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The Guides Newsletter - Important Clinical Concepts
from Past Issues
“Spondylolisthesis versus Alteration of Motion
Segment Integrity” by Craig M. Uejo MD, MPH
This is the fifth in a series of articles
written to assist evaluators in their use and interpretation
of The AMA Guides to the Evaluation of Permanent
Impairment, Fifth Edition (Cocchiarella L, Andersson G,
AMA Guides to the Evaluation of Permanent Impairment, Fifth
Edition, AMA Press, 2001). It will be used to help summarize
key points of clarification documented in past issues of The
Guides Newsletter. References to specific issues will be
provided to allow anyone the opportunity to review the entire
issue/article for assistance in understanding and accuracy of
reporting.
This particular article will discuss the
issues of whether Spondylolisthesis noted on static view
radiographs is evidence to support an impairment rating for
Alteration of Motion Segment Integrity (AMSI). This particular
issue was discussed in the July/August 2003 edition of The
Guides Newsletter.
Spondylolisthesis versus Alteration of
Motion Segment Integrity(AMSI) Spondylolisthesis is
not equivalent to alteration of motion segment integrity.
While spondylolisthesis may represent a condition in which
there was a level of instability present in the lumbar spine,
the AMA Guides, 5th ed. does not equate the two terms.
The finding of spondylolisthesis is not considered an
impairment by itself without significant “instability”
radiographically documented at MMI.
This issue was explored in the July – August
2003 issue of the Guides Newsletter. As noted in that
issue, the finding of spondylolisthesis, in itself, does not
result in ratable impairment. Alteration of motion segment
integrity exists only when there is significant dynamic
increased translational or angular motion, eg, demonstrated by
flexion vs extension views and meeting the definitions
provided in the Guides, or a successful or unsuccessful
surgical fusion. Some of the confusion concerning the term
used in the Guides re alteration of motion segment
integrity arises because multiple different, but similar,
terms exist.
In any case, spondylolisthesis without
flexion/extension views that document evidence of instability
at MMI is not ratable as AMSI.
Look for additional articles in this series,
The Guides Newsletter – Important Clinical Concepts
from Past Issues, coming in upcoming issues of this Brigham
and Associates Ezine.
Click Here for Further Discussions
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Hello!
Hope the change of seasons finds you all doing well! We are
pleased to see that Guides IQ has been receiving such positive
feedback and encourage all of you who have purchased your
subscription to participate in the Overview Call, and those of
you who have not yet subscribed to view the complimentary
Carpal Tunnel Syndrome video with the links in the article
below. Please feel free to provide us with any feedback by
giving us a call or replying to this email.
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| Client Call- Discussion on Optimizing your Rating
Reports |
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We are having a "Meeting of the Minds" for our valued
clients that utilize our Impairment Rating Services. If you
have ever used our rating review services, or would like to
use our review services, please join our calls to share your
ideas or just listen and learn from others.
Last week at the California Joint Powers Authority
conference in Lake Tahoe, one of our clients reported that
they are experiencing a 20:1 return on investment with our
reviews. The cases they refer typically are more complex and
they reported an average savings of $10,000 per case. Based on
these results they have decided to have all ratings reviewed.
Many clients report that most treating physicians will correct
their ratings based on our review. Our goal is to assure
accurate, unbiased impairment evaluations. We are unique in
being the nationally recognized experts on the Guides and
having every case reviewed by an experienced physician – with
reports typically issued within 5 days.
We had an excellent discussion with that client about how
to select the most appropriate service (ranging from our low
cost Rating Review Screening Service to our detailed narrative
reports), provide specific information using our online
referral form, and to make the best use of our reports. The
feedback was very helpful, and we want to hear from all of our
clients. Therefore, we are having a client teleconference call
where we can have an open discussion of impairment rating
reviews, receive your valued input, and learn how to most
effectively manage impairment ratings.
Please Note Dates & Times Below:
- California Clients: TODAY: Thursday, September 28th-
2.00 p.m. PST
- National Clients: Monday, Oct. 2nd, 2:00p.m. EST, 11a.m.
PST
To join the CA Client Call today: Please Call:
1-212-812-2800 and enter access code: 5316 2159 a few minutes
before 2pm PST.
To join the National Client Call: Please reply to
this email or call 1-888-262-1202 to sign up.
