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Emily A. Spieler, JD; Peter S. Barth, PhD; John F. Burton, Jr, PhD, LLB; Jay Himmelstein, MD; Linda Rudolph, MD, MPH

JAMA. 2000;283:519-523.

The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition, is the most commonly used tool in the United States for rating permanent impairments for disability systems. The Guides, currently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability. To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.

Author Affiliations: West Virginia University College of Law, Morgantown (Dr Spieler); Department of Economics, University of Connecticut, Storrs (Dr Barth); School of Management and Labor Relations, Rutgers University, New Brunswick, NJ (Dr Burton); Department of Family Medicine and Community Health and the Center for Health Policy and Research, University of Massachusetts, Worcester (Dr Himmelstein); and Division of Workers' Compensation, California Department of Industrial Relations, San Francisco (Dr Rudolph).

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