The term method has replaced the 4th AMA guides term models in the 5th edition Guides when referring to DRE or ROM.The DRE method remains the primary method of choice for evaluating spine injury or disease.The word differentiators (4th Edition)has been replaced by the term objective findings in the 5th Edition.In the few instances that both theDRE nor ROM methods are able to be used the assessor should use both methods and award the higher rating.
For re-evaluation , there are strict rules : if the DRE method is used initially, the DRE or ROM method can be used subsequently,if a different spine region is involved.If the ROM method was used initially ,it must be used again.
The DRE method is the principal method to evaluate impairment from a distinct injury, if the impairment can be well characterised by the DRE method or if the cause of the impairment is not easily determined and the DRE method describes the impairment.DRE is also used in cases with cortico-spinal involvement with decompression and multi-level fusions within the same region.Cases with cortico-spinal involvement treated with decompression and multi-level fusions within the same region should be rated with the DRE method because assessing ROM in paralysed individuals is difficult.Impairments within a DRE category carry a range, with adjustments of up to 3% to account for treatment effects and changes in the ability to perform ADLs.
The ROM Method is used for recurrent conditions, when conditions occur within a single spine region.The ROM Method is used if within a SINGLE spine region there are MULTIPLE events or pathologies e.g. radiculopathy at L4, L5 and S1; multiple recurrences or episodes-or radiculopathy at multiple levels; multi-level motion alteration; and multiple fracturesi n a single region.
The ROM Method is also recommended for : spinal stenosis with radiculopathy ,except following trauma; conditions not well represented by the DRE method.
Both the DRE and ROM Methods provide ratings in whole person impairment (WPI), which can be converted to regional body impairment using conversion factors e.g. in AMA 5 in section 15-13.
The DRE Method has diagnostic categories that account for common neurologic and muscular changes associated with the condition.The ROM Method accounts for diagnoses and directly measures neurologic and ROM changes.
In summary, always use the DRE Method if the case can be classified by the DRE Method :"The DRE method is the principal methodology used to evaluate an individual who has a distinct injury".When the cause of the impairment is not easily determined and if the impairment can be well characterised by the DRE Method, the assessor should use the DRE Method(AMA5 p 379).
The ROM Method is used only if criteria are met for its use:(i) multi-level in one region,(ii)repeat or recurrent condition/injury,or(iii) impairment is due to illness ( and not injury).DRE-->place in category and re-use if repeated injury in future and DRE was initially used).ROM: :(i) Diagnosis, (ii) Measure ROM, (iii) Determine neurologic deficit--.Combine areas (i) to (iii) using Combined values Chart(not arithmetic addition).
To apportion ratings, % from prior findings can be arithmetically subtracted from curet % findings.either the DRE or ROM Method can be used to apportion impairment caused by more than one condition or event.If the ROM Method was previously used, it MUST be used again.If the DRE Method was used, EITHER DRE or ROM can be used, for the second rating.
DR MICHAEL CORONEOS CIME MASE
NATIONAL RACS EXAMINER
FAIM FRACS FACS FRCSI FRCS(EDIN)SN MB BS (1ST CLASS HONS) MAPS MASE CIME MNSA MNSQ MANZSOM
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