ICF

World Health Organization Classification Assessment Surveys & Terminology Group

as the New Member in the

WHO Family of International

Classificationswww.who.int/classification/icf

Basic Messages

• ICF has been systematically revised in the last decade– large international and multidisciplinary participation– extensive field testing– guided by scientific principles

• taxonomic guidelines: logic and terminology• practical utility: feasibility, ease of use, ethical guidelines• reliability, validity and comparability

• When the rubber hits the road... – ICF can serve as a useful tool for Health Information Systems

• evaluation: needs, outcomes, costs, quality, satisfaction• service provision, social policy

– Application guidelines, training, tools are needed

World Health Assembly

Endorse and publish ICF

use the ICF in Member States in:

research

surveillance

reporting

Joint use with ICD

Operational subsets:

surveys

clinical encounters

Periodic revision

Interventions procedures

Reasons for encounter

ICD-10International Statistical

Classification of Diseases & Related

Health Problems

ICFInternational

Classification of Functioning, Disability

and Health

INDNomenclature of

Diseases

Specialityadaptations

Primary care

adaptations

WHO Family of International Classifications

Associated Products Main Classifications Adaptations

ICF Publications

1. Main volume with glossary- Full version 9999 cat.- Short version 99 cat.

2. Clinical Descriptions& Assessment Guidelines

3. Assessment Criteriafor Research

4. Other versions- Specialty adaptations

• Children and Youth

5. Dedicated Assessment Tools

Aims

• to provide a scientific basis for consequences of health conditions

• to establish a common language to improve communications

• to permit comparison of data across:– countries – health care disciplines – services – time

• to provide a systematic coding scheme for health information systems

Foundations of ICF

Human Functioning - not merely disability

Universal Model - not a minority model

Integrative Model - not merely medical or social

Interactive Model - not linear progressive

Parity - not etiological causality

Context - inclusive - not person alone

Cultural applicability - not western concepts

Operational - not theory driven alone

Life span coverage - not adult driven

Human Functioning not disability alone

• Body functions vs impairments• Body Structures

• Activities vs activity limitation

1980 disability

• Participation vs handicap

Participation or Handicap?

neutral language

• “politically correct”

• correct use– intervention

– opportunity

–positive aspects

Universal Model vs. Minority Model

Everyone may have disabilityContinuumMulti-dimensional

Certain impairment groupsCategoricalUni-dimensional

Medical versus Social Model

• PERSONAL problem vs SOCIAL problem

• medical care vs social integration

• individual treatment vs social action

• professional help vs individual & collective responsibility

• personal vs environmental adjustment manipulation

• behaviour vs attitude

• care vs human rights

• health care policy vs politics

• individual adaptation vs social change

Sequence of Concepts ICIDH 1980

Impairments

Disease ordisorder

Disabilities Handicaps

Health Condition (disorder/disease)

Interaction of ConceptsICF 2001

Environmental Factors

Personal Factors

Body function&structure

(Impairment)

Activities(Limitation)

Participation(Restriction)

Equity / Parity

• Loss of limb landmines = diabetes = thalidomide

• Missed days at usual activitiesflu = depression = back pain = angina

• Stigmaleprosy = schizophrenia = epilepsy = HIV

Contextual Factors

Person genderageother health

conditionscoping stylesocial

backgroundeducationprofessionpast experiencecharacter style

EnvironmentProductsClose milieuInstitutionsSocial NormsCultureBuilt-environmentPolitical factorsNature

Cultural Applicability

• Conceptual and funtional equivalence of Classification • Translatability• Usability• International Comparisons

Comparability: equivalence across cultures

•Conceptual equivalence:

similar understanding /meaning of concepts

•Functional equivalence:

similar domains

• Metric equivalence:

similar measurement characteristics

ICF Field Testing

• 7 years 1994-2001

• 61 countries

• ICF drafts translated into / tested

in 27 languages

• 38 National Consensus Conferences

• 7 International Consensus Conf.

• 2000 Live Case evaluations

• 3500 Case Summary evaluations

StructureClassification

Parts

Components

Constructs/qualifiers

Domains and categories

at different levels

ICF

Part 1:Functioning and

Disability

Part 2:Contextual

Factors

Body Functions

and Structures

Activities andParticipation

Environmental Factors

Personal Factors

Change inBody

StructuresCapacity Performance Facilitator/

Barrier

Item levels:

1st 2nd

3rd

4th

Item levels:

1st 2nd

3rd

4th

Item levels:

1st 2nd

3rd

4th

Change inBody

Functions

Item levels:

1st 2nd

3rd

4th

Item levels:

1st 2nd

3rd

4th

ICF Components

Body Functions&

Structures

Activities &

Participation

Environmental Factors

Barriers

Facilitators

Functions

Structures

Capacity

Performance

Body Functions and Structures

Skin and related structuresFunctions of the skin and related structures

Structures related to movementNeuromusculoskeletal and movement-related functions

Structures related to the genitourinary and reproductive systems

Genitourinary and reproductive functions

Structures related to the digestive, metabolic and endocrine systems

Functions of the digestive, metabolic and endocrine systems

Structures of the cardiovascular, immunological and respiratory systems

Functions of the cardiovascular, haematological, immunological and respiratory systems

Structures involved in voice and speech

Voice and speech functions

The eye, ear and related structuresSensory functions and pain

Structures of the nervous systemMental functions

Activities and Participation

1 Learning &Applying Knowledge2 General Tasks and Demands3 Communication4 Movement5 Self Care6 Domestic Life Areas7 Interpersonal Interactions8 Major Life Areas9 Community, Social & Civic Life

Environmental Factors

1. Products and technology

2. Natural environment and human-made changes to the environment

3. Support and relationships

4. Attitudes

5. Services, systems and policies

ICF Applications

• Health sector• Social security• Education sector• Labour sector• Economics & development sector• Legislation & law• Other ….

ICF in health & disability statistics

• Common Domains– Mobility - Cognition - Mood– Self Care - Usual Activities ...

• link data from both health and disability

• Multiple Components

• overcomes the “impairment” focus

• Environmental Factors

• Comparability

• Needs assessment • Outcome assessment• Utilization patterns• Comparison of different interventions• Consumer satisfaction

• Service performance– outcomes– cost-effectiveness

• Electronic records• Clinical terminology

ICF in clinical practice & management

ICF in policy making

• assessment of population health

• impact of disability

–economic

–social

• evidence-base for policy makers on different policy interventions

–responsiveness of services–efficiency –performance assessment

ICF research applications

• joint assessment of disease and functioning– description of association

– intervention response & synchrony of change

– explanatory power on:• utilization

• needs

• costs

• outcomes

– Cost-effectiveness of interventions

– Unified approaches