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The International Classification of Functioning, Disability and Health (ICF), published by the World Health Organization in 2001, is introduced. Its history, purposes, terminology, structure and its complementary relation to ICD-10 is described.
With the approval of the International Classification of Functioning, Disability and Health by the World Health Assembly in May 2001, the concurrent use of both health-status measures and the International Classification of Functioning, Disability and Health is expected. It is therefore important to understand the relationship between these two concepts. The objective of this paper is to provide a systematic and standardized approach when linking health-status measures to the International Classification of Functioning, Disability and Health. The specific aims are to develop rules, to test their reliability and to illustrate these rules with examples. Ten linking rules and an example of their use are presented in this paper. The percentage agreement between two health professionals for 8 health-status instruments tested is also presented. A high level of agreement between the health professionals reflects that the linking rules established in this study allow the sound linking of items from health-status measures to the International Classification of Functioning, Disability and Health.
OBJECTIVE: The International Classification of Functioning, Disability and Health (ICF) aims to classify functioning and health by a number of categories divided over 3 components: body functions and body structures, participation and activities, and environmental factors. We identified the common health problems of patients with ankylosing spondylitis (AS) based on the ICF from the perspective of the patient. METHODS: During structured interviews with the extended ICF checklist, trained assessors collected data from 111 patients with AS. ICF categories identified by more than 5% of the patients as at least mildly impaired or restricted were selected. Categories identified by less than 5% were removed. Additional impairments/restrictions reported by more than 5% of the patients, after the structured interviews and not yet included in the checklist, were added. RESULTS: One hundred nineteen (72%) out of 165 categories of the extended ICF checklist were identified to be at least mildly impaired or restricted. Within each of the 4 components of the ICF, at least one-third of the categories were impaired or restricted for more than 50% of the patients. Thirty-nine (33%) categories were related to movement and mobility. Within the component "environmental factors" the categories "support of immediate family" and "health professionals" were the most important facilitators, "climate" was the most important barrier. Eight impairments were additionally mentioned as relevant. These were hierarchically lower levels of ICF categories previously included and they were added. CONCLUSION: One hundred twenty-seven ICF categories represent the comprehensive classification of functioning in AS from the patients' perspective. The results underscore the need to address the 4 ICF components when classifying functioning and to emphasize that functioning implies more than physical functioning.
OBJECTIVE: The International Classification of Functioning, Disability and Health (ICF) is used increasingly to describe and classify functioning in medicine without being a psychometrically sound measure. All categories of the ICF are quantified using the same generic 0-4 scale. The objective of this study was to assess observer agreement when describing and classifying functioning with the ICF. DESIGN: A second-level category of the ICF, d430 lifting and carrying objects, was used as an example. To the qualifiers of this category, clinically meaningful definitions were assigned. Data were collected in a cross-sectional survey with repeated measurement. We report raw, specific and chance-corrected measures or agreement, a graphical method and the results of log-linear models for ordinal agreement. SUBJECTS/PATIENTS: A convenience sample of patients requiring physical therapy in an acute hospital. RESULTS: Twenty-five patients were assessed twice by 2 observers. Raw agreement was 0.52. Kappa was 0.36, indicating fair agreement. Different hierarchical log-linear models indicated that the strength of agreement was not homogeneous over all categories. CONCLUSION: Observer agreement has to be evaluated when describing and classifying functioning using the ICF Qualifiers'scale. When assessing inter-observer reliability, the first step is to calculate a summary statistic. Modelling agreement yields valuable insight into the structure of a contingency table, which can lead to further improvement of the scale.
OBJECTIVE: The International Classification of Functioning, Disability, and Health (ICF) is designed to provide a common language and framework for describing health and health-related states. The goal of this research was to investigate human and automated coding of functional status information using the ICF framework. DESIGN: The authors extended an existing natural language processing (NLP) system to encode rehabilitation discharge summaries according to the ICF. MEASUREMENTS: The authors conducted a formal evaluation, comparing the coding performed by expert coders, non-expert coders, and the NLP system. RESULTS: Automated coding can be used to assign codes using the ICF, with results similar to those obtained by human coders, at least for the selection of ICF code and assignment of the performance qualifier. Coders achieved high agreement on ICF code assignment. CONCLUSION: This research is a key next step in the development of the ICF as a sensitive and universal classification of functional status information. It is worthwhile to continue to investigate automated ICF coding.
