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Comparative Analysis of Impairment Ratings From the 5th to 6th Editions of the AMA Guides

Busse, Jason W., DC, PhD; de Vaal, Marieke M., MD; Ham, S. John, MD, PhD; Sadeghirad, Behnam, PharmD, MPH; van Beers, Loes W.A.H., MSc; Couban, Rachel J., MA, MISt; Kallyth, Sun Makosso, PhD; Poolman, Rudolf W., MD, PhD

Journal of Occupational and Environmental Medicine: December 2018 - Volume 60 - Issue 12 - p 1108–1111
doi: 10.1097/JOM.0000000000001440

Objective: The association of American Medical Association's (AMA) Guides edition with impairment ratings is uncertain.

Methods: We used data from a consecutive sample of 249 injured workers referred for an independent evaluation 10 months before and after assessors switched from the 5th to the 6th edition of the AMA Guides.

Results: The median whole person impairment rating was 7.0% (interquartile range [IQR]: 4 to 14) for 131 claimants assessed with the 5th edition of the Guides, and 4.0% (IQR: 2 to 8) for 118 claimants assessed with the 6th edition (P-value for difference: 0.002). Multivariable analysis showed a 36.4% relative reduction (95% confidence interval [CI] 17.2% to 57.3%) in impairment rating with the 6th edition of the Guides versus the 5th edition.

Conclusions: The 6th edition of the AMA Guides provides systematically lower impairment ratings for injured workers than the 5th edition.

The Michael G. DeGroote Institute for Pain Research and Care (Dr Busse, Ms Couban, and Dr Kallyth); Department of Anesthesia (Dr Busse); Department of Health Research Methods, Evidence, and Impact (Dr Busse, Dr Sadeghirad); The Michael G. DeGroote Centre for Medicinal Cannabis Research (Dr Busse), McMaster University, Hamilton, Ontario, Canada; Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands (Dr de Vaal, Dr Ham, Mr van Beers, and Dr Poolman).

Address correspondence to: Rudolf W. Poolman, MD, PhD, Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands (

Funding: No funds were received for the preparation of this manuscript.

Competing interests: Authors Busse, de Vaal, Ham, Sadeghirad, van Beers, Couban, Kallyth, and Poolman have no relationships/conditions/circumstances that present potential conflict of interest.

Contributors: R.W.P. and J.W.B. conceived the study design; M.M.dV., S.J.H., and L.W.A.H.vB. acquired the data; B.S. and S.M.K. performed the data analysis; J.W.B., M.M.dV., S.J.H., L.W.A.H.vB., and R.W.P. interpreted the data and findings; J.W.B., B.S., and R.J.C. drafted the manuscript; R.W.P. and J.W.B. provided the methodological support and study supervision. All authors reviewed the study findings and read and approved the final version before submission. R.W.P., J.W.B., and B.S. have full access to all the data in the study and the final responsibility for the decision to submit for publication.

Ethical approval: The Medisch-ethische commissie OLVG approved our study protocol prior to data collection.

Data sharing: Study protocol and statistical code: Available from Dr. Sadeghirad (e-mail: Data set: Not available.

The authors report no conflicts of interest.

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Copyright © 2018 by the American College of Occupational and Environmental Medicine