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Chiropractic Research Review

Reliability Problems in AMA Impairment Rating Guides

The American Medical Association's (AMA) spinal range-of-motion guides for impairment ratings are used in the United States, Australia, New Zealand and other countries, yet questions have arisen concerning the reliability of some of the measurements used to determine impairment in patients with low back pain.

Essentially, reliability is the ability of a diagnostic procedure to elicit similar results when used by the same or different examiner(s) on the same patient. This study sought to determine reliability in two specific procedures: measurement of thoracolumbar spine range of motion (ROM) with a long-arm goniometer, and measurement of lumbar spine ROM with a dual inclinometer. Thirty-four subjects (20-65 years of age and with chronic low back or leg pain of at least six months duration) completed a Pain Visual Analogue Scale (PVAS), then underwent two tests based on the AMA Guides aforementioned recommendations.

Both of the recommendations concerning measurement of low back ROM exhibited poor interrater and intrarater reliability. Thus, multiple raters had difficulty eliciting similar results with the same patient, and even had difficulty reproducing their own individual results with the same patient. Specifically, the authors suggested that "a subject measured by two different examiners on the same day may be assessed as having (excluding the contribution from rotation) between 0% and 18% whole-body impairment."

Take Note: The authors conclude that the implications of these findings are significant for employers, employees and insurers who currently rely on the AMA Guides in workers' compensation and entitlement cases.

Nitschke JE, Nattrass CL, Disler PB, et al. Reliability of the American Medical Association Guides' model for measuring spinal range of motion. Spine, Feb. 1, 1999:24(3), pp262-268.

Chiropractic Research Review

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