Spinal DRE or ROM - Which should you use?

Spinal impairment rating is performed using one of two methods: the diagnosis-related estimate (DRE) or range-of-motion (ROM) method.

The DRE method is the principal methodology used to evaluate an individual who has had a distinct injury. When the cause of the impairment is not easily determined and if the impairment can be well characterized by the DRE method, the evaluator should use the DRE method.

The ROM method is used in several situations:

1. When an impairment is not caused by an injury, if the cause of the condition is uncertain and the DRE method does not apply, or an individual cannot be easily categorized in a DRE class. It is acknowledged that the cause of impairment (injury, illness, or aging) cannot always be determined. The reason for using the ROM method under these circumstances must be carefully supported in writing.
2. When there is multilevel involvement in the same spinal region (e.g., fractures at multiple levels, disk herniations, or stenosis with radiculopathy at multiple levels or bilaterally).
3. Where there is alteration of motion segment integrity (e.g., fusions) at multiple levels in the same spinal region, unless there is involvement of the corticospinal tract (then use the DRE method for corticospinal tract involvement).
4. Where there is recurrent radiculopathy caused by a new (recurrent) disk herniation or a recurrent injury in the same spinal region.
5. Where there are multiple episodes of other pathology producing alteration of motion segment integrity and/or radiculopathy.

The ROM method can also be used if statutorily mandated in a particular jurisdiction.

In the small number of instances in which the ROM and DRE methods can both be used, evaluate the individual with both methods and award the higher rating.

Figure 15-4 Spine Impairment Evaluation Process

Taken from: AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, page 379, section 15.2.

See Section 15.2 in the Online Guides