The way we think about health and disease determines to a considerable extent what we do and say in our clinical encounters with patients. The recent publication and promotion of the World Health Organization's International Classification of Function, Health, and Disability (known as the ICF) represents an exciting new way to consider health and disease. In the context of children and youth with cerebral palsy, this model offers many heretofore ignored "point of entry" for counselling and intervention with these conditions. This model also provides many possibilities to explore research questions with a fresh approach. This article outlines the ICF model and discusses these opportunities.
The International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) provides an international and interprofessional scientific basis for understanding and studying health. The concept of participation plays an important role in the classification and has become a central construct in health care, rehabilitation, and in occupational therapy. The aim of this paper is to provide a critical analysis of the concept of participation in the ICF. As background, the origins and current presentation of the ICF are presented. The use and function of the ICF and the contemporary discussions regarding the classification are reviewed. An occupational perspective on participation in the ICF reveals major shortcomings regarding the subjective experience of meaning and autonomy. Furthermore, the ICF has limitations in capturing different kinds of participation in a single life situation. Following these analyses we discuss the advantages and shortcomings of using the ICF, and how an occupational perspective can contribute to an ongoing discussion about the development of the ICF.
The degree of agreement between a clinical multi-professional work-capacity assessment and the Comprehensive World Health Organisation International Classification of Functioning, Disability and Health (ICF) Core Sets for chronic pain and risk factors for no return to work was investigated. A review of data records and interviews with team members included measures of body function/structure, activities/participation and environmental factors. Predictors for return to work were reviewed. The team used eight different methods for data collection. Of the 29 categories concerning environmental factors, two were excluded; the methods used were more unstructured, e.g. interviews. The agreement with the 41 predictors of work resumption was high. The clinical work-capacity assessment agreed largely with the Comprehensive ICF Core Sets for the components body function, body structure, activities and participation. Nine categories out of 69 were not included. The clinical work-capacity assessment agreed largely with the Comprehensive ICF Core Sets for chronic pain conditions and with 40 predictors of work resumption. Clinically speaking, however, the current work-capacity assessment lacks on-the-job site evaluations and this most certainly affects reliability. The same is true for ICF, although the structure lacks proper coding for relevant factors found at work.
UNLABELLED: This article describes a typical, yet fictionalized woman with Alzheimer's disease during her first week at a nursing home. Readers are challenged to ask themselves in what areas of difficulty a speech-language pathologist may or may not be able to contribute to the success of this resident. The authors use the World Health Organization's International Classification of Functioning, Disability, and Health [International Classification of Functioning, Disability, and Health, 2001, Geneva, Switzerland] as the framework for assessments and the resident-centered interventions for this case study. LEARNING OUTCOMES: 1. The reader will be able to identify the four main constructs of the ICF classification system. 2. The reader will be able to identify three environmental factors that may influence the functioning of a person with Alzheimer's disease. 3. The reader will be able to discuss at least four interventions that can be implemented by a speech-language pathologist to improve a nursing home resident's participation in daily activities.
The International Classification of Functioning, Disability and Health-ICF addresses the broad need for a common language and classification of functioning and disability. A parallel need is appropriate measures compatible with the content of the ICF to document the nature and impact of limitations of function, activities and participation. The interaction of developmental characteristics and disability among children represent special challenges for classification as well as measurement. Demographic trends emphasize the need for universal measures that encompass the components of the ICF and can be used in surveillance, screening and evaluation. This paper identifies issues related to application of the ICF to measure disability in childhood; reviews approaches and tools to assess childhood disability and identifies priorities for the development of measures of functioning and disability in children based on the ICF. The development of measures should be framed within a framework of children's rights and application of the biopsychosocial model to document profiles of functioning and disability of children.
