People with Disabilities Often Overlooked in Orthopedic Research

More than one in four adults in the United States have some type of disability as of 2026, according to the Centers for Disease Control and Prevention. A Yale study published in the Cureus Journal of Medical Science found that patients with disabilities are almost entirely unrepresented in orthopedic research.

"When we look at how healthcare disparities are studied, we see a lot of excellent work tracking how race or insurance status affects patient outcomes," says David Frumberg, MD, an associate professor in the Department of Orthopedics & Rehabilitation at Yale School of Medicine and the principal investigator of the study. "But disability is routinely left out of the equation. Physicians typically treat disabilities as a medical condition to be managed rather than a distinct demographic that faces barriers."

To uncover the depth of this issue, Frumberg and his team evaluated five years of data from the top 20 American orthopedic journals. They analyzed 124 studies that examined disparities and focused on underserved populations.

While nearly half of the studies looked at how race or financial status affected a patient's care, only 5%, or just six studies out of 124, looked at disability.

The lack of research highlights a flaw in how medical data are collected, according to Frumberg.

Most large-scale medical studies rely on administrative claims and registries, which are massive databases used by insurance companies and hospitals to track patient care. These databases are excellent at recording a patient's age, race, or zip code. However, they rarely have a specific, standardized checkbox for people with a physical or cognitive disability.

Instead, researchers look at what are called proxy variables. These are indirect clues, such as whether a patient can walk independently, used to subjectively decide if a disability is present. This often leads to misclassifications, making it incredibly difficult to determine what these patients experience.

Frumberg says the medical community has traditionally viewed a disability simply as a comorbidity. In healthcare terms, a comorbidity is a medical condition a patient has, such as high blood pressure or diabetes. Because disability is viewed this way, researchers often use statistical tools to adjust for it, effectively erasing the disability from the results so it does not skew the data for the rest of the population.

"By treating disability merely as a background medical condition to smooth out during data analysis, we miss the human element entirely," Frumberg explains. "A person with a disability doesn't just have a different medical profile. They navigate a completely different physical and social world. If orthopedic research ignores that, clinicians will too."

This omission in clinical research has serious implications. Musculoskeletal conditions like severe arthritis or broken bones account for more than half of all disabling conditions reported by American adults. This means people who already live with disabilities are highly likely to need an orthopedic surgeon at some point in their lives.

When they do need care, the hurdles are physical, financial, and institutional. Patients with disabilities frequently encounter physical barriers, such as examination tables that do not lower or diagnostic imaging machines that cannot accommodate a wheelchair.

Beyond the physical architecture, there are also invisible barriers. Communication gaps between doctors and patients with intellectual disabilities can lead to misunderstandings about surgery risks. Additionally, healthcare providers may make assumptions about a patient’s quality of life, or even their ability to recover from a major operation.

“The goal of identifying these gaps is to spark systemic change,” Frumberg adds. By way of this study, he and his team argue that the orthopedic community must intentionally redesign how it approaches medical research.

To address this, he believes national medical databases need to start tracking both functional status and disability explicitly. When hospitals design surgical wards and rehabilitation centers, they must move towards inclusive design principles by creating spaces that are naturally accessible to everyone, rather than trying to adapt a traditional space as an afterthought.

Recognizing disability as a major health disparity domain is the first step toward aligning modern medicine with the legal and ethical goals of the Americans with Disabilities Act, believes Frumberg.

"We need a fundamental shift in our research priorities," Frumberg emphasizes. "True equity in orthopedic surgery means ensuring that our innovations and treatments are accessible to everyone. We unfortunately cannot fix the barriers we refuse to measure."