title: Commentary on the American Medical Association guides' lumbar impairment validity checks.
abstract: METHODS
  The American Medical Association's (AMA) Guides to the Evaluation of Permanent Impairment range of motion-based (ROM) lumbar impairment model validity checks were reviewed. Published literature of lumbar ROM (LROM) testing also was reviewed for application of the AMA validity checking protocols.
  
  
  OBJECTIVE
  The utility and feasibility of use of the AMA Guides' ROM lumbar impairment ratings were examined.
  
  
  BACKGROUND
  Although they appear to be essential components of the ROM model, few published studies report use of these validity checks. Of at least 22 reviewed studies of LROM testing, only six studies included at least three measurements (the bare minimum) of LROM. Furthermore, only two (9.1%) reported performance of the LROM validity check. Only one, however, reported the results.
  
  
  METHODS
  English language journals were searched on Medline using "region, lumbar," "range of motion," "validity of results," "observer variation," and "low back pain" as title and subject search terms. The study methodologies approximating the AMA Guides' specifications were included in the analysis.
  
  
  RESULTS
  Under normal conditions of ROM measurement, 33% of three consecutive lumbar flexion and 27% of three consecutive lumbar extension measurements failed the LROM validity check. In addition, across three different experimental sessions (each with more than three consecutive LROM measurements taken) only 15 participants (33%) had valid flexion scores and only 24 participants (53%) had valid extension scores across all three sessions.
  
  
  CONCLUSIONS
  Technical complications inherent in the ROM-based impairment-rating model render the validity checks difficult to perform satisfactorily and thus rarely used.
authors.affiliation: Workers' Compensation Board of British Columbia, Canada.
authors.forename: O A
authors.initials: OA
authors.lastname: Zuberbier
authors.forename: D G
authors.initials: DG
authors.lastname: Hunt
authors.forename: A J
authors.initials: AJ
authors.lastname: Kozlowski
authors.forename: J
authors.initials: J
authors.lastname: Berkowitz
authors.forename: I Z
authors.initials: IZ
authors.lastname: Schultz
authors.forename: J M
authors.initials: JM
authors.lastname: Crook
authors.forename: R A
authors.initials: RA
authors.lastname: Milner
mesh_terms: D000574:American Medical Association; D004185:Disability Evaluation; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000502:physiology*; D017410:Practice Guidelines as Topic; D016059:Range of Motion, Articular / Q000502:physiology*; D014481:United States