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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The Importance of Activities of Daily Living

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Activities of Daily Living are among the most neglected topics to be reported in impairment reports. The AMA Guides to the Evaluation of Permanent Impairment Fifth Edition clearly defines activiites of daily living (ADLs) as essential for understanding the impact and creation of impairment ratings (Chapter 1; Philosophy, Purpose, and Appropriate Use of the Guides).  Table 1-2 Page 4 lists 34 defined activities of daily living.

Every impairment report created under the AMA Guides should have a clear review of all 34 ADLs. The report should indicate positive and negative responses. It is essential to understand that the goal of the ADL is not to identify functional issues in the workplace. The goal is actually quite the opposite. The goal is to identify an individual’s ability to perform “common activities of daily living (ADL), excluding work.” (Page 4). This allows all individuals to be evaluated on a common basis, the actives necessary in daily living. Remember, this table has nothing to do with the work place.

ADLs have various levels of impact on the impairment calculations depending on the chapter in the Guides 5th Edition. In Chapter 8, The Skin, ADLs are used as primary determination for impairment class assignment (Table 8-2 Page 178). In Chapter 15, The Spine, ADLs are used to adjust the impairment value range (Section 15.4, Page 384). In Chapter 16, Upper Extremity, ADLs are used very little in the rating methods.

Finally, remember as you view activities of daily living some simply cause pain but do not disrupt an activity. Other times the the condition may completely preclude an activity. A well crafted impairment report will make these distinctions. Also, do not simply “write-off” some ADL activities as not relevant. For example, an individual with a shoulder injury may report difficulty with the activities of walking because of pain when the arm swings with the gait motion, or climbing stairs because of pain using the handrail. Traditionally we do not think of walking and climbing steps as being important with a shoulder injury.

A strong understanding of how the ADLs are used in the creation of impairment values will serve you well when discussing and analyzing report conclusions. Require reports to be standardized with this section, and use attention to detail in the ADL section to assess the level of detail that has gone into the report.

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