Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities

Many health professionals have expressed difficulty finding ways to keep people with disabilities engaged in community-based physical activity/rehabilitation programs. A major reason for this low adherence may be that the recommended intervention plan does not match well with the specific needs of the individual. Various personal and/or environmental factors along with the person's level of functioning can impede participation in healthful physical activity/rehabilitation. The International Classification of Functioning, Disability and Health (ICF) can be a useful tool for identifying key factors associated with participation in community-based physical activity/rehabilitation. The ICF allows health professionals to identify the level of functioning at the body, person and societal level, as well as understand the person-environment contextual factors that may impede or enhance participation. This paper describes how the ICF can assist health professionals in identifying a broader constellation of factors when prescribing physical activity/rehabilitation programs for persons with varying levels of disability.     

The international classification of functioning, disability and health and its application to cognitive disorders

PURPOSE: This paper describes the conceptual foundation and systematic framework of the International Classification of Functioning, Disability, and Health (ICF) as a mechanism for understanding the course and consequences of various health related states. The specific application of the ICF with persons with cognitive dysfunction is also presented. METHOD: A comprehensive literature review related to the conceptualization of the ICF, its classification scheme and coding process is presented. Information on cognitive disorders including prevalence, functional manifestations and the assessment of a person's cognitive functioning and the applicability of the ICF's holistic classification and coding of cognitive dysfunction within the components of body structure and function, activity and participation, and environmental attributes is also reviewed. CONCLUSION: The ICF has the potential to classify and interpret cognitive deficits on a global level and thereby reflects upon the overall health and functioning of the individual in major life activities. The coding system systematically organizes measures related to the person's cognitive status and the resulting functional outcomes. The ICF focuses on individuals' performance of activities in all aspects of life and validates the independence and well-being of persons with disabilities making it an important instrument to be used by rehabilitation professionals.     

The International Classification of Functioning Disability and Health: its development process and content validity

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) has provided a new foundation for our understanding of health, functioning, and disability. However, different challenges have to be addressed during its implementation process. The objective of this paper is to address two of these challenges, namely, the study of the content validity of the ICF and its relationship to other health-related concepts such as well-being, quality of life (QoL) and health-related quality of life (HRQoL). Ongoing validation studies confirm that the ICF is an exhaustive classification, i.e. it covers most of the health and health-related domains that make up the human experience of functioning and disability, and the most environmental factors that influence that experience of functioning and disability. The ICF also contributes to the understanding of health on a continuum ranging from a body-centred view ('the bodily experience of health'), to a more comprehensive perspective ('the entire health experience'), and finally, to an overarching view ('the human experience') which sees health as part of the human condition. The ICF allows the operationalization of health as part of the human experience on this continuum as health from a narrow perspective to the broad perspective of functioning. The ICF with its categories can also serve as starting point for the operationalization of objective well-being. Since HRQoL can be defined as an individual's perceptions of health and health-related domains of well-being, the ICF categories encompassed in the ICF concept of functioning can also serve as the basis for the operationalization of HRQoL.     

Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities

Many health professionals have expressed difficulty finding ways to keep people with disabilities engaged in community-based physical activity/rehabilitation programs. A major reason for this low adherence may be that the recommended intervention plan does not match well with the specific needs of the individual. Various personal and/or environmental factors along with the person's level of functioning can impede participation in healthful physical activity/rehabilitation. The International Classification of Functioning, Disability and Health (ICF) can be a useful tool for identifying key factors associated with participation in community-based physical activity/rehabilitation. The ICF allows health professionals to identify the level of functioning at the body, person and societal level, as well as understand the person-environment contextual factors that may impede or enhance participation. This paper describes how the ICF can assist health professionals in identifying a broader constellation of factors when prescribing physical activity/rehabilitation programs for persons with varying levels of disability.     

