142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Intra- and Inter-rater Reliability of the Guides to the Evaluation of Permanent Impairment

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Sonya Meyers, MD , School of Public Health, University of Illinois at Chicago, Chicago, IL
Linda Forst, MD, MPH , School of Public Health, Environmental and Occupational Health Sciences, University of Illinois, Chicago, IL

Per 2009 Bureau of Labor Statistics, 3.1 million injured workers represent 94% of reported injuries in the US.

The Guides to the Evaluation of Permanent Impairment (The Guides) was developed by the American Medical Association in 1958 to guide health care practitioners in rating impairment for injured workers.

There is a gap in the literature on an impairment rating system that is reproducible and reliable, with ratings that correlate with functional capacity, work capacity, and quality of life following a work related injury.

We will compare intra- and inter-rater reliability of ratings for injuries among individual raters, among raters within single medical specialties, and among raters between different medical specialties; to determine the perceived barriers for the raters using this system.


We have 20 cases of low back injuries and of upper extremity injuries that have been piloted with physicians associated with the UIC occupational medicine training program. These cases represent a range of ratings. We will conduct the study with 1) occupational medicine specialists, 2) hand surgeons, and 3) spine surgeons.  We will survey the attitudes towards impairment ratings to examine preconceptions and their influence on impairment ratings.


Based on pilot study, The Guides scores are about 11 points higher than scores awarded by the Illinois Worker Compensation Commission arbitrator.


Conclusions are pending data collection and analysis.

Learning Areas:

Occupational health and safety
Other professions or practice related to public health
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Identify The Guides may lack correlation with functional capacity, work capacity, and quality of life after occupational injury.

Keyword(s): Occupational Health and Safety, Disabilities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an occupational and environmental medicine resident physician who is licensed to practice medicine in Illinois and California. I have conducted multiple independent medical examinations and associated record reviews for various medical conditions including but not limited to musculoskeletal, cardiovascular, endocrine, and neurlogical disorders. I also have conducted over 30 utilization record reviews for contested disability insurance applications under appropriate attending physician supervision. I am the PI of the abstract submitted.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.