International Classification of Functioning, Disability and Health (ICF)

KNR 365

WHO

•Who is WHO?▫World Health Organization

▫United Nations’ agency

▫Established in 1948

▫Objective is attainment by all peoples of the highest level of health (not just absence of disease)

WHO Family of International Classifications•International Classification of Diseases

(ICD-10) Codes diagnoses and mortality causes

•International Classification of Functioning, Disability and Health (ICF)

Classification system of functioning Over 1,400 classifications

•International Classification of Health Intervention (ICHI)

Currently being developed Different professions developed own (our

text)

International Classification of Functioning, Disability and Health (ICF)

•Provides standard language & framework for description of health & disability▫Across disciplines, service delivery

settings, countries, disabilities

•TR will need to learn the content & language of ICF to talk/work with other professions▫Interventions▫Outcomes

ICF

•1st version was 1980▫Focused on impairment, disability &

handicap

•Revised in 2001▫Focuses on health & functioning vs.

disability▫Endorsed by 191 nations including US▫Endorsed by PT, OT, TR and other

healthcare organization

ICF

•Classification of health and health-related domains, that help to describe:

▫Changes in body function and structure▫What a person can do in a standard

environment (level of capacity)▫What a person can do in their usual

environment (level of performance)

ICF Applications (Individual level)• For the assessment of individuals: What is the person's

level of functioning?• For individual treatment planning: What treatments

or interventions can maximizefunctioning?

• For the evaluation of treatment and other interventions: What are the outcomes of the treatment? How useful were the interventions?

• For communication among physicians, nurses, physiotherapists, and other health works, social service works and community agencies

• For self-evaluation by consumers: How would I rate my capacity in mobility or communication?

Conceptual Models of Disability

•What is the Medical Model?

▫Views disability as feature of person▫Disability is directly caused by disease,

trauma, or other health conditions▫Requires medical care provided by

professionals▫Call for medical treatment or intervention

to “correct” the problem

Conceptual Models of Disability

•What is the Social Model?

▫Views disability as a socially created problem

▫It is not just an attribute of a person▫Disability demands a political response▫Problems are created by unaccommodating

physical environment brought about by attitudes & other features of the social environment

Conceptual Models of Disability

•What is the Biopsychosocial Model?

▫ICF based on this model▫Integration of medical & social models▫Disability and function viewed as outcomes

of interaction between health conditions (disease, disorders, injuries) and contextual factors

Conceptual Models of Disability

•Contextual factors▫External environmental factors

Social attitudes, architectural barriers, legal & social structures, climate, etc.

▫Internal personal factors Gender, age, coping skills, social background,

education, past & present experiences, etc. Factors that influence how disability is

experienced by the individual

Biopsychosocial Model: ICF Interactions

Key ICF Definitions• Body functions: physiological functions of body

systems• Body structures: anatomical parts of the body• Impairments: problems in body function or

structure• Activity: execution of a task or action• Participation: involvement in a life situation• Participation restrictions: problems in

involvement in life situations• Environmental factors: make up the physical,

social and attitudinal environment in which people live.

Conceptual Model of ICF

Part 1. Functioning and Disability(a) Body Functions and Structures

- Changes in body functions (physiological)

- Changes on body structures (anatomical)(b) Activities and Participation

- Capacity: Executing tasks in a standard environment

- Performance: Executing tasks in the current environment

Conceptual Model of ICF

Part 2. Contextual Factors(c) Environmental factors

- Facilitating or hindering impact of features of the physical, social, and attitudinal world

(d) Personal factors- Impact of attributes of person

See Porter & burlingame, p. 4

Body Functions (b – many TR scope)(relates to function in isolation)