Value and application of the ICF in rehabilitation medicine

CONTEXT: Rehabilitation medicine may be defined as the multi- and interdisciplinary management of a person's functioning and health. Rehabilitation medicine defines itself with respect to concepts of functioning, disability and health. Assessment and intervention management rely on these concepts. The current framework of disability--the WHO International Classification of Functioning, Disability and Health (ICF)--providing a coherent view of health from a biological, individual and social perspective. ISSUE: However, ICF success will depend on its compatibility with measures used in rehabilitation and on the improvement of its practicability. Thus, it is expected to see the development of the ICF based on versions of currently used instruments and on the development of ICF core sets. CONCLUSION: The new language ICF is an exciting landmark event for rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multi-professional communication and improve communication between patients and rehabilitation professionals.     

Value and application of the ICF in rehabilitation medicine

Rehabilitation medicine may be defined as the multi- and interdisciplinary management of a person's functioning and health. Rehabilitation medicine defines itself with respect to concepts of functioning, disability and health. Assessment and intervention management rely on this concept. The current framework of disability--the WHO International Classification of Functioning, Disability and Health (ICF)--providing a coherent view of health from a biological, individual and social perspective. However, ICF success will depend on its compatibility with measures used in rehabilitation and on the improvement of its practicability. Thus, it is expected to see the development of the ICF based on versions of currently used instruments and on the development of ICF Core Sets. The new language ICF is an exciting landmark event for rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multi-professional communication and improve communication between patients and rehabilitation professionals.     

Assessing the impact of health conditions using the ICF

Purpose.?People may suffer from diseases and a variety of health conditions, but a full understanding of the experience of their health condition also requires comprehensive information about the impact of the disease or the health condition on the person. This article operationalises the impacts of health conditions as classified in the International Classification of Diseases (ICD) in terms of the concept of functioning as found in the International Classification of Functioning, Disability and Health (ICF). It identifies a set of ICF categories as the functioning properties – to describe the impact of health conditions generically across health conditions to be jointly used with the ICD.

Method.?The ICF categories to characterise the functioning properties of any health condition have been selected from three main generic health profile instruments: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), the World Health Survey (WHS) Questionnaire and a list of candidate categories of the generic ICF core set.

Results.?A set of ICF categories to describe the impact of a health condition is presented according to specific functioning domains.

Conclusions.?The joint use of the ICD and the ICF through the list of functioning properties and in the context of ICD-11 development captures the valuable synergy of the two classifications. It enhances patient management, intervention design and the reporting of health. It also enables us to distinguish severity of disease from its impacts. The ICD–ICF joint use creates a shared formal representation across the continuum of care for health information system implementation.     

Counting disability: global and national estimation

Purpose: How many people with disabilities are in the world? How is disability defined? How can we measure disability in an accurate and comparable way? These are some of the key questions which the recently published World Bank/WHO World Report on Disability (WRD) addresses.

Method: Multiple data sources and methods were used by WHO and the World Bank to estimate a global figure, with the ICF as the underlying data standard. Key international data sources were the World Health Survey of 2002–2004 and the 2004 updates from the Global Burden of Disease study. The World Report on Disability also includes a compilation of country-reported prevalence from census and surveys. This paper presents and discusses key findings of the Irish National Disability Survey (2006) to illustrate the value of the ICF framework for disability statistics and most especially the environmental factors component.

Results: The World Report estimates that globally one billion people or 15% of the world’s population experience disabilities. Between 110–190 million people (2% of the world’s population) experience severe or extreme difficulties in functioning. Definitions and measures of disability vary widely across countries. The Irish Disability Survey shows the substantial impact of environmental factors on people’s functioning. For example, attitudes, and the presence or absence of facilitating equipment, support services, flexible working arrangements and transport significantly affect participation of people with disabilities in Irish society.

Conclusions: To improve the quality of disability information, the World Report recommends the use of a common definition and concepts of disability based on WHO’s International Classification of Functioning Disability and Health (ICF). Furthermore, disability measurement needs to apply a multidimensional approach, in particular, measuring disability in terms of the level of difficulty a person is experiencing in multiple areas of life, rather than head counting severe impairment types in a dichotomous way. Environmental factors have significant effects on individual functioning and should be considered as an integral part in disability measurement.

