Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment: Lower Extremities
Identifieur interne : 004087 ( Pmc/Corpus ); précédent : 004086; suivant : 004088Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment: Lower Extremities
Auteurs : Hee-Chun Kim ; Joon-Sung Kim ; Kee-Haeng Lee ; Ho Seong Lee ; Eun-Seok Choi ; Jay-Young YuSource :
- Journal of Korean Medical Science [ 1011-8934 ] ; 2009.
Abstract
Lower Extremities Committee of Korean Academy of Medical Sciences Guideline for Impairment Rating develops new guidelines which are based on McBride method, American Medical Association Guides, Disability evaluation by The Korean Orthopaedic Association, The Korean Neurosurgery Society, and Korean Academy of Rehabilitation Medicine. The committee analyzed and discussed to create an ideal method practical in Korea. Our committee endeavors to develop new methods which are easy to use, but are suitable for professional use and also independent from the examinee's intentions. The lower extremities are evaluated on the basis of anatomic change, functional change, and diagnosis based evaluation. Nine methods are used to assess the lower extremities. Anatomic assessment includes leg length discrepancy, ankylosis, amputation, skin loss, peripheral nerve injury, and vascular disease. In functional assessment, range of motion and muscle strength are included. Diagnosis-based assessments are used to evaluate impairment caused by specific fractures, deformities, ligament instability, meniscectomies, post-traumatic arthritis, fusion of the foot, and lower extremity joint replacements.
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DOI: 10.3346/jkms.2009.24.S2.S299
PubMed: 19503687
PubMed Central: 2690070
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment: Lower Extremities</title><author><name sortKey="Kim, Hee Chun" sort="Kim, Hee Chun" uniqKey="Kim H" first="Hee-Chun" last="Kim">Hee-Chun Kim</name><affiliation><nlm:aff id="A1">Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Joon Sung" sort="Kim, Joon Sung" uniqKey="Kim J" first="Joon-Sung" last="Kim">Joon-Sung Kim</name><affiliation><nlm:aff id="A2">Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Kee Haeng" sort="Lee, Kee Haeng" uniqKey="Lee K" first="Kee-Haeng" last="Lee">Kee-Haeng Lee</name><affiliation><nlm:aff id="A3">Department of Orthopaedic Surgery, Holy Family Hospital, The Catholic University of Korea, Bucheon, Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Ho Seong" sort="Lee, Ho Seong" uniqKey="Lee H" first="Ho Seong" last="Lee">Ho Seong Lee</name><affiliation><nlm:aff id="A4">Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</nlm:aff></affiliation></author><author><name sortKey="Choi, Eun Seok" sort="Choi, Eun Seok" uniqKey="Choi E" first="Eun-Seok" last="Choi">Eun-Seok Choi</name><affiliation><nlm:aff id="A5">Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Daejeon, Korea.</nlm:aff></affiliation></author><author><name sortKey="Yu, Jay Young" sort="Yu, Jay Young" uniqKey="Yu J" first="Jay-Young" last="Yu">Jay-Young Yu</name><affiliation><nlm:aff id="A6">Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Gumi, Korea.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19503687</idno><idno type="pmc">2690070</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690070</idno><idno type="RBID">PMC:2690070</idno><idno type="doi">10.3346/jkms.2009.24.S2.S299</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">004087</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004087</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment: Lower Extremities</title><author><name sortKey="Kim, Hee Chun" sort="Kim, Hee Chun" uniqKey="Kim H" first="Hee-Chun" last="Kim">Hee-Chun Kim</name><affiliation><nlm:aff id="A1">Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.</nlm:aff></affiliation></author><author><name sortKey="Kim, Joon Sung" sort="Kim, Joon Sung" uniqKey="Kim J" first="Joon-Sung" last="Kim">Joon-Sung Kim</name><affiliation><nlm:aff id="A2">Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Kee Haeng" sort="Lee, Kee Haeng" uniqKey="Lee K" first="Kee-Haeng" last="Lee">Kee-Haeng Lee</name><affiliation><nlm:aff id="A3">Department of Orthopaedic Surgery, Holy Family Hospital, The Catholic University of Korea, Bucheon, Korea.