Application of the ICF to referral delay in total joint arthroplasty

Diane Dixon, Beth Pollard, David Rowley, Marie Johnson

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


The factors that affect referral for total joint arthroplasty (TJA) have been widely studied. Implicit in this work is the assumption that patient health status should determine priority for surgery. However, specification of patient health status lacks a strong theoretical framework. This study employs the WHO model of health outcomes, the International Classification of Functioning, Disability and Health (ICF), to examine patient health factors in the referral process for TJA.
Within 8 weeks prior to TJA, 260 patients electing for primary TJA completed a questionnaire which measured the ICF (impairment, activity limitations and participation restrictions) and four types of delay in their journey from initial consultation with their primary care physician to surgery.
Impairment did not affect any stage of the referral process. In contrast, patients who had experienced a delay of 26 weeks or less between referral to a surgeon and being placed on the waiting list for surgery reported greater activity limitations and participation restrictions than patients who had waited more than 26 weeks. Further, patients who reported having wanted surgery for more than 52 weeks reported greater participation restrictions than patients who had wanted surgery for less than 52 weeks.
The ICF identifies three health outcomes, two of which (activity limitations and participation restrictions) are related to delay in the referral process for TJA. The ICF is a useful theoretical framework for the study of factors that influence prioritisation for surgery. The level of functional and social disability appears to inform prioritisation for TJA by consultant orthopaedic surgeons.

Original languageEnglish
Article numbere23
Number of pages3
JournalQuality and Safety in Health Care
Issue number6
Early online date27 Jun 2010
Publication statusPublished - Dec 2010


  • clinically important differences
  • quality of life
  • knee replacement
  • total hip
  • priority
  • surgery
  • osteoarthritis
  • instruments
  • validation
  • equity


Dive into the research topics of 'Application of the ICF to referral delay in total joint arthroplasty'. Together they form a unique fingerprint.

Cite this