Functioning and disability associated with mental disorders: the evolution since ICIDH

The International Mental Health Task Force participated actively from the outset of the revision of the ICIDH and development of the ICF. The Task Force was responsible for development of all aspects of functioning and disability associated with mental disorders. Building upon knowledge gained since the publication of the ICIDH, it had unique responsibility for development of the ICF chapter on mental functioning. It was also responsible to assure the ICF section on activities and participation integrated and reflected the functioning and disability associated with mental disorders without the redundancy of ICIDH. As context to the revision, the article describes the relationship of diagnostic classifications of mental disorders with disability, and analyses the mental disorder aspects of impairments and disabilities in the ICIDH. Membership in the Task Force represented diversity in geographical, cultural, professional, and personal perspectives on disabilities. This diverse acumen was focused on a range of activities that both specified the unique aspects of functioning and disability associated with mental disorders and assured inclusion of the mental health perspective on the domains of functioning and disability common to physical conditions. Finally, the article notes four current applications of the ICF that are inclusive of the mental health perspective.     

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.     

The Environment in the International Classification of Functioning,Disability and Health

Background The World Health Organization has adopted two classifications relating to disability, one was published in 1980 and the more recent one in 2001. Although the international classification of functioning, disability and health (ICF) was drafted as a revision of the international classification of impairments, disabilities and handicaps (ICIDH), the ICF is based on major changes when compared with the ICIDH. One of them has to do with the environment. Method Quotations from the classification manuals and related articles are presented in order to make clear the scope of the environment in the ICF. Results The ICF has a universal application. The gap between capacity and performance reflects the barriers created by the environment. Conclusions In the ICF, universalism and barriers have specific meanings, reflecting specific policy choices.     

Revision of the ICIDH: mental health aspects

Summary

This article reviews the key issues arising in the revision of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) from a mental health perspective, and describes the work of the Disability Working Group of the WHO's Division of Mental Health. The ICIDH, which describes the consequences of disorders at three levels as impairments, disabilities, and handicaps, is generally applicable and useful for mental health purposes. While some impairments are mainly a consequence of ‘mental’ disorders (e.g. cognitive impairment), there should be no differences between mental and physical disorders in the classification scheme, to avoid a dichotomy between mind and body. There is also a need to improve the ways in which interference with the performance of social roles is described, since this is often the most obvious consequence of mental disorders. This article presents the potentials of the ICIDH in the field of mental health, and gives recommendations for the development of the revision process of the ICIDH. To stimulate the process of producing a ‘common language’ in the ICIDH related to mental health issues, former and potential users of the ICIDH are invited to give comments and suggestions.     

基于ICF构建学习障碍儿童功能分析与运动康复方案研究

目的 应用《国际功能、残疾和健康分类》(ICF)对学习障碍儿童的整体功能特点进行分析,并制定个别化运动康复方案。方法 基于ICF的理论架构和ICD-11的疾病诊断,从儿童发展和成长的角度,对学习障碍儿童的认知、理解、注意和思维等功能进行分析,并根据“生物-心理-社会”的健康模式及身体活动的身心交互理论,构建针对学习障碍儿童以功能为导向的个别化运动康复方案。结果 学习障碍儿童的身体功能障碍集中表现在精神功能方面,在活动和参与方面体现为学习和应用知识、完成一般任务、与人交流等的活动受限和参与局限,且学校环境中的教育用品和技术及其服务、政策和体制等因素也都会影响学习障碍儿童。运动康复有利于学习障碍儿童改善精神和运动功能,并有效提升智力、认知、注意力、沟通、活动等能力,促进儿童全面发展。根据《WHO关于身体活动和久坐行为的指南》以及相关国家身体活动指南中针对儿童的部分,选取适合学习障碍儿童的运动方案,进行中等强度到高强度的身体活动至少每天60 min,以及每周不少于3次的高强度训练,配合适宜的体育游戏和休闲体育活动可有效改善学习效果,降低学习障碍影响。结论 运用ICD-11和ICF对学习障碍儿童的疾病、功能障碍和运动特点进行系统分析,基于身心交互作用理论和ICF的生物-心理-社会的健康模式,建立了整体康复和功能导向的运动康复方案,这些方案推荐每天进行至少60 min的中等强度身体活动,包括有氧运动和体育游戏等,以及每周至少3次且时长不低于30 min的高强度身体活动,包括肌力训练和体育竞赛等。结合儿童的学习障碍和运动功能特点,制定基于功能的个别化运动康复方案,可有效改善学习障碍儿童认知、注意和思维等功能,改善学习障碍,促进儿童的全面发展。     

The ICIDH: health problems in a medical and social perspective

Summary

The ICIDH is a classification of health problems. Impairments, disabilities, and handicaps are to be considered as three different interpretations of a person's health state. Use of the ICIDH is indicated when a person's health problems need to be described at a particular point in time, both in medical and in social terms, i.e. including their significance for the daily life functioning of the patient. It is argued that the ICIDH is relevant to health problems other than just those for disabled and for chronically ill. The ICIDH subtitle and the model explaining the relations between disease and impairment—disability—handicap do not reflect a clear notion of the perspective of the ICIDH on health problems. An overview of ICIDH applications shows that the ICIDH is being used not so much for the evaluation of the health-care system but for many other purposes, among these the understanding of therapeutic activities.     