</nlm:aff></affiliation></author><author><name sortKey="Lee, Ho Seong" sort="Lee, Ho Seong" uniqKey="Lee H" first="Ho Seong" last="Lee">Ho Seong Lee</name><affiliation><nlm:aff id="A4">Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</nlm:aff></affiliation></author><author><name sortKey="Choi, Eun Seok" sort="Choi, Eun Seok" uniqKey="Choi E" first="Eun-Seok" last="Choi">Eun-Seok Choi</name><affiliation><nlm:aff id="A5">Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Daejeon, Korea.</nlm:aff></affiliation></author><author><name sortKey="Yu, Jay Young" sort="Yu, Jay Young" uniqKey="Yu J" first="Jay-Young" last="Yu">Jay-Young Yu</name><affiliation><nlm:aff id="A6">Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Gumi, Korea.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Korean Medical Science</title><idno type="ISSN">1011-8934</idno><idno type="eISSN">1598-6357</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Lower Extremities Committee of Korean Academy of Medical Sciences Guideline for Impairment Rating develops new guidelines which are based on McBride method, American Medical Association Guides, Disability evaluation by The Korean Orthopaedic Association, The Korean Neurosurgery Society, and Korean Academy of Rehabilitation Medicine. The committee analyzed and discussed to create an ideal method practical in Korea. Our committee endeavors to develop new methods which are easy to use, but are suitable for professional use and also independent from the examinee's intentions. The lower extremities are evaluated on the basis of anatomic change, functional change, and diagnosis based evaluation. Nine methods are used to assess the lower extremities. Anatomic assessment includes leg length discrepancy, ankylosis, amputation, skin loss, peripheral nerve injury, and vascular disease. In functional assessment, range of motion and muscle strength are included. Diagnosis-based assessments are used to evaluate impairment caused by specific fractures, deformities, ligament instability, meniscectomies, post-traumatic arthritis, fusion of the foot, and lower extremity joint replacements.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Cocch, L" uniqKey="Cocch L">L Cocch</name></author><author><name sortKey="Andersson, Gbj" uniqKey="Andersson G">GBJ Andersson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcbride, Ed" uniqKey="Mcbride E">ED McBride</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Sabharwal, S" uniqKey="Sabharwal S">S Sabharwal</name></author><author><name sortKey="Zhao, C" uniqKey="Zhao C">C Zhao</name></author><author><name sortKey="Mckeon, Jj" uniqKey="Mckeon J">JJ McKeon</name></author><author><name sortKey="Mcclemens, E" uniqKey="Mcclemens E">E McClemens</name></author><author><name sortKey="Edgar, M" uniqKey="Edgar M">M Edgar</name></author><author><name sortKey="Behrens, F" uniqKey="Behrens F">F Behrens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Norkin, Cc" uniqKey="Norkin C">CC Norkin</name></author><author><name sortKey="White, Dj" uniqKey="White D">DJ White</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marshall, Jl" uniqKey="Marshall J">JL Marshall</name></author><author><name sortKey="Fetto, Jf" uniqKey="Fetto J">JF Fetto</name></author><author><name sortKey="Botero, Pm" uniqKey="Botero P">PM Botero</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gross, Ae" uniqKey="Gross A">AE Gross</name></author><author><name sortKey="Lavoie, Mv" uniqKey="Lavoie M">MV Lavoie</name></author><author><name sortKey="Mcdermott, P" uniqKey="Mcdermott P">P McDermott</name></author><author><name sortKey="Marks, P" uniqKey="Marks P">P Marks</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Insall, Jn" uniqKey="Insall J">JN Insall</name></author><author><name sortKey="Dorr, Ld" uniqKey="Dorr L">LD Dorr</name></author><author><name sortKey="Scott, Rd" uniqKey="Scott R">RD Scott</name></author><author><name sortKey="Scott, Wn" uniqKey="Scott W">WN Scott</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Korean Med Sci</journal-id><journal-id journal-id-type="publisher-id">JKMS</journal-id><journal-title-group><journal-title>Journal of Korean Medical Science</journal-title></journal-title-group><issn pub-type="ppub">1011-8934</issn><issn pub-type="epub">1598-6357</issn><publisher><publisher-name>The Korean Academy of Medical Sciences</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19503687</article-id><article-id