Healthcare Provider Issues and Perspective: Impairment Ratings and Disability Determinations.

Approximately 1 in 4 adults in the United States have a disability that affects major life activities. This article provides a brief historical perspective of disability determination, and revisits the conceptual foundation for understanding the current models of disablement and their general application to the major US disability systems and nuances thereof. The expectations placed on the physician-expert examiner and why the physiatrist is ideally equipped to function in this role are discussed. The article is intended to provide a heightened awareness of the medicolegal framework, potential pitfalls, and other ramifications of such undertakings.

The Independent Medical Examination: Necessary Elements and Reporting Expectations of the Physician Examiner.

The Independent Medical Examination (IME), as it is commonly referred to, is currently a mainstay of the medicolegal system. The IME is typically a one-time interview, physical examination, and supplemental record review performed by an impartial (ie, nontreating) physician at the request of a claimant's legal counsel or opposing defense attorney, in order to provide focused answers to a particular set of questions intended to help resolve a medicolegal dispute over the claimant's alleged work injury or personal injury claim. IME services provide opportunity for physicians to broaden and diversify their expertise and scope of practice.

Time for critically ill patients to regain mobility after early mobilization in the intensive care unit and transition to a general inpatient floor.

PURPOSE: The purpose of this study is to determine if patient mobility achievements in an intensive care unit (ICU) setting are sustained during subsequent phases of hospitalization, specifically after transferring to inpatient floors and on the day of hospital discharge. MATERIALS AND METHODS: The study is an analysis of adult patients who stayed in the ICU for 48 hours or more during the second quarter of 2013. The study sample included 182 patients who transferred to a general inpatient floor after the ICU stay. RESULTS: Patients experienced an average delay of 16 hours to regain or exceed chair level of mobility and 7 hours to regain ambulation level after transferring to an inpatient floor. One third of patients ambulated in the ICU, and those patients had significantly shorter post-ICU and hospital stays compared with patients who did not ambulate in the ICU. Delays in regaining mobility on the floor were modestly associated with initial Morse Fall Score and being male. CONCLUSIONS: Mobility progression through the hospital course is imperative to improving patient outcomes. Study findings show the need for improvement in maintaining early ICU mobilization achievement during the crucial phase between ICU stay and hospital discharge.

Changes for the new AMA Guides to impairment ratings, 6th Edition: implications and applications for physician disability evaluations.

OBJECTIVE: U.S. Disability Systems share a common procedural approach to the determination of disability for purposes of compensation. The structural and anatomical consequences of the injury or disease are defined and measured according to medical impairment, which is used to estimate the individual's loss in terms of their capacity to perform activities of daily living (ADLs) and, presumptively, their losses in terms of vocational and non-vocational pursuits and quality of life. The physician is traditionally empowered to rate the severity of impairment in terms of a percentage loss to the "whole person" and according to criteria specific to each disability system. Often, the impairment percentage so derived, then is directly translated into a monetary sum for purposes of compensating these losses. The AMA periodically publishes and updates a physician impairment rating guide (the AMA Guides). The 6th Edition, published in 2008, incorporates the definitions and terminology of the ICF and provides a simple means of assessment of ADLs as part of the rating process. It also has shifted the ratings criteria towards a diagnosis-based approach, ostensibly to improve inter-rater consistency and reliability. CONCLUSION: Further work is needed to refine and validate ADL-based functional assessment tools applicable to medical impairment ratings, and to demonstrate the levels of consistency and reliability of the new rating method. Of equal importance, operational standardization across systems is also needed to enable common criteria and metrics to be developed and applied when determining the non-medical aspects of disability according to vocational and non-vocational pursuits and quality of life. Impairment ratings cannot be optimally designed to serve as the singular determinant of, nor be held solely accountable for, the disability awards.

Merits and shortcomings of the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th edition. A physiatric perspective.

We review in this article the most recent edition of the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides) from a physiatric perspective. Important general changes within the framework from the 4th to the 5th edition are highlighted. Those sections of the AMA Guides most often consulted by physiatrists are examined in critical detail, including sections dealing with the spine, upper and lower extremities, neurologic impairments, and impairments due to pain.