Recommendations to Guide Revision of the Guides to the Evaluation of Permanent Impairment

The American Medical Association's Guides to the Evaluation of Permanent Im pairment, Fourth Edition, is the most commonly used tool in the United Stat es for rating permanent impairments for disability systems. The Guides, cur rently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the l ack of a comprehensive, valid, reliable, unbiased, and evidence-based syste m for rating impairments; and the way in which workers' compensation system s use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for eva luation of permanent impairment, not disability. To maintain wide acceptanc e of the Guides, its authors need to improve the validity, internal consist ency, and comprehensiveness of the ratings; document reliability and reprod ucibility of the results; and make the Guides easily comprehensible and acc essible to physicians.