AIM: This paper reports a study to explore systematically the usefulness of the International Classification of Functioning, Disability and Health to nurses giving patient care. BACKGROUND: The International Classification of Functioning, Disability and Health has a history of more than 20 years. Although this World Health Organization classification offers multidisciplinary use, nurses are not familiar with it. METHODS: Applications of the International Classification for nursing practice were developed and evaluated in a multi-centre project, composed of a series of 10 projects in a variety of settings. These applications were a variety of tools, such as assessment forms, care plans and transfer forms. The study used information from 653 patients, 469 nurses and 178 others (International Classification experts; other professionals with whom nurses communicate or discuss patient data). FINDINGS: Large sections of the International Classification were used in the 10 projects, revealing a predominant focus on body functions (53% of all three-digit codes and corresponding terms used). Although large sections of the Classification were useful in practice applications, some items were identified that could be added, improved or described with more detail. Positive remarks made by nurses referred to the scope of the International Classification, which encouraged assessing beyond a patient's functional impairments. CONCLUSIONS: The International Classification of Functioning, Disability and Health can be a useful tool in classifying and communicating aspects of patient functioning by nurses. A level of moderate detail within the Classification (three-digit level) seems appropriate for most nursing purposes. Our results on items that could be added or improved can serve as input in future revisions of the Classification. Future use of the International Classification should be encouraged, because of its relevance to nursing and its potential for multidisciplinary use in patient care.
The recently endorsed World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) is proposed as a new tool to describe human functioning and health in a multiprofessional approach for individuals of all ages. Its application to paediatric neurorehabilitation may be of great help, especially in children with complex disabilities. However, experience with its application in this field is still limited. We tested the application of ICF in 40 children (26 males, 14 females; age range 3 to 18 years; mean age 11 years 1 month, SD 5 years 3 months) with various types and degrees of disability. We tested the applicability and reliability of the classification, and studied its correlation with well-established measures of functioning (Verbal IQ; gross motor function measure; functional independence measure). The ICF proved to be applicable and reliable, and strongly correlated with established scales. However, several of the Activity and Participation components do not fully capture the developmental nature of many abilities of children. Our study, although acknowledging the universal application of the ICF, and the ICF's value as a clinical tool, calls for its specific adaptation to accommodate better the peculiarities of child functioning and disability.
OBJECTIVE: To compare the content covered by twelve obesity-specific health status measures using the International Classification of Functioning, Disability and Health (ICF). DESIGN: Obesity-specific health status measures were identified and then linked to the ICF separately by two trained health professionals according to standardized guidelines. The degree of agreement between health professionals was calculated by means of the kappa (kappa) statistic. Bootstrapped confidence intervals (CI) were calculated. The obesity-specific health-status measures were compared on the component and category level of the ICF. MEASUREMENTS: welve condition-specific health-status measures were identified and included in this study, namely the obesity-related problem scale, the obesity eating problems scale, the obesity-related coping and obesity-related distress questionnaire, the impact of weight on quality of life questionnaire (short version), the health-related quality of life questionnaire, the obesity adjustment survey (short form), the short specific quality of life scale, the obesity-related well-being questionnaire, the bariatric analysis and reporting outcome system, the bariatric quality of life index, the obesity and weight loss quality of life questionnaire and the weight-related symptom measure. RESULTS: In the 280 items of the eight measures, a total of 413 concepts were identified and linked to the 87 different ICF categories. The measures varied strongly in the number of concepts contained and the number of ICF categories used to map these concepts. Items on body functions varied form 12% in the obesity-related problem scale to 95% in the weight-related symptom measure. The estimated kappa coefficients ranged between 0.79 (CI: 0.72, 0.86) at the component ICFs level and 0.97 (CI: 0.93, 1.0) at the third ICF's level. CONCLUSION: The ICF proved highly useful for the content comparison of obesity-specific health-status measures. The results may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies in obesity.