The implementation of the International Classification of Functioning, Disability and Health in Germany: experiences and problems

The bio-psycho-social model of the International Classification of Functioning, Disability and Health (ICF) has already found wide acceptance in Germany. In particular, the introduction of contextual factors (environmental factors and personal factors) is welcomed. Several rehabilitation facilities have used the model and the chapters of the revision version (Beta-2) as guidelines for documenting their interviews with rehabilitation patients. Their experiences are encouraging. However, it has already been recognized that coding with the ICF will be difficult and time consuming. Thus, the practicability of the ICF should be improved. Training in the use of the ICF is absolutely essential. It is welcomed that the ICF provides a common vocabulary for both people with disability and for professionals in the fields of rehabilitation and disability. This is particularly important in Germany because we have a rather complicated social system. In contrast to the International Classification of Impairments, Disabilities and Handicaps (ICIDH), the ICF, in general, contains neutral terms only. Many of our physicians in rehabilitation complain about that. Obviously they also need to be able to express the signs and symptoms of restrictions of functioning in negative terms and in this respect they feel that the ICIDH was more helpful. While both the concept of activities and the concept of participation are clearly understood from the point of view of content some of us have severe problems with the operationalization of both concepts via qualifiers. From a theoretical perspective we regret that the concept of activity is not theory driven and that the concept of participation is not operationalized independently from the concept of activity. A proposal for solving these problems is given. In Germany, the ICIDH, or the ICF latterly, has been taken into account in the following areas. The new German Social Code Number IX (SGB IX) from 2001, Rehabilitation and participation of people with disabilities, is based on the ICF. All guidelines and general recommendations within the context of rehabilitation have been adjusted to the ICF. The ICF plays an important role in the training for the medical field of physical medicine and rehabilitation and is also included in the training curricula of the medical specializations of social medicine and rehabilitation. The German research programme "Rehabilitation sciences" includes some projects dealing with the ICF. The model of consequences of diseases (ICIDH) has been part of the rehabilitation quality insurance programme of the German Pension Insurance since 1994. Since 1 April 2004, the institutes of the German Health Insurance have applied the ICF to their rehabilitation application form.     

On the application of the ICIDH and ICF in developing countries: evidence from the United Nations Disability Statistics Database (DISTAT)

The paper reviews the application of the ICIDH and the ICF in developing countries using data and information available in the United Nations Disability Statistics Database at the United Nations Statistics Division. The focus of the paper is limited to studies carried out in the 1990s and also censuses conducted in the 2000 round of censuses. There are substantial variations between studies in the questions used to identify the population with disabilities, and for most countries, these questions are not based on either the ICIDH or the ICF. Disability status is ascertained mainly through use of impairment screens that include a list of a few severe impairments. Recent studies show use of the ICIDH and also the ICF in the development of questions on disability. This may be attributed mainly to guidelines in the United Nations census recommendations regarding use of the ICIDH framework and terminology to develop the question(s) on disability. Work of the United Nations Statistics Division aimed at improving the international comparability of methods and use of international standards could increase use of the ICF in disability measurement. This includes regional training workshops and also the work of the newly created Washington City Group on Disability Measurement.     

On the application of the ICIDH and ICF in developing countries: evidence from the United Nations Disability Statistics Database (DISTAT)

The paper reviews the application of the ICIDH and the ICF in developing countries using data and information available in the United Nations Disability Statistics Database at the United Nations Statistics Division. The focus of the paper is limited to studies carried out in the 1990s and also censuses conducted in the 2000 round of censuses. There are substantial variations between studies in the questions used to identify the population with disabilities, and for most countries, these questions are not based on either the ICIDH or the ICF. Disability status is ascertained mainly through use of impairment screens that include a list of a few severe impairments. Recent studies show use of the ICIDH and also the ICF in the development of questions on disability. This may be attributed mainly to guidelines in the United Nations census recommendations regarding use of the ICIDH framework and terminology to develop the question(s) on disability. Work of the United Nations Statistics Division aimed at improving the international comparability of methods and use of international standards could increase use of the ICF in disability measurement. This includes regional training workshops and also the work of the newly created Washington City Group on Disability Measurement.     

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.     