pub-id-type="pmc">2690070</article-id><article-id pub-id-type="doi">10.3346/jkms.2009.24.S2.S299</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Development of Korean Academy of Medical Sciences Guideline Rating the Physical Impairment: Lower Extremities</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Hee-Chun</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Kim</surname><given-names>Joon-Sung</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Kee-Haeng</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Ho Seong</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Choi</surname><given-names>Eun-Seok</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Yu</surname><given-names>Jay-Young</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.</aff><aff id="A2"><label>2</label>Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.</aff><aff id="A3"><label>3</label>Department of Orthopaedic Surgery, Holy Family Hospital, The Catholic University of Korea, Bucheon, Korea.</aff><aff id="A4"><label>4</label>Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.</aff><aff id="A5"><label>5</label>Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Daejeon, Korea.</aff><aff id="A6"><label>6</label>Department of Occupational and Environmental Medicine, Soonchunhyang University Hospital, Gumi, Korea.</aff><author-notes><corresp>Address for correspondence: Joon-Sung Kim, M.D. Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93-6 Ji-dong, Paldal-gu, Suwon 442-723, Korea. Tel: +82.31-249-7650, Fax: +82.31-251-4481, <email>svpmr@chol.com</email></corresp></author-notes><pub-date pub-type="ppub"><month>5</month><year>2009</year></pub-date><pub-date pub-type="epub"><day>31</day><month>5</month><year>2009</year></pub-date><volume>24</volume><issue>Suppl 2</issue><fpage>S299</fpage><lpage>S306</lpage><history><date date-type="received"><day>05</day><month>4</month><year>2009</year></date><date date-type="accepted"><day>04</day><month>5</month><year>2009</year></date></history><permissions><copyright-statement>Copyright © 2009 The Korean Academy of Medical Sciences</copyright-statement><copyright-year>2009</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0">http://creativecommons.org/licenses/by-nc/3.0</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Lower Extremities Committee of Korean Academy of Medical Sciences Guideline for Impairment Rating develops new guidelines which are based on McBride method, American Medical Association Guides, Disability evaluation by The Korean Orthopaedic Association, The Korean Neurosurgery Society, and Korean Academy of Rehabilitation Medicine. The committee analyzed and discussed to create an ideal method practical in Korea. Our committee endeavors to develop new methods which are easy to use, but are suitable for professional use and also independent from the examinee's intentions. The lower extremities are evaluated on the basis of anatomic change, functional change, and diagnosis based evaluation. Nine methods are used to assess the lower extremities. Anatomic assessment includes leg length discrepancy, ankylosis, amputation, skin loss, peripheral nerve injury, and vascular disease. In functional assessment, range of motion and muscle strength are included. Diagnosis-based assessments are used to evaluate impairment caused by specific fractures, deformities, ligament instability, meniscectomies, post-traumatic arthritis, fusion of the foot, and lower extremity joint replacements.</p></abstract><kwd-group><kwd>Disability Evaluation</kwd><kwd>Lower Extremity</kwd><kwd>Impairment</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>INTRODUCTION</title><p>Ten methods can be used to assess the lower extremities. These methods are classified by assessment methods: anatomic, functional, diagnosis-based.</p><p>The evaluator decides the diagnosis at first, then checks whether or not the individual has reached maximal medical improvement (MMI). The next step is to identify each part of the lower extremities (pelvis, hip, thigh, knee, foot, and toe). The evaluator estimates the disability using the ten items: amputation, leg length discrepancy, ankylosis, partial ankylosis (range of motion), nerve injury, muscle weakness, diagnosis-based estimation, joint replacement, vascular disease, skin loss, and then calculate the impairment rating. Assessment by muscle weakness is chosen when the other estimations are inappropriate. If lower extremity impairment is due to an underlying spine disorder, the evaluation of the impairment would be conducted with the spine impairment rating.