What are Activities of Daily Living in the AMA Guides 5th Edition?

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An impairment report without an inventory of the patient’s Activities of Daily Living (or ADLs, as we like to say) is like trying to drive to an unknown destination without a map. After all, how can you determine the severity of an injured worker’s impairment without understanding how his or her daily life is (or isn’t) affected?

If you’re a provider writing an impairment report such as a PR-4 report, then asking your patient about his or her activities of daily living is essential. If you’re a claims adjuster or an attorney reviewing an impairment report, keep an eye out for whether or not the physician has made note of the ADLs.

What You Should Know About Activities of Daily Living

  • In the the AMA Guides 5th Edition, the Activities of Daily Living (ADLs) are an inventory of 34 activity measurements that show how an injury affects the life of the individual (page 4).
  • The activities of daily living include basic functions such as eating, speaking, personal hygiene, and moving around.
  •  The doctor’s description of ADLs serves as objective support when adjusting the final injury value (Whole Person Impairment WPI) up or down.
  • Once determined, the ADL value may serve this function for multiple impairments being calculated. For example, a shoulder injury may not even consider ADL, while a skin injury requires the ADLs to place the condition in a primary category. Other conditions use ADLs somewhere in between, such as determining the influence of pain on a nerve function.

Attention Medical Providers!

If you are examining a worker who has injured multiple body parts, then a separate ADL inventory must be performed on each injured body part. For example, if the worker has injured both her knee and her shoulder, then you should check to see how both her shoulder injury and her knee injury affect each activity.

It’s a lot of work, but it’s necessary. Here’s why:

  1. A complete ADL inventory tells the person who reads the report (such as an insurance administrator) that you invested additional time and effort into understanding the employee’s level of disability.
  2. A complete survey of the activities of daily living is a set of data that further supports the conclusions and final calculations of the reports impairment rating.

For example…

If you, as a medical provider, assign a worker’s injury a very high impairment rating—such as 90% whole person impairment—then the claims adjuster for the claim needs to understand why. If you demonstrate that the injury has disrupted all of the worker’s activities of daily living, then the impairment rating is supported. But if you don’t mention the activities of daily living at all, then you might very well receive a phone call from the insurance company in short order.

Reports that lack mention of the complete ADL inventory should be carefully considered before the conclusions are accepted as valid.

If a reader of an impairment report is unable to understand how much an injury affects the individual’s daily life, understanding the reasons for arriving at the final whole person impairment (WPI) are nearly impossible.

Bottom line: If you create impairment reports, include a complete ADL inventory. If you’re a RateFast user, then you already know that our PR-4 report-writing system  ensures that you ask about each activity for all body parts.

If you review impairment reports, insist that activities of daily living inventories are provided.

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Do you have all the tools you need to perform an impairment exam?

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Doctors can’t calculate an accurate impairment rating without the proper tools. Here at RateFast, we’ve reviewed a lot (a lot) of impairment ratings, and in our experience, one reason why doctors produce incorrect unjustifiable ratings is because they did not take the necessary measurements.

Accurate impairment ratings require accurate measurements, and to get the right measurements, you need the right tools.

Tools to Calculate Impairment Ratings

  1. Height and weight scale and blood pressure cuff — You need basic measurements and the worker’s basic vital signs.
  2. Tape measure — Made of flexible material, like fabric.
  3. Goniometer — Used for measuring joint ranges of motion. We prefer using goniometer apps on our phones. If you have an Android phone, you can download the RateFast Simple Goniometer for free from the Google Play store. If you have an iPhone, check the Apple App Store soon!
  4. Inclinometer — An inclinometer is used to measure the spine ranges of motion. You can also use use two phone goniometers, or one digital master/slave inclinometer.
  5. Grip dynomometer — Here in California, this is only for pain-free cases, greater than one year from date of injury or surgery.
  6. Pinch dynomometer — Like the grip dynomometer, this is only for pain-free cases, greater than one year from date of injury or surgery.
  7. Monofilament set — Be sure to have a 10 gram member in the set.
  8. Two point nerve discriminator — You can use a bent paperclip measured to 6 mm distance.

That does it. Once you get these tools, you’ll be ready to gather the correct measurements for your impairment ratings like a pro.

What about the rating itself?

Of course, to actually calculate the impairment rating in California (and many other states), you’ll also need the A.M.A. Guides 5th Edition. Then, you’ll need some time to plow through all the tables, diagrams, and charts.

Alternatively, you can join RateFast, and let our impairment rating specialists calculate the rating for you.

How to Measure and Report Ratable Atrophy According to the AMA Guides, 5th Edition

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If you’re a medical provider, then at some point in your career you will probably observe atrophy in one of your workers’ compensation cases. We hope this post is useful for you if one of your patients has atrophy that is related to a work injury.

Muscle atrophy is a medical term that is used to describe the loss of muscle size or mass when concerning orthopedic injuries or conditions. For more on the definition of atrophy, click here.

Today, we’re discussing ratable atrophy, as defined by the AMA Guides, 5th Edition.

According to Chapter 15, The Spine (page 382), ratable atrophy in the spine requires a 1 centimeter (cm) difference or greater in the arm, forearm or leg (calf), and 2 cm or greater in the thigh.

Chapter 17, The Lower Extremities, page 530 Table 17-6 allows rating values to be assigned for 1 cm or grater for the thigh or calf.

Make sure muscle atrophy measurements are reported in centimeters. If they are entered in inches, convert and round the value to the nearest centimeter (cm).

Make sure that ratings assigned for muscle atrophy are reported and provided for the injured side.

Make sure that you’re using the correct chapter (Chapter 15, The Spine or Chapter 17, The Lower Extremities) when impairment values for thigh muscle atrophy are being assigned. If you don’t use the correct chapter of the AMA Guides when assigning ratable atrophy, then the impairment rating will be wrong!

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How to Calculate an Impairment Rating for a Skin Condition

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Does Impairment Rating Get Under Your Skin?

Today we Chapter 8 in the AMA Guides 5th Edition: “The Skin.” Specifically, we want to make sure that you place a skin condition in the appropriate class for impairment rating.

The rating table, found on page 178 of the Guides, represents the rating strategy for the entire “Skin” chapter. The rating method is a class based rating system comprised of 5 classes. The whole person impairment range for the chapter is 0-95%.

The rating method in this chapter is primarily driven by the impact of the skin condition on activities of daily living (ADL;Table 1-2 Page 4).

Inventory the Activities of Daily Living!

Initial classification of the skin condition is based on determining how many ADLs (activities of daily living) are “limited.” The ADLs that are considered to be limited by the industrial injury or condition are then grouped into the following categories:

  1. No (none)
  2. Few
  3. Many
  4. Most

Classes 3 and 4 are differentiated by “intermittent confinement at home or domicile.”

Summary

When creating or reviewing an impairment rating for the injured employee’s skin, make certain the ADLs have been properly reviewed. It is necessary that those ADLs used to classify the rating category clearly are indicated as “limited.” When “Many” ADLs are reported as “limited,” a statement should be included if the condition results in the individual being confined to his or her home.

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