Implications for Rehabilitation

• Rehabilitation practitioners and researchers can be part of the international work towards an epidemiology of functioning and disability, by using a common language and frame of reference – the ICF – and by gathering and sharing information and statistics as recommended by the World Report on Disability.

• Better comparability between clinical or case based data and population data will also enable analyses which serve to improve the health of populations globally.

• Environmental factors – physical, social and attitudinal – must be recorded or measured as part of the context which influences the experience and level of functioning and can offer useful information to guide positive interventions.

     

Assessment of everyday functioning in young children with disabilities: an ICF-based analysis of concepts and content of the Pediatric Evaluation of Disability Inventory (PEDI)

BACKGROUND: Assessment of everyday functioning in children may depend to a considerable extent on the framework used to conceptualise functioning and disability. The Pediatric Evaluation of Disability Inventory (PEDI) has incorporated the mediating role of the environment on disability, using different measurement scales. The construction of the Functional Skills scales, which measure capability, and the Caregiver Assistance scales, which measure performance, was based on the Nagi disablement scheme. The International Classification of Functioning, Disability and Health (ICF) represents a new framework of functioning and disability that could be used to compare the measurement constructs and the content of different outcome measurements. PURPOSE: To examine the conceptual basis and the content of the PEDI using the ICF. METHOD: Phrases that describe the conceptual basis of the PEDI scales and of the ICF classifications were systematically collected and compared. Two researchers classified the item content of the Functional Skills scales independently before consensus was reached. RESULTS: The analyses indicate that the conceptual basis of the PEDI scales to a large extent match the ICF concepts of activity, participation and environmental factors. Both the PEDI and the ICF use the constructs of capacity and performance, but differ in how to operationalise these constructs. The classification of the Functional Skills scales shows that the PEDI primarily is a measure of activities and participation. The frequently use of environmental codes to classify the context of the requested functions demonstrates that the PEDI has incorporated the environment into the assessment. CONCLUSIONS: Our analyses indicate that the ICF could serve as a conceptual framework to clarify the measurement construct of the PEDI scales, and as taxonomy to describe and clarify the item content of the Functional Skills scales. Both as framework and taxonomy the ICF showed limitations in covering functioning in early childhood.     

The ICF Contextual Factors related to speech-language pathology

The World Health Organization's International Classification of Functioning, Disability and Health (ICF) conceptualizes functioning and disability as a dynamic interaction between a person's health condition and their contextual factors. Contextual factors “represent the complete background of an individual's life and living” and comprise two components: Environmental Factors and Personal Factors. This review aims to: (1) discuss why contextual factors are important for speech-language pathologists to address in their clinical practice, (2) describe how environmental factors are coded in the ICF, (3) identify environmental factors that are relevant for people with communication disorders, and (4) identify personal factors that are relevant for people with communication disorders. Research on environmental factors that can influence the functioning of individuals with various communication disorders is presented, in addition to studies on personal factors that are important for speech-language pathologists to consider. The paper concludes that speech-language pathologists need to address contextual factors routinely, in order to provide a holistic approach to intervention for their clients. Furthermore, although a number of contextual factors that are relevant for people with communication disorders have been reported in the literature, more research is needed in this area.     

Measuring chronic health condition and disability as distinct concepts in national surveys of school-aged children in Canada: a comprehensive review with recommendations based on the ICD-10 and ICF

Purpose: With the aim of improving the measurement of child health and disability in survey research, this paper reviews the coverage of chronic health conditions and the domains of disability and related environmental factors as they are laid out in the ICD-10 and ICF, respectively, in national surveys of school-aged children conducted in Canada since 1980. Recommendations are made for future survey use and construction. Methods: Two reviewers independently examined each of the surveys. Coverage of chronic health conditions, the domains of disability, and environmental factors in survey questions was identified by mapping question content onto ICD-10 and ICF codes. The reviewers then compared their findings and came to a final consensus. Results: Surveys vary in the range and depth of coverage of the ICD-10 and ICF chapters. Disability surveys and health surveys for persons aged 12 and over contain the most comprehensive lists of chronic conditions. Coverage of impairments is limited. Coverage of activity limitations and participation restrictions is most limited in the domains of personal care and domestic life. Environmental factors not covered include natural environmental changes, attitudes, and policies. Conclusions: Development of a comprehensive standard list of chronic health conditions based on the ICD-10 and development of standard survey measures of the domains of disability and environmental factors based on the ICF for use in surveys of school-aged children would facilitate an understanding of children's health and disability in the context of the current international health framework provided by the World Health Organization.     