</p><p>There are some methods to calculate the impairment rating scales that can be combined, but other methods can not be combined. If the evaluator cannot determine which methods are correct, then the evaluator uses all methods that are related to the condition, and chooses the highest impairment rating.</p></sec><sec sec-type="methods"><title>MATERIALS AND METHODS</title><p>The Korean Academy of Medical Sciences comprises the Lower Extremities Committee of Korean Guideline for Impairment Rating in which orthopedic surgeons, neurosurgeons, physiatrists, and occupational and environmental medicine doctors participated. This committee analyzed the American Medical Association (AMA) Guides (<xref ref-type="bibr" rid="B1">1</xref>), McBride method (<xref ref-type="bibr" rid="B2">2</xref>), the guide of Korean Orthopaedic Association (<xref ref-type="bibr" rid="B3">3</xref>), the guide of Korean Neurosurgical Society (<xref ref-type="bibr" rid="B4">4</xref>), the Korean Academy of Rehabilitation Medicine (<xref ref-type="bibr" rid="B5">5</xref>) and created a new guide based on the AMA Guides.</p></sec><sec sec-type="results"><title>RESULTS</title><sec><title>Methods of assessment</title><p>There are three methods to assess the disability of the lower extremities. These methods are based on anatomical, functional, and diagnosis-based estimations (<xref ref-type="table" rid="T1">Table 1</xref>).</p></sec><sec><title>Combination of evaluation methods</title><p>The amputation cannot be combined with leg length discrepancy, ankylosis, nerve injury, partial ankylosis, or muscle weakness. The leg length discrepancy cannot be combined with amputation. Ankylosis and partial ankylosis cannot be combined muscle weakness and diagnosis-based estimates. Nerve injury and muscle weakness cannot be combined each other. If there is arthritis without ankylosis, it can be estimated by muscle weakness. When we use the muscle weakness, it should be Grade III or IV by the manual muscle test. If the muscle power is less than Grade III, it should be assessed by the nerve injury. Diagnosis-based estimates cannot be combined with ankylosis, partial ankylosis, or muscle weakness.</p></sec><sec><title>Amputation</title><p>The impairment rate depends on the site of amputation and length of the stump. The impairment rate of lower extremity is presented in <xref ref-type="table" rid="T2">Table 2</xref>. The maximal impairment rate is less than 100% of the leg except hemipelvictomy. The hemipelvictomy is 110% of lower extremity function. In case of metatarsal amputation, if the remnant of the metatarsal bone is less than 25%, it is categorized as a Lisfran amputation. Tarsometatarsal amputation includes the proximal one-fourth transmetatarsal amputation. The length of stump is estimated by the radiography.</p></sec><sec><title>Leg length discrepancy</title><p>The minimum disability is more than 1.5 cm difference. The measurement for leg length is done in supine position. Measurement is done for the distance between the anterior superior iliac spine and the medial malleollus on the involved side, and compare it with the opposite side. This method has at least 0.5 to 1.0 cm variance (<xref ref-type="bibr" rid="B6">6</xref>). In case of pelvic angulation, knee contracture, and severe leg edema, scanogram is recommended (<xref ref-type="table" rid="T3">Table 3</xref>).</p></sec><sec><title>Total ankylosis</title><sec><title>Hip joint</title><p>Impairment due to ankylosis of hip estimate flexion, adduction, abduction, internal rotation, and external rotation. The optimal position of ankylosis is 25° to 40° flexion and neutral rotation, adduction, and abduction. This position represents a 50% lower extremity impairment. Impairment estimates for rotation, abduction and adduction deformities are added (<xref ref-type="table" rid="T4">Table 4</xref>).</p></sec><sec><title>Knee joint</title><p>Impairment for flexion, valgus, varus, internal rotation, and external rotation. The optimal ankylosis position is 10° to 15° of flexion with neutral alignment. Ankylosis in the optimal position is a 67% lower extremity impairment (<xref ref-type="table" rid="T5">Table 5</xref>).