2024 AMA Guides: Updates and Enhancements for Musculoskeletal Impairment Evaluation

To ensure fair and equitable impairment ratings, it is crucial for physicians conducting these assessments to be aware of the 2024 updates to the American Medical Association (AMA) Guides. This year, the AMA Guides Panel has updated the evaluation methodology for permanent physical impairment in Chapter 15 (Upper Limb), Chapter 16 (Lower Limb), and Chapter 17 (Spine and Pelvis).

The last print edition of the AMA Guides to the Evaluation of Permanent Impairment (6th ed.) was published in 2008. Since 2021, the guides have transitioned to a web-based format. Although updates in 2021, 2022, and 2023 did not significantly impact the musculoskeletal (MSK) chapters, significant changes have been made starting in 2024.

In 2022, the Guides Panel formed the MSK subcommittee, which then created additional subcommittees for each chapter. The objective was to improve the methodology to provide more efficient impairment ratings while maintaining accuracy, consistency, reliability, and reproducibility. The RAND/UCLA Appropriateness Method combined with a modified Delphi process was used to evaluate existing scientific research on impairment evaluations. The subcommittees determined that five steps are required for conducting an impairment assessment, as detailed in Table 1.

The enhanced Diagnosis-Based Impairment (DBI) Tables have replaced the Net Adjustment Formula and the Grade Modifier Tables for Functional History, Physician Examination, and Clinical Studies from the 2008 edition. Now, all necessary information is contained within one DBI Table using the concept of a diagnostic row, which aligns specific individual elements from clinical history, physical examination, and relevant clinical studies with the confirmed diagnosis.

The confirmed diagnosis, aligning with the natural history of the condition and being clinically relevant to the impairment assessed, determines the appropriate class, grade, and impairment value. This structured approach ensures fair, equitable, accurate, and consistent impairment ratings for MSK conditions. A study on the transition to the 2024 edition found that the updated method and enhanced DBI Tables improve the standardized rating process, making it more user-friendly and superior for inexperienced evaluators.

In summary, the enhanced approach aligns with the traditional way physicians assess patients using clinical history, physical examination, and relevant clinical studies, then applying that information to specific individual elements in a diagnostic row within the appropriate DBI Table.

Additional information on this update will be available at the 26th Annual AAOS Workers’ Compensation and Musculoskeletal Injuries Course.

J. Mark Melhorn, MD, FAAOS, is the course director for the AAOS Workers’ Compensation and Musculoskeletal Injuries Course.

References

1. Fitch K, Bernstein SJ, Aguilar MD, et al: The RAND/UCLA Appropriateness Method User's Manual. RAND; 2001.
2. Melhorn JM, Gelinas B, Martin DW, et al: Advancements in AMA Guides Musculoskeletal Impairment Evaluations: improved reliability and ease of use. J Occup Environ Med 2024;66(9):737-42.

Sign up now for the 26th Annual AAOS Workers’ Compensation and Musculoskeletal Injuries Course

Join AAOS for the 26th Annual AAOS Workers’ Compensation and Musculoskeletal Injuries Course, a virtual event taking place on Nov. 9. Featuring live-streamed lectures, interactive panels, and expert-led discussions, this year’s course introduces new faculty and topics to provide up-to-date insights on causation, diagnosis, and treatment options for occupational injuries and illnesses. Attendees will gain practical strategies for utilization review, causation analysis, report writing, medical liability, depositions, and effective communication with patients—all aimed at enhancing patient outcomes.

For more information and to register, visit aaos.org/workcomp24.