• Mental functions• Sensory functions and pain• Voice and speech functions• Functions of cardiovascular, hematological,

immunological and respiratory systems• Functions of the digestive, metabolic and

endocrine systems• Genitourinary and reproductive functions• Neuromusculoskeletal and movement related

functions• Functions of skin and related structures

Body Structures (s – doctor score)• Structures of the nervous system• Eye, ear and related structures• Structures involved in voice and speech• Structures of the cardiovascular,

immunological and respiratory systems• Structures related to the digestive, metabolic

and endocrine systems• Structures related to the genitourinary and

reproductive system• Structures related to movement• Skin and related structures

Activities and Participation (d – TR scope)(relates to ability to do an activity)

•Learning and applying knowledge•General tasks and demands•Communication•Mobility•Self-care•Domestic life•Interpersonal interactions and

relationships•Major life areas•Community, social and civic life

Environmental Factors (e – TR scope)

•Products and technology•Natural environment and human-made

changes to environment•Support and relationships•Attitudes•Services, systems and policies

Personal Factors

•Not coded in ICF because of wide international variability

•Still included because of importance to understanding functioning & disability

Age Race

Gender Food preferences

Race Fitness

Lifestyle Habits

Upbringing Coping styles

Education Social background

ICF Coding ExampleLevel Example Coding

Chapter Chapter 2: Sensory Functions and Pain

b2

2nd level Seeing Functions b210

3rd level Quality of vision b2102

4th level Colour vision b21021

ICF Qualifiers

•ICF domain becomes a classification when qualifiers are used▫Qualifiers record presence and severity of a

problem in functioning at the body, person, and societal levels

▫1 or 2 qualifiers may apply per ICF domain

ICF Qualifiers (cont.)Scale Descriptor %

0 No problem (none, absent, negligible) 0-4

1 Mild problem (slight, low) 2-24

2 Moderate (medium, fair) 25-49

3 Severe (high, extreme) 50-95

4 Complete (total) 96-100

ICF Qualifiers (cont.)Construct First Qualifier Second Qualifier

Body Functions (b) Generic qualifier with the negativescale used to indicate the extent ormagnitude of an impairmentExample: b167.3 to indicate a severeimpairment in specific mental functions oflanguage

None

ICF Qualifiers (cont.)Construct First Qualifier Second Qualifier

Body Structure (s) Generic qualifier with the negativescale used to indicate the extent ormagnitude of an impairmentExample: s730.3 to indicate a severeimpairment of the upper extremity

Used to indicate the nature of thechange in the respective body structure0 no change in structure1 total absence2 partial absence3 additional part4 aberrant dimensions5 discontinuity6 deviating position7 qualitative changes in structure,including accumulation of fluid8 not specified9 not applicableExample: s7300.32 to indicate the partialabsence of the upper extremity

ICF Qualifiers (cont.)Construct First Qualifier Second qualifier

Activity & Participation (d)

PERFORMANCEGeneric qualifierProblem in the person's currentenvironmentExample: d5101.1_ to indicate mild difficultywith bathing the whole body with the use ofassistive devices that are available to theperson in his or her current environment

CAPACITYGeneric qualifierLimitation without assistanceExample: d5101._2 to indicate moderate difficultywith bathing the whole body and implies thatthere is moderate difficulty without the use of assistive devices or personal help

ICF Qualifiers (cont.)Construct First Qualifier Second Qualifier

Environmental Factors (e)

Generic qualifier, with negative and positive scale to denote extent ofbarriers and facilitators respectivelyExample: e130.2 to indicate that products foreducation are a moderate barrier.Conversely, e130+2 would indicate thatproducts for education are a moderatefacilitator

None

ICF Core Sets

•Brain injury rehabilitation•Breast cancer•Cardiopulmonary conditions•Depression•Multiple Sclerosis•Stroke

▫Etc.

•Also ICF-CY (children)

ICF TR Resources• Howard, D., Browning, C., & Lee, Y. (2007). The

International Classification of Functioning, Disability, and Health: Therapeutic recreation code sets and salient diagnostic core sets. Therapeutic Recreation Journal, 41(1), 61-81.

• Porter, H. R., & VanPuymbroeck, M. (2007). Utilization of the International Classification of Functioning, Disability, and Health within therapeutic recreation practice. Therapeutic Recreation Journal, 41(1), 47-60.