</p></sec><sec><title>Ankle joint</title><p>Impairment due to ankylosis of ankle estimate dorsiflexion, plantar flexion, valgus, varus, internal rotation, and external rotation. The optimal position of ankylosis is neutral position. Ankylosis in the optimal position is a 25% lower extremity impairment. Impairment of foot deformities are added (<xref ref-type="table" rid="T6">Table 6</xref>).</p></sec><sec><title>Toes</title><p>Impairment due to ankylosis of toe estimate dorsiflexion and plantar flexion in the great toe (<xref ref-type="table" rid="T7">Table 7</xref>).</p></sec></sec><sec><title>Partial ankylosis (range of motion)</title><p>Lower extremity impairment can be evaluated by assessing the range of motion of its joints. If the restricted range of motion is based on organic abnormality, measurement is done for the range three times and use the greatest range as an evaluation (<xref ref-type="bibr" rid="B7">7</xref>).</p><sec><title>Hip</title><p>Flexion, extension, internal rotation, external rotation, abduction, and adduction are estimated. The impairment rate due to partial ankylosis of the hip is presented in <xref ref-type="table" rid="T8">Table 8</xref>.</p></sec><sec><title>Knee</title><p>Flexion, flexion contracture, varus, and valgus position are estimated. The impairment rate due to partial ankylosis of the knee is presented in <xref ref-type="table" rid="T9">Table 9</xref>.</p></sec><sec><title>Ankle and foot</title><p>In ankle motion, platar flexion, flexion contracture and dorsiflexion are estimated. In foot motion, inversion, eversion, valgus, and varus position are estimated. The impairment rate due to partial ankylosis of the ankle and foot is presented in <xref ref-type="table" rid="T10">Table 10</xref>-<xref ref-type="table" rid="T13">13</xref>.</p></sec></sec><sec><title>Muscle weakness</title><p>Muscle weakness is measured by manual muscle testing. When we use muscle weakness method, it should be Grade III or IV by manual muscle test. If the muscle power is less than Grade III, it should be assessed according to peripheral nerve injury (<xref ref-type="table" rid="T14">Table 14</xref>).</p></sec><sec><title>Diagnosis-based estimation</title><p>Sometimes the diagnosis-based estimation is more precise than other methods. This method includes fractures, ligament injury, meniscal injury, fractures with deformity. In fracture category, malunion, nonunion, angulation and malrotation are estimated. Joint instability due to ligament injury in the knee and ankle is evaluated by stress radiography (<xref ref-type="bibr" rid="B8">8</xref>).</p><sec><title>Hip</title><p>The impairment rate of hip based on diagnosis-based estimation method is presented in <xref ref-type="table" rid="T15">Table 15</xref>.</p></sec><sec><title>Knee</title><p>The impairment rate of knee based on diagnosis-based estimation method is presented in <xref ref-type="table" rid="T16">Table 16</xref>.</p></sec><sec><title>Ankle and foot</title><p>The impairment rate of ankle and foot based on diagnosis-based estimation method is presented in <xref ref-type="table" rid="T17">Table 17</xref>.</p></sec></sec><sec><title>Joint replacement</title><p>The evaluation of joint replacement is based on the functional score in the hip (<xref ref-type="bibr" rid="B9">9</xref>) and knee joint (<xref ref-type="bibr" rid="B10">10</xref>) and the range of motion in the ankle joint (<xref ref-type="table" rid="T18">Table 18</xref>).</p><sec><title>Hip joint replacement</title><p>Pain, function, activities, deformity, range of motion are evaluated. Each category has points and add the points to determine the total scores. Rating hip replacement results are presented in <xref ref-type="table" rid="T19">Table 19</xref>.</p></sec><sec><title>Knee joint replacement</title><p>Pain, range of motion, stability, flexion contracture, extension lag, and alignment are evaluated. Rating knee replacement results are presented in <xref ref-type="table" rid="T20">Table 20</xref>.</p></sec><sec><title>Ankle joint replacement</title><p>Only range of motion is evaluated. The impairment rate due to ankle joint replacement is presented in <xref ref-type="table" rid="T21">Table 21</xref>.