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Guides IQ- Special Pricing Deadline- Sept
30th |
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This on demand AMA Guides training contains over 60 modules
of training on the Guides - the equivalent of 3 to 4 days of
seminars. The training provides 16 hours of Category I AMA
Credit & QME Credit. You can access the resources whenever
necessary – to build knowledge and to manage a specific case.
The resource is available on a membership model: members pay a
modest annual subscription – a fraction of the true cost
associated with attending a meeting.
What does it contain?
- Video presentations on the AMA Guides – 5th and 4th
editions – demonstration of proper examination techniques
- Online self-assessment
- Digital publications
- Members only forum and monthly teleconference calls, and
much more!
If you subscribe prior to the end of the month you will
receive $200 off of the annual membership fee. If you delay
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- Price: $697.00/yearly subscription (Offer good until
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- Multiple User Discounts Available
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- Click
here to View Free Video Demonstration on Chapter 2 (only
available until Sept. 30th)
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Click Here to View Carpal Tunnel Syndrome
Demonstration |
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Chapter Highlights of the AMA Guides to the Evaluation
of Permanent Impairment, Fifth
Edition |
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Chapter Two: Practical Application of the Guides
by Aimee Lazell, CIR, WCCP
This article is the second in a series intended to point
out a few of the highlights from each chapter of the AMA
Guides to the Evaluation of Permanent Impairment, Fifth
Edition (Cocchiarella L, Andersson G, AMA Guides to the
Evaluation of Permanent Impairment, Fifth Edition, AMA Press,
2001).
This article will discuss important points of reference for
Chapter Two of the AMA Guides, which addresses the
Practical Applications of the Guides. Section 2.5
discusses the rules for evaluation of impairment. Below are
important points of reference for this section.
2.5c Consistency: This section explains that
consistency tests “are designed to ensure reproducibility and
greater accuracy.” Measurements of one evaluator or between
two different observers must be within 10% of each other to be
considered accurate and reliable.
2.5e Pain: “The impairment ratings in each chapter
make allowance for any accompanying pain.” This is also
discussed in Chapter 18: Pain. The Guides consider the
anticipated pain level for each ratable condition.
2.5f Using Assistive Devices in Evaluation A
physician should rate a patient’s condition without the use of
a prosthesis or assistive device if it can be removed or
eliminated relatively easily.
2.5g Adjustments for Effects of Treatment or Lack of
Treatment There are times when treatment for an illness
will result in total remission of signs and symptoms of that
illness. “In these instances, the physician may increase the
impairment estimate by a small percentage of 1-3%.” This can
not be applied if the physician has assigned additional
impairment for pain according to Chapter 18.
Section 2.5g also states that if a patient declines
surgery, prescription medication or any form of treatment,
this does not increase or decrease the estimated impairment
for the patient’s condition.
Watch for the next article in the series, which will
highlight sections of Chapter 3: The Cardiovascular System.
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On the
Calendar |
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Please visit us at our Exhibit at these conferences:
CSIA Oktoberfest of Learning, October 6, 2006, San
Francisco, CA
AADEP Annual Conference, Nov 8-10, St. Petersburg, FL
National Workers' Comp & Disability Conference, Las
Vegas, NV, November 14-16, 2006
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Webinar 101-
Oct/Nov Series Starting |
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AMA Guides Webinar 101 - The Fundamentals is an
overview on the use of the AMA Guides, with a focus on
principles of impairment evaluation, and assessment of spine,
upper extremity, lower extremity, neurological, and pain
impairments. The seminar is offered in four convenient two
hour sessions, totaling eight hours of superb training. This
seminar is designed for physicians, attorneys, and claims
staff with minimal or no experience in the use of the Guides.
It is also an excellent review for individuals who may have
attended an introductory course and desire further review and
clarification. Most individuals require two to three learning
experiences to grasp the complexities of impairment
evaluation.
View PowerPoint Presentation while listening to qualified
and experienced instructor live via conference call. Have your
questions answered live.
Webinar 101 Schedule:
- Wednesday, October 18, 2006 12-2 PST
- Wednesday, October 25, 2006 12-2 PST
- Wednesday, November 1, 2006 12-2 PST
- Wednesday, November 8, 2006 12-2 PST
Register: Click
Here or Call 1-888-262-1202 Price: $395/attendee (Multiple
attendee discount available) |
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Click Here for Details & to
Register |
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