Nature and the natural environment as health facilitators: the need to reconceptualize the ICF environmental factors

Purpose: This work examines the environmental factors component of the International Classification of Functioning, Disability, and Health (ICF) relative to current health-facilitating evidence about natural environmental factors. We argue that the environmental factors component warrants reconceptualization in order to offer an extended and more systematic framework for identifying and measuring health-facilitating natural environmental factors. Method: Current evidence highlighting the potential health-facilitating benefits of natural environmental factors is synthesized and considered in the context of the ICF framework and its coding system. Results: In its current form, the ICF’s conceptual framework and coding system are inadequate for identifying and measuring natural environmental factors in individuals and groups with and/or without health conditions. Conclusion: The ICF provides an advanced framework for health and disability that reflects contemporary conceptualizations about health. However, given the scope of emerging evidence highlighting positive health and well-being outcomes associated with natural environmental factors, we believe the environmental factors component requires further advancement to reflect this current knowledge. Reconceptualizing the environmental factors component supports a more holistic interpretation of the continuum of environmental factors as both facilitators and barriers. In doing so, it strengthens the ICF’s utility in identifying and measuring health-facilitating natural environmental factors.

Implications for Rehabilitation

• Natural environmental factors constitute salient features of the environment with implications to health and disability, not simply aesthetic qualities.

• Fostering contact with nature and the natural environment may provide opportunities for respite and promote health benefits for individuals who experience a range of disability.

• Positive human-nature-health relationships may contribute to the maintenance and promotion of health at the population level.

     

The International Classification of Functioning,Disability and Health: a new tool for understanding disability and health

Reliable and timely information about the health of populations is part of the World Health Organization's mandate in the development of international public health policy. To capture data concerning functioning and disability, or non-fatal health outcomes, WHO has recently published the revised International Classification of Functioning, Disability and Health (ICF). In this article, the authors briefly outline the revision process and discuss the rationale for the ICF and the needs that it serves in rehabilitation. The ICF is shown to be an essential tool for identifying and measuring efficacy and effectiveness of rehabilitation services, both through functional profiling and intervention targeting. Existing applications of the ICF in rehabilitation are then surveyed. The ICF, in short, offers an international, scientific tool for understanding human functioning and disability for clinical, research, policy development and a range of other public health uses.     

The International Classification of Functioning, Disability and Health: a new tool for understanding disability and health

Reliable and timely information about the health of populations is part of the World Health Organization's mandate in the development of international public health policy. To capture data concerning functioning and disability, or non-fatal health outcomes, WHO has recently published the revised International Classification of Functioning, Disability and Health (ICF). In this article, the authors briefly outline the revision process and discuss the rationale for the ICF and the needs that it serves in rehabilitation. The ICF is shown to be an essential tool for identifying and measuring efficacy and effectiveness of rehabilitation services, both through functional profiling and intervention targeting. Existing applications of the ICF in rehabilitation are then surveyed. The ICF, in short, offers an international, scientific tool for understanding human functioning and disability for clinical, research, policy development and a range of other public health uses.     

Assessment of everyday functioning in young children with disabilities: An ICF-based analysis of concepts and content of the Pediatric Evaluation of Disability Inventory (PEDI)

Background.?Assessment of everyday functioning in children may depend to a considerable extent on the framework used to conceptualise functioning and disability. The Pediatric Evaluation of Disability Inventory (PEDI) has incorporated the mediating role of the environment on disability, using different measurement scales. The construction of the Functional Skills scales, which measure capability, and the Caregiver Assistance scales, which measure performance, was based on the Nagi disablement scheme. The International Classification of Functioning, Disability and Health (ICF) represents a new framework of functioning and disability that could be used to compare the measurement constructs and the content of different outcome measurements.

