Joint Replacement Selection Clinical Score - Medical Algorithm

Description

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

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Description

Objective

ICD-10

New Zealand Priority Score for Major Joint Replacement

Purpose: To determine the clinical score used to prioritize major joint replacement surgery in New Zealand in 1997.

Description

Objective

ICD-10