Advancements in AMA Guides Musculoskeletal Impairment Evaluations: Improved Reliability and Ease of Use.

OBJECTIVE: Describe and evaluate methodological improvements in AMA Guides to the Evaluation of Permanent Impairment (Guides) Sixth Edition 2024, including an updated sequential method and enhanced diagnosis-based impairment tables, compared to the Guides Sixth 2008. METHODS: Three physician experts and three pre-medical students, respectively, completed two rounds of impairment ratings using the AMA Guides Sixth 2008 vs. 2024 methods. Impairment values and completion times using each method were compared for both groups. RESULTS: Time to complete an impairment rating by experts averaged 3.5 minutes using Guides 2024 compared with 13.9 minutes using Guides 2008, with 100% accuracy and reliability for both. Students' time averaged 5.3 minutes and 15.9 minutes, respectively, with increased accuracy and reliability with Guides 2024. CONCLUSIONS: The Guides Sixth 2024 allowed more-efficient impairment ratings while retaining accuracy, consistency, reliability, and reproducibility.

Potential Misinformation in the Official Disability Guidelines About the Diagnosis and Treatment of Carpal Tunnel Syndrome.

OBJECTIVE: Workers' compensation guidelines may reinforce unhelpful thoughts regarding symptoms that are known to increase symptom intensity and magnitude of incapability. METHODS: One guideline commonly used (the Official Disability Guidelines) was reviewed regarding carpal tunnel syndrome. For 15 statements, we created an alternative statement based on a set of consensus principles for health, value, and quality in care. One hundred eight upper extremity surgeons of the Science of Variation Group reviewed both versions of the statements to indicate their preference. RESULTS: Surgeons preferred seven revised statements and five guideline statements and were neutral on three statements. Favored revisions related to more accurate discernment of symptoms that are clearly related to idiopathic median neuropathy and representative of severity of pathology. CONCLUSIONS: There may be important mental health considerations for care under a work claim, such as unhelpful thoughts or distress regarding symptoms, which are not adequately considered by the Official Disability Guidelines.

Determination of Medicolegal Causation.

Causation determination has become the gateway to treatment and reimbursement in workers' compensation and personal injury cases. The science of causation is constantly evolving, which is improving our understanding of individual physical thresholds, associated risk factors, and individual biopsychosocioeconomic factors. New laws place constantly changing legal thresholds for determining work-relatedness and proximate cause. The underlying foundation for fairness is quality science to support decisions made by the legal system to provide the injured worker the appropriate treatment to restore their function and decrease their functional impairment and/or assist in determining appropriate proximate cause in personal injury cases.

Median Nerve Symptoms, Signs, and Electrodiagnostic Abnormalities Among Working Adults.

INTRODUCTION: Diagnostic screening tests for carpal tunnel syndrome (CTS) have not been rigorously assessed in large populations. METHODS: This study is a cross-sectional analysis from a prospective cohort study. Participants' (n = 1,194) symptoms and disease prevalence were measured. Sensitivity, specificity, and positive and negative predictive values (NPVs) were calculated. RESULTS: When defining CTS as tingling/numbness in at least two median nerve-served digits and an abnormal median nerve conduction study, the prevalence was 8.9%. The sensitivity of paresthesias with nocturnal awakening was 77.4%. The sensitivity of the Phalen sign was 52.8% and that of the Hoffman-Tinel sign was only 37.7%. DISCUSSION: The highest sensitivity (77.4%) for a case definition of CTS in this population of workers was for nocturnal tingling/numbness in a median nerve distribution, and the highest specificity (97.5%) was for continuous tingling/numbness. The Phalen sign has a sensitivity of 52.8% and NPV of 95%, suggesting that the NPV is of particular diagnostic value. Hoffman-Tinel signs seem primarily helpful for the NPV (93.7%). LEVEL OF EVIDENCE: Level II diagnostic study.

ACOEM practice guidelines: elbow disorders.

OBJECTIVE: The American College of Occupational and Environmental Medicine has updated the treatment guidelines in its Elbow Disorders chapter through revision processes begun in 2006. This abbreviated version of that chapter highlights some of the evidence and recommendations developed. METHODS: Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 108 high- or moderate-quality trials were identified for elbow disorders. RESULTS: Guidance has been developed for 13 major diagnoses and includes 270 specific recommendations. CONCLUSION: Quality evidence is now available to guide treatment for elbow disorders, particularly for lateral epicondylalgia.

Reliability of a visual analog version of the QuickDASH.

BACKGROUND: The QuickDASH, an abbreviated form of the Disabilities of the Arm, Shoulder and Hand Questionnaire, uses a graded-adjectives ordinal measurement response scale. In order to improve the sensitivity of the measure and to make it compatible with widely used measures of pain and disability, a visual analog scale version was developed. The present study investigated the reliability of the new version over time when used for the evaluation of patients undergoing treatment. METHODS: A test-retest model with a two-day interval was used to evaluate a sample of thirty-eight consecutive patients in an interdisciplinary tertiary rehabilitation setting who were identified as having an upper extremity disorder. RESULTS: The intraclass correlation coefficient indicating test-retest reliability was 0.90 for the eleven-item QuickDASH visual analog scale questionnaire (without the work component) and 0.94 for the fifteen-item questionnaire (with the work component), neither of which was significantly different from the results reported for the original questionnaire. CONCLUSIONS: The QuickDASH visual analog scale questionnaire has acceptable reliability over time, and it can be used as an alternative to the original QuickDASH.

How we prevent prevention of musculoskeletal disorders in the workplace.

American businesses face huge costs for work-related musculoskeletal pain. Work-related musculoskeletal pain is not new or unique to the population of the United States. Many historic manifestations of workplace pain have been related to innovation and technology changes. Incidence rates and severity of symptoms have had an interesting relationship to the public concern and governmental decisions. In 1999, a National Academy of Sciences study found total costs to be more than US dollar 1 trillion per year and concluded that effective prevention of workplace pain through active intervention is not only possible, but results in a significant cost savings for the employer while reducing the disability experienced by the employee. Employers have been reluctant to embrace the benefits of workplace prevention for work-related musculoskeletal pain. The purpose of this review is to examine (1). what is know about prevention of work-related musculoskeletal pain and workplace musculoskeletal disorders, (2). a brief description of several prevention preventing behaviors, (3). an analysis of how these preventing behaviors are maintained, and (4). suggestions on how to reverse these prevention preventing behaviors.