Purpose.?To examine the conceptual basis and the content of the PEDI using the ICF.

Method.?Phrases that describe the conceptual basis of the PEDI scales and of the ICF classifications were systematically collected and compared. Two researchers classified the item content of the Functional Skills scales independently before consensus was reached.

Results.?The analyses indicate that the conceptual basis of the PEDI scales to a large extent match the ICF concepts of activity, participation and environmental factors. Both the PEDI and the ICF use the constructs of capacity and performance, but differ in how to operationalise these constructs. The classification of the Functional Skills scales shows that the PEDI primarily is a measure of activities and participation. The frequently use of environmental codes to classify the context of the requested functions demonstrates that the PEDI has incorporated the environment into the assessment.

Conclusions.?Our analyses indicate that the ICF could serve as a conceptual framework to clarify the measurement construct of the PEDI scales, and as taxonomy to describe and clarify the item content of the Functional Skills scales. Both as framework and taxonomy the ICF showed limitations in covering functioning in early childhood.     

The International Disability Rights Movement and the ICF

PURPOSE: To outline the thinking of disabled people about their situation and status before the formulation of the ICIDH (International Classification of Impairment, Disability and Handicap) in 1980, the growth of the international disability rights movement since 1980, its subsequent involvement in the revision process and then its hopes as to the effectiveness of the ICF (the International Classification of Functioning, Disability and Health-the revised ICIDH) in the future. METHOD: This is a personal analysis based on the author's experience as a disability rights activist and as a member of the World Council of Disabled Peoples' International (DPI), elected in 1987 to represent DPI in the revision process and who later became Chair of the Environmental Task Force. RESULTS: These are shown to be a major shift from the medical model of disability to the adoption of the interactive model and the impacts of environmental factors in all aspects of health and functioning. CONCLUSIONS: That proper use of the environmental factors within the ICF will ensure appropriate policies, systems and services for health care and support, provide measurable indicators for health status and sustainable development and underpin the recognition that disability is a human rights issue.     

Value and application of the ICF in rehabilitation medicine

Context: Rehabilitation medicine may be defined as the multi- and interdisciplinary management of a person's functioning and health. Rehabilitation medicine defines itself with respect to concepts of functioning, disability and health. Assessment and intervention management rely on these concepts. The current framework of disability--the WHO International Classification of Functioning, Disability and Health (ICF)--providing a coherent view of health from a biological, individual and social perspective. Issue: However, ICF success will depend on its compatibility with measures used in rehabilitation and on the improvement of its practicability. Thus, it is expected to see the development of the ICF based on versions of currently used instruments and on the development of ICF core sets. Conclusion: The new language ICF is an exciting landmark event for rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multi-professional communication and improve communication between patients and rehabilitation professionals.     

Use of International Classification of Functioning, Disability and Health (ICF) to describe patient-reported disability in multiple sclerosis and identification of relevant environmental factors.

OBJECTIVE: To use the International Classification of Functioning, Disability and Health (ICF) to describe patient-reported disability in multiple sclerosis and identify relevant environmental factors. METHODS: Cross-sectional survey of 101 participants in the community. Their multiple sclerosis-related problems were linked with ICF categories (second level) using a checklist, consensus between health professionals and the "linking rules". The impact of multiple sclerosis on health areas corresponding to 48 ICF categories was also assessed. RESULTS: A total of 170 ICF categories were identified (mean age 49 years, 72 were female). Average number of problems reported was 18. The categories include 48 (42%) for body function, 16 (34%) body structure, 68 (58%) activities and participation and 38 (51%) for environmental factors. Extreme impact in health areas corresponding to ICF categories for activities and participation were reported for mobility, work, everyday home activities, community and social activities. While those for the environmental factors (barriers) included products for mobility, attitudes of extended family, restriction accessing social security and health resources. CONCLUSION: This study is a first step in the use of the ICF in persons with multiple sclerosis and towards development of the ICF Core set for multiple sclerosis from a broader international perspective.