This paper provides an introduction to the content and concepts of the World Health Organization's new International Classification of Functioning, Disability and Health (2001) and discusses its potential applications in rehabilitation services and research. Great interest has been expressed in the International Classification of Functioning, Disability and Health by its potential users and there is growing evidence that its conceptual framework is consistent with the understanding of functioning both for professionals and for people with disabilities.
A shared language and conceptual framework is essential to successful interprofessional collaboration. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides a shared language and conceptual framework that transcends traditional disciplinary boundaries. This paper will familiarize readers with the ICF and describe the biopsychosocial perspective that is adopted in its conceptual framework and language. The presentation of a case study will illustrate how the ICF can enhance interprofessional learning by promoting a multidimensional perspective of an individual's health concerns. The case study will also highlight the value of the shared language and conceptual framework of the ICF for interprofessional collaboration. It is argued that a strong foundation in the principles exemplified by the ICF may serve to enhance interprofessional communication, and in so doing, encourage involvement in interprofessional collaboration and healthcare.
The paper describes and evaluates the theoretical underpinnings of the International Classification of Functioning, Disability and Health (ICF), and develops the proposition that its conceptual framework provides a coherent, if uneven, guide through the competing conceptions of disability. To date, however, there has been little evaluation of the theoretical efficacy of the ICF. In seeking to redress this, the paper develops the argument that the ICF fails to specify, in any detail, the content of some of its main claims about the nature of impairment and disability. This has the potential to limit its capacity to educate and influence users about the relational nature of disability. The paper develops the contention that three parts of the ICF require further conceptual clarification and development: (a) (re)defining the nature of impairment; (b) specifying the content of biopsychosocial theory; and (c) clarifying the meaning and implications of universalisation as a principle for guiding the development of disability policies.
OBJECTIVES: To identify the most common health problems experienced by patients with acute inflammatory arthritis using the International Classification of Functioning, Disability and Health (ICF), and to provide empirical data for the development of an ICF Core Set for acute inflammatory arthritis. METHODS: Cross-sectional survey of patients with acute inflammatory arthritis of two or more joints requiring admission to an acute hospital. The second level categories of the ICF were used to collect information on patients' health problems. Relative frequencies of impairments, limitations and restrictions in the study population were reported for the ICF components Body Functions, Body Structures, and Activities and Participations. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported. RESULTS: In total, 130 patients were included in the survey. The mean age of the population was 59.9 years (median age 63.0 years), 75% of the patients were female. Most had rheumatoid arthritis (57%) or early inflammatory polyarthritis (22%). Fifty-four second-level ICF categories had a prevalence of 30% or more: 3 (8%) belonged to the component Body Structures and 10 (13%) to the component Body Functions. Most categories were identified in the components Activities and Participation (19; 23%) and Environmental Factors (22; 56%). CONCLUSION: Patients with acute inflammatory arthritis can be well described by ICF categories and components. This study is the first step towards the development of an ICF Core Set for patients with acute inflammatory arthritis.
BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF), a classification system published in 2001 by the World Health Organization (WHO), provides a common language and framework for describing functional status information (FSI) in health records. METHODS: Informed by ongoing research in coding FSI in patient records, this paper qualitatively assesses the ICF framework with respect to the desiderata for controlled medical vocabularies, an enumerated a list of desirable qualities for controlled medical vocabularies proposed by Cimino [J.J. Cimino, Desiderata for controlled medical vocabularies in the twenty-first century, Meth. Inform. Med. 37 (1998) 394-403]. RESULTS: The ICF satisfies 5 of the 12 desiderata. Five points were not satisfied and two points could not be evaluated. CONCLUSION: The ICF is a rich source of relevant terms, concepts, and relationships, but it was not developed in consideration of requirements for formal terminologies. Therefore, it could serve as a base from which to develop a formal terminology of functioning and disability. This assessment is a key next step in the development of the ICF as a sensitive, universal measure of functional status.