</p></sec></sec><sec><title>Peripheral vascular disease</title><p>Impairment due to peripheral vascular disease is based on clinical symptoms. <xref ref-type="table" rid="T22">Table 22</xref> shows the lower extremity impairment rate due to peripheral vascular disease. This table provide impairment due to arterial disease, vascular disease, and lymphedema of lower extremity. These diseases should be confirmed by radiologic study, sonography or lymphoscintigraphy.</p><p>In the lymphedema patient, lymphatic flow decrease is detected by lymphoscintigraphy. For stage II lymphedema and more than 3 cm circumference difference which needs elastic support is class 2. For stage III lymphedema and more than 5 cm circumference difference which needs elastic support is class 3.</p></sec><sec><title>Skin loss</title><p>Full-thickness skin loss in the weight bearing area makes a disability. Impairment due to skin loss of the foot is presented in <xref ref-type="table" rid="T23">Table 23</xref>.</p></sec></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>Korean Guideline for Impairment Rating of lower extremities were developed mainly based on the criteria in the 5th edition of AMA Guides. It is different from AMA Guides in that Korean Guideline omits some classification which is not realistic in Korea. In the muscle weakness category, if muscle power is less than Grade III it would be evaluated in the peripheral nervous system. It may reduce inaccuracy. In this guideline, the method which can be modified by examinee such as gait derangement is excluded. Through this process we can make it simpler and more objective guideline than AMA Guides. When we use this new guideline for the evaluation of disability, the examiner should know about comprehensive medical history and review the all records. After understanding the patient's symptoms and signs, evaluator should do physical examination thoroughly. The physician should record lower extremity-related physical findings, such as range of motion, limb length discrepancy, deformity, reflexes, muscle strength, muscle atrophy, ligament laxity, motor and sensory deficits, and specific diagnoses such as fractures.</p><p>In summary, a stepwise approach of evaluating a lower extremity impairment is as follows;</p><p><list list-type="order"><list-item><p>Establish the diagnosis.</p></list-item><list-item><p>Determine whether maximal medical improvement has been reached.</p></list-item><list-item><p>Identify each lower extremity anatomic region with abnormalities that are related to injury in question.</p></list-item><list-item><p>Calculate impairment according to the text and tables for each applicable method.</p></list-item><list-item><p>Identify and calculate injury which is related to peripheral nervous system impairment.</p></list-item><list-item><p>Identify and calculate all injuries which is related to the peripheral vascular system.</p></list-item><list-item><p>The lower extremity impairment rating for each limb is then converted to whole person impairment.</p></list-item></list></p></sec></body><back><ref-list><ref id="B1"><label>1</label><element-citation publication-type="book"><collab>American Medical Association</collab><person-group person-group-type="editor"><name><surname>Cocch</surname><given-names>L</given-names></name><name><surname>Andersson</surname><given-names>GBJ</given-names></name></person-group><article-title>The lower extremities</article-title><source>The Guides to the Evaluation of Permanent Impairment</source><year>2001</year><edition>5th ed</edition><publisher-loc>Chicago, Ill</publisher-loc><publisher-name>American Medical Association</publisher-name><fpage>523</fpage><lpage>564</lpage></element-citation></ref><ref id="B2"><label>2</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>McBride</surname><given-names>ED</given-names></name></person-group><source>Disability evaluation and principles of treatment of compensable injuries</source><year>1963</year><edition>6th ed</edition><publisher-loc>Philadelphia</publisher-loc><publisher-name>JB Lippincott Co</publisher-name><fpage>68</fpage><lpage>103</lpage></element-citation></ref><ref id="B3"><label>3</label><element-citation publication-type="book"><collab>The Korean Orthopaedic Association</collab><source>Disability evaluation</source><year>2005</year><edition>1st ed</edition><publisher-loc>Seoul</publisher-loc><publisher-name>Seoul Medicine</publisher-name><fpage>93</fpage><lpage>118</lpage></element-citation></ref><ref