THE DEVELOPMENT OF GUIDELINE FACTORS FOR THE EVALUATION OF DISABILITYIN NECK AND BACK INJURIES

This is the second article documenting the development of guideline fa ctors for the evaluation of spine injuries by a committee supported by the Division of Industrial Accidents (DIA) in the State of California . The committee was asked to develop guidelines that incorporated cerv ical and thoracic spine injuries into the original guidelines develope d for lumbar spine injuries (Clark et al, Spine 1988; 13:332). Multipl e Independent Medical Examiners (IMEs) were requested to rate disabili ty on 42 case reports submitted to the DIA. A tremendous variation exi sted in the disability rating recommended by physicians given the same set of facts. One hundred eighty-five IMEs then were asked to evaluat e a series of potential factors influencing disability. Each factor wa s listed according to its perceived importance in determining disabili ty. These factors then were subjected to an intensive search of the me dical and scientific literature to determine their validity. A final l ist of 28 factors for the cervical and thoracic spine were developed a nd combined with the previously published factors for the lumbar spine . This led to the development of 37 factors or guidelines for the eval uation of spine disability. Testing of this schedule was performed by reviewing 159 submitted disability consultation reports. This review s howed that there were no factors in the reports that were not included in the schedule. An average of 3.1 subjective factors and 2.3 objecti ve factors were noted in the reports, with a very poor relationship be tween the number of factors and the level of disability given by the a ssessing physician. It is thought that the incorporation of the propos ed guideline factors into the current disability rating system would a llow for a more reproducible evaluation of disability and allow Worker s' Compensation judges and administrators to make disability decisions based on documentable and reliable facts.