A clinical score is used to prioritize major joint replacement for patients in New Zealand. This is hoped to achieve better care and accountability in a publicly funded health care system.
Overview of Questionnaire
Clinical Feature in Affected Joint |
Parameter Assessed |
Percent of Total Score |
---|---|---|
pain |
degree of pain |
20% |
|
occurrence of pain |
20% |
functional activity |
time walked |
10% |
|
other functional limitations |
10% |
movement and deformity |
pain on examination |
10% |
|
other abnormal findings |
10% |
other factors |
multiple joint disease |
10% |
|
ability to work, give care to dependents, live independently |
10% |
where:
• The degree of pain is assigned while the patient is on maximum medical therapy.
• Other functional limitations includes putting on shoes, managing stairs, sitting to standing, sexual activity, recreation or hobbies, and need for walking aids.
• Pain on examination is the overall results for both active and passive range of motion.
• Other abnormal findings is limited to orthopedic problems such as reduced range of motion, deformity, limp, instability, and progressive X-ray findings.
• Ability to work, etc. is that which can be ascribed to the affected joint.
Parameter |
Finding |
Points |
---|---|---|
degree of pain |
none |
0 |
|
mild (slight or occasional pain; patient has not altered patterns of activity or work) |
4 |
|
mild-moderate (moderate or frequent pain; patient has not altered patterns of activity or work) |
6 |
|
moderate (patient is active but has had to modify or give up some activities because of pain) |
9 |
|
moderate-severe (fairly severe pain with substantially limited activities) |
14 |
|
severe (major pain and serious limitation) |
20 |
occurrence of pain |
none or with first steps only |
0 |
|
only after long walks (30 minutes) |
4 |
|
with all walking, mostly day pain |
10 |
|
significant, regular night pain |
20 |
time walked |
unlimited |
0 |
|
31 - 60 minutes |
2 |
|
11 - 30 minutes |
4 |
|
2 - 10 minutes |
6 |
|
< 2 minutes or indoors only |
8 |
|
unable to walk |
10 |
other functional limitations |
none |
0 |
|
mild |
2 |
|
moderate |
4 |
|
severe |
10 |
pain on examination |
none |
0 |
|
mild |
2 |
|
moderate |
5 |
|
severe |
10 |
other abnormal findings |
none |
0 |
|
mild |
2 |
|
moderate |
5 |
|
severe |
10 |
multiple joint disease |
no, only single joint affected |
0 |
|
yes, each affected joint is mild-to-moderate in severity |
4 |
|
yes, severe involvement |
10 |
ability to work, give care to dependents, live independently |
not threatened or difficult |
0 |
|
not threatened but more difficult |
4 |
|
threatened but not immediately |
6 |
|
immediately threatened |
10 |
priority score =
= SUM(points for 8 parameters)
Interpretation:
• minimum score = 0
• maximum score = 100
Purpose: To determine the clinical score used to prioritize major joint replacement surgery in New Zealand in 1997.
Objective: selection
ICD-10: M15-M19,