id="B4"><label>4</label><element-citation publication-type="book"><collab>The Korean Neurosurgical Society</collab><source>Disability evaluation</source><year>2004</year><publisher-loc>Seoul</publisher-loc><publisher-name>ML Communication Co., Ltd</publisher-name><fpage>29</fpage><lpage>34</lpage></element-citation></ref><ref id="B5"><label>5</label><element-citation publication-type="book"><collab>Korean Academy of Rehabilitation Medicine</collab><source>Disability evaluation</source><year>2006</year><publisher-loc>Seoul</publisher-loc><publisher-name>ML Communication Co., Ltd</publisher-name><fpage>29</fpage><lpage>54</lpage></element-citation></ref><ref id="B6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sabharwal</surname><given-names>S</given-names></name><name><surname>Zhao</surname><given-names>C</given-names></name><name><surname>McKeon</surname><given-names>JJ</given-names></name><name><surname>McClemens</surname><given-names>E</given-names></name><name><surname>Edgar</surname><given-names>M</given-names></name><name><surname>Behrens</surname><given-names>F</given-names></name></person-group><article-title>Computed radiographic measurement of limb-length discrepancy. Full-length standing anteroposterior radiograph compared with scanogram</article-title><source>J Bone Joint Surg Am</source><year>2006</year><fpage>2243</fpage><lpage>2251</lpage><pub-id pub-id-type="pmid">17015603</pub-id></element-citation></ref><ref id="B7"><label>7</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Norkin</surname><given-names>CC</given-names></name><name><surname>White</surname><given-names>DJ</given-names></name></person-group><source>Measurement of joint motion: a guide to goniometry</source><year>2003</year><edition>3rd ed</edition><publisher-loc>Philadelphia</publisher-loc><publisher-name>F.A. Davis</publisher-name><fpage>183</fpage><lpage>292</lpage></element-citation></ref><ref id="B8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marshall</surname><given-names>JL</given-names></name><name><surname>Fetto</surname><given-names>JF</given-names></name><name><surname>Botero</surname><given-names>PM</given-names></name></person-group><article-title>Knee ligament injuries: a standardized evaluation method</article-title><source>Clin Orthop Relat Res</source><year>1977</year><fpage>115</fpage><lpage>129</lpage><pub-id pub-id-type="pmid">856512</pub-id></element-citation></ref><ref id="B9"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gross</surname><given-names>AE</given-names></name><name><surname>Lavoie</surname><given-names>MV</given-names></name><name><surname>McDermott</surname><given-names>P</given-names></name><name><surname>Marks</surname><given-names>P</given-names></name></person-group><article-title>The use of allograft bone in revision of total hip arthroplasty</article-title><source>Clin Orthop Relat Res</source><year>1985</year><fpage>115</fpage><lpage>122</lpage><pub-id pub-id-type="pmid">3893824</pub-id></element-citation></ref><ref id="B10"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Insall</surname><given-names>JN</given-names></name><name><surname>Dorr</surname><given-names>LD</given-names></name><name><surname>Scott</surname><given-names>RD</given-names></name><name><surname>Scott</surname><given-names>WN</given-names></name></person-group><article-title>Rationale of the Knee Society clinical rating system</article-title><source>Clin Orthop Relat Res</source><year>1989</year><fpage>13</fpage><lpage>14</lpage><pub-id pub-id-type="pmid">2805470</pub-id></element-citation></ref></ref-list></back><floats-group><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Methods used in evaluating impairments of the lower extremities</p></caption><graphic xlink:href="jkms-24-S299-i001"></graphic></table-wrap><table-wrap id="T2" position="float"><label>Table 1</label><caption><p>Impairment estimates for amputations</p></caption><graphic xlink:href="jkms-24-S299-i002"></graphic><table-wrap-foot><fn><p>MTP, metatarsophangeal.