbing Stairs ◽  
Free Living Conditions

Background:The purpose of this study was to investigate the validity and reliability evidences of the Omron BI pedometer, which could count steps taken even when worn at different locations on the body.Methods:Forty (20 males and 20 females) adults were recruited to walk wearing 5 sets, 1 set at a time, of 10 BI pedometers during testing, 1 each at 10 different locations. For comparison, they also wore 2 Yamax Digi-Walker SW-200 pedometers and a Dynastream AMP 331 activity monitor. The subjects walked in 3 free-living conditions: a fat sidewalk, stairs, and mixed conditions.Results:Except for a slight decrease in accuracy in the pant pocket locations, Omron BI pedometers counted steps accurately across other locations when subjects walked on the fat sidewalk, and the performance was consistent across devices and trials. When the subjects climbed up stairs, however, the absolute error % of the pant pocket locations increased significantly (P < .05) and similar or higher error rates were found in the AMP 331 and SW-200s.Conclusions:The Omron BI pedometer can accurately count steps when worn at various locations on the body in free-living conditions except for front pant pocket locations, especially when climbing stairs.

scholarly journals Immunobiology and Application of Aloe vera-Based Scaffolds in Tissue Engineering

2021 ◽  
Vol 22 (4) ◽  
pp. 1708
Author(s):  
Saeedeh Darzi ◽  
Kallyanashis Paul ◽  
Shanilka Leitan ◽  
Jerome A. Werkmeister ◽  
Shayanti Mukherjee
Keyword(s):  
Tissue Engineering ◽  
Foreign Body ◽  
Scientific Evidence ◽  
Aloe Vera ◽  
Material Design ◽  
Foreign Body Response ◽  
The Body ◽  
Design Strategies ◽  
Immunomodulatory Effects ◽  
Body Response

Aloe vera (AV), a succulent plant belonging to the Liliaceae family, has been widely used for biomedical and pharmaceutical application. Its popularity stems from several of its bioactive components that have anti-oxidant, anti-microbial, anti-inflammatory and even immunomodulatory effects. Given such unique multi-modal biological impact, AV has been considered as a biomaterial for regenerative medicine and tissue engineering applications, where tissue repair and neo-angiogenesis are vital. This review outlines the growing scientific evidence that demonstrates the advantage of AV as tissue engineering scaffolds. We particularly highlight the recent advances in the application of AV-based scaffolds. From a tissue engineering perspective, it is pivotal that the implanted scaffolds strike an appropriate foreign body response to be well-accepted in the body without complications. Herein, we highlight the key cellular processes that regulate the foreign body response to implanted scaffolds and underline the immunomodulatory effects incurred by AV on the innate and adaptive system. Given that AV has several beneficial components, we discuss the importance of delving deeper into uncovering its action mechanism and thereby improving material design strategies for better tissue engineering constructs for biomedical applications.

The Shroud of Turin

1997 ◽  
Vol 9 (1) ◽  
pp. 121-140
Author(s):  
Thaddeus J. Trenn ◽  
Keyword(s):  
Body Image ◽  
Scientific Evidence ◽  
The Body ◽  
Religious Art ◽  
Satisfactory Explanation ◽  
Marshall Mcluhan ◽  
Modern Age ◽  
Shroud Of Turin ◽  
High Degree ◽  
As If

The Shroud of Turin, a linen cloth with but a faint image, continues to capture the interest of many people of diverse beliefs. Although the measured age of the cloth is relatively recent, other scientific findings indicate an earlier provenance. Any firm conclusions regarding the cloth's history remain premature. No satisfactory explanation has been found as yet for how the image on the cloth was produced structurally or stylistically. Iconographic evidence suggests that the image was the source of facial peculiarities found in early works of religious art. The body image bears a striking yet preternatural correlation with Scriptural accounts of wounds. Curiously, the image on the cloth functions as a photographic negative, exhibiting a high degree of resolution, as if the original were produced in pixels. Despite serious efforts to discover some artistic origin md medium, scientific evidence points in the direction that it was not produced by hands. If it is tme that the medium is the message, as Marshall McLuhan wrote, then the Turin Shroud may be a parable for the modern age.

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