Reference to ICIDH in French surveys on disability

This article deals with the development of a basis for data collection and statistics on disability in France. After having recalled the first attempts to establish statistics on disability, highlighting the lack of a reliable conceptual basis, its shows how ICIDH spread out from the geriatrics research field to the disability research field, followed by public management of disability and health care, and recently by the national statistics administration. The article aims at showing that the use of ICIDH always needed adaptations to fit in the forms of data collection and questionnaires. It also demonstrates that its tri-dimensional conception of disability considerably helped to specify the kind of data that were expected and the way they could be organised to enrich the view on disability. In its last part, it mentions what the French reactions were to the submission of ICF by WHO at the World Health Assembly in May 2001 and what could be the consequences in the matter of statistics on disability in France.     

Reference to ICIDH in French surveys on disability

This article deals with the development of a basis for data collection and statistics on disability in France. After having recalled the first attempts to establish statistics on disability, highlighting the lack of a reliable conceptual basis, its shows how ICIDH spread out from the geriatrics research field to the disability research field, followed by public management of disability and health care, and recently by the national statistics administration. The article aims at showing that the use of ICIDH always needed adaptations to fit in the forms of data collection and questionnaires. It also demonstrates that its tri-dimensional conception of disability considerably helped to specify the kind of data that were expected and the way they could be organised to enrich the view on disability. In its last part, it mentions what the French reactions were to the submission of ICF by WHO at the World Health Assembly in May 2001 and what could be the consequences in the matter of statistics on disability in France.     

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.     

The World Health Organisation's terminology and classification: application to severe disability

Purpose:?The purpose of this article is to describe the international classification system proposed by the World Health Organisation for describing individuals with disability. Initially the ‘International classification of impairment, disability and handicap’ (ICIDH) was used. This has been replaced by the ‘International classification of functioning, disability and health’ (ICF). Both of these systems will be described and followed by a discussion of the advantages and disadvantages of using the WHOs classification framework. An application to the field of severe disability will be made throughout.

Method:?Providing a theoretical framework for classification of disability in accordance with the system proposed by the WHO.

Results:?The ICF is a useful tool that contributes to uniformity of international terminology and standardization in the disability field. It is not a minority model, and focuses on strengths and skills.

Conclusions:?An international classification system such as the ICF offers a conceptual framework for information that is relevant to the long-term consequences of disability. Although any type of classification system has certain limitations, the advantages present within the ICF outweigh the limitations.     

The World Health Organisation's terminology and classification: application to severe disability

PURPOSE: The purpose of this article is to describe the international classification system proposed by the World Health Organisation for describing individuals with disability. Initially the 'International classification of impairment, disability and handicap' (ICIDH) was used. This has been replaced by the 'International classification of functioning, disability and health' (ICF). Both of these systems will be described and followed by a discussion of the advantages and disadvantages of using the WHOs classification framework. An application to the field of severe disability will be made throughout. METHOD: Providing a theoretical framework for classification of disability in accordance with the system proposed by the WHO. RESULTS: The ICF is a useful tool that contributes to uniformity of international terminology and standardization in the disability field. It is not a minority model, and focuses on strengths and skills. CONCLUSIONS: An international classification system such as the ICF offers a conceptual framework for information that is relevant to the long-term consequences of disability. Although any type of classification system has certain limitations, the advantages present within the ICF outweigh the limitations.     

Enhancing the conceptual clarity and utility of the international classification of functioning,disability & health: the potential of a new graphic representation

Purpose: To present a new graphic representation of the international classification of functioning, disability and health (ICF), entitled the ICF-conceptual revision (ICF-CR). The ICF-CR aims to be clearer and more usable tool than the ICF graphic currently used by starting to address criticisms of the ICF raised in the literature, with a focus on positioning quality of life (QoL) in relation to the ICF’s other components. Method: This is a conceptual paper based on a review of criticisms of the ICF and related literature published on human functioning. Results: In addition to criticisms of the current graphic, four criticisms of the ICF are discussed in relation to the development of the ICF-CR, including: the lack of development of biopsychosocial theory, the lack of clarity between activities and participation, the language used, and the absence of QoL. General systems theory is used to help construct the new graphic in addressing these criticisms and to position QoL. Conclusions: The ICF-CR is designed to be a more responsive graphic of human functioning; one which enhances the clarity of principles integral to the ICF, including biopsychosocial theory and universalism. It is hoped the ICF-CR will promote continued discussion toward the goal of enhancing the ICF, both visually and conceptually.

Implications for Rehabilitation

• The International classification of functioning, disability and health (ICF) is a widely used framework in the disability and rehabilitation domains; however, many criticisms of the framework and its current graphic exist.

• The ICF-conceptual revision (ICF-CR) is a new graphic representation of the ICF that enhances its biopsychosocial content, positions quality of life (QOL) as an emergent component, and allows for dynamic visualization which is more in line with the actual nature of human functioning and QOL.

• Users of the ICF may find the ICF-CR useful to incorporate into their own work.