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Impairment due to leg length discrepancy</p></caption><graphic xlink:href="jkms-24-S299-i003"></graphic></table-wrap><table-wrap id="T4" position="float"><label>Table 4</label><caption><p>Impairment due to hip ankylosis</p></caption><graphic xlink:href="jkms-24-S299-i004"></graphic></table-wrap><table-wrap id="T5" position="float"><label>Table 5</label><caption><p>Impairment due to knee ankylosis</p></caption><graphic xlink:href="jkms-24-S299-i005"></graphic></table-wrap><table-wrap id="T6" position="float"><label>Table 6</label><caption><p>Impairment due to ankle ankylosis</p></caption><graphic xlink:href="jkms-24-S299-i006"></graphic></table-wrap><table-wrap id="T7" position="float"><label>Table 7</label><caption><p>Impairment due to toe ankylosis</p></caption><graphic xlink:href="jkms-24-S299-i007"></graphic></table-wrap><table-wrap id="T8" position="float"><label>Table 8</label><caption><p>Hip motion impairment</p></caption><graphic xlink:href="jkms-24-S299-i008"></graphic></table-wrap><table-wrap id="T9" position="float"><label>Table 9</label><caption><p>Knee impairment</p></caption><graphic xlink:href="jkms-24-S299-i009"></graphic></table-wrap><table-wrap id="T10" position="float"><label>Table 10</label><caption><p>Ankle motion impairment</p></caption><graphic xlink:href="jkms-24-S299-i010"></graphic></table-wrap><table-wrap id="T11" position="float"><label>Table 11</label><caption><p>Hindfoot impairment</p></caption><graphic xlink:href="jkms-24-S299-i011"></graphic></table-wrap><table-wrap id="T12" position="float"><label>Table 12</label><caption><p>Forefoot impairment</p></caption><graphic xlink:href="jkms-24-S299-i012"></graphic></table-wrap><table-wrap id="T13" position="float"><label>Table 13</label><caption><p>Toe impairment</p></caption><graphic xlink:href="jkms-24-S299-i013"></graphic></table-wrap><table-wrap id="T14" position="float"><label>Table 14</label><caption><p>Impairment due to lower extremity muscle weakness</p></caption><graphic xlink:href="jkms-24-S299-i014"></graphic></table-wrap><table-wrap id="T15" position="float"><label>Table 15</label><caption><p>Impairment estimate for the hip lesion</p></caption><graphic xlink:href="jkms-24-S299-i015"></graphic><table-wrap-foot><fn><p>ROM, range of motion.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T16" position="float"><label>Table 16</label><caption><p>Impairment estimate for the knee lesion</p></caption><graphic xlink:href="jkms-24-S299-i016"></graphic></table-wrap><table-wrap id="T17" position="float"><label>Table 17</label><caption><p>Impairment estimate for the ankle and foot lesion</p></caption><graphic xlink:href="jkms-24-S299-i017"></graphic><table-wrap-foot><fn><p>MRI, magnetic resonance imaging.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T18" position="float"><label>Table 18</label><caption><p>Impairment estimate for the hip and knee joint replacement</p></caption><graphic xlink:href="jkms-24-S299-i018"></graphic></table-wrap><table-wrap id="T19" position="float"><label>Table 19</label><caption><p>Rating hip replacement results<sup>*</sup></p></caption><graphic xlink:href="jkms-24-S299-i019"></graphic><table-wrap-foot><fn><p><sup>*</sup>Add the points from categories a, b, c, d, and e to determine the total scores which represent the result of replacement. Modified from Gross AE, Lavoie MV, McDermott P, Marks P. The use of allograft bone in revision of total hip arthroplasty. Clin Orthop Relat Res 1985; 115-22.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T20" position="float"><label>Table 20</label><caption><p>Rating knee replacement results<sup>*</sup></p></caption><graphic xlink:href="jkms-24-S299-i020"></graphic><table-wrap-foot><fn><p><sup>*</sup>The point total for estimating knee replacement results is the sum of the points in categories a, b, and c minus the sum of the points in categories d, e, and f. Modified from Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; 13-4.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T21" position="float"><label>Table 21</label><caption><p>Impairment estimate for ankle joint replacement</p></caption><graphic xlink:href="jkms-24-S299-i021"></graphic></table-wrap><table-wrap id="T22" position="float"><label>Table 22</label><caption><p>Lower extremity impairment due to peripheral vascular disease</p></caption><graphic xlink:href="jkms-24-S299-i022"></graphic></table-wrap><table-wrap id="T23" position="float"><label>Table 23</label><caption><p>Impairment for skin loss</p></caption><graphic xlink:href="jkms-24-S299-i023"></graphic></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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