Guides to the Evaluation of Permanent Impairment »

Cocchiarella, Linda, MD, MSc (American Medical Association); Andersson, Gunnar B.J., MD, PhD (Rush-Presbyterian-St Luke's Medical Center)

This reference for clinicians describes criteria for the assessment and rating of an individual's permanent impairment in the United States. Introductory chapters discuss such topics as impairment evaluation in Workers' Compensation cases and the physician's role based on the Americans with Disabilities Act. The main part of the text consists of individual chapters devoted to various systems of the body. Each of these chapters includes an overview of impairment assessment for that body system; a description and interpretation of common signs and symptoms of disorders; a summary of common investigative clinical procedures; case studies; and clinical criteria used to determine impairment ratings. Annotation c. Book News, Inc., Portland, OR (booknews.com)

Doody Review Services

Reviewer:J. Thomas Pierce, MBBS PhD(Navy Environmental Health Center)
Description:The Guides defines a new standard for impairment assessment, applying the International Classification of Functionality (ICF) in order to make the impairment ratings more relevant and to promote greater precision for this process. Assisting Dr. Rondinelli are 10 senior editors, 3 contributing editors, a 20-person advisory committee, and roughly 50 chapter authors, along with 100 reviewers across three continents. By my count, chapters typically include case examples of conditions (typically stretching from class 0 to class 3 -4), at least a half dozen illustrations, and 5-20 tables.
Purpose:The first page fairly describes the history, if not the purpose of this book: "Tolerance of and care for the sick and the disabled (are) elemental components of our social fabric, rooted in the origins of human society." Chapter 2 notes that the book is "written by medical doctors for other medical doctors as a tool to translate human pathology resulting from a trauma or disease process into a percentage of the whole person." The inclusion of ICF terminology and definitions requires careful reading beyond just looking up conditions and determining an impairment class.
Audience:While the primary users of this book may be fairly narrowly defined as physicians involved in the rating process, a much broader range of individuals will likely read it, if not use it. From the standpoint of clinical anatomy, this book provides an excellent review of nearly everything one (hopefully) learned in medical school. It would be naive not to believe this book will acquire readership in the insurance, loss prevention, and legal communities. In fairness, it should also be noted that the members of the disabled community have been principal advocates and pathfinders for the entire ICF movement.
Features:A key overarching principle of this book is that evaluations should address complementary scales of human usable capacity in the setting of performance qualifiers. I found it advisable to spend a lot of time rereading the conceptual foundations before looking at other chapters. Chapters could be termed suites: introductory (3); systemic (6); sensorineural (3); dermal (1); ear, nose, and throat (1); and orthopedic (3). The orthopedic contributors tend to use more illustrations and tables while some of the systemic chapter authors are more reliant on words.
Assessment:Evaluators might liken the contribution made by this book to Churchill's observation regarding democracy. ("Indeed, it has been said that democracy is the worst form of Government except all those other forms that have been tried from time to time." (.-Winston S. Churchill: His Complete Speeches, 1897-1963, ed. Robert Rhodes James, vol. 7, p. 7566 (1974).) I would like to compliment the editors on addressing tough questions and remaining fair. Given its reorientation in terms of ICF, the Guides' treatment of permanent impairment incorporates consensus opinions from the World Health Organization and the Institute of Medicine. In an era of increasingly sophisticated means of revisionist surgery and regenerative therapeutics, new means of evaluating permanency must be used. The seminal paper of Saad Nagi (1969) allowed subsequent development of the ICF concept, but it will be publications such as this that can truly operationalize its meaning.