the international classification of functioning, disability and health (icf)

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

A tool for self-learning

German WHO-FIC Collaborating CentreICF Research Branch

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Welcome to this ICF self-learning tool

The purpose of this self-learning tool is to provide users with basic knowledge of the ICF and its uses.

The course is composed of seven sections. Each section has one or more units. At the end of each unit you will find a

Keep in mind slide that summarizes the most important facts about the unit. At the end of each section you will

find the hint for the Exercises (questions and tasks)

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

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Contents:

1. Introduction - Need for the ICF2. Aims of the ICF3. Uses of the ICF 4. The ICF Integrative Bio-Psycho-Social model of

functioning and disability5. The structure and codes of the classification6. Coding with the ICF7. WHO Family of International Classifications (FIC)

Learning ICF

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Learning ICF

1. Introduction – Need for the ICF

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In the following section you will:

• learn why the description of functioning and disability is important for people with different health conditions

• understand why information about functioning is essential for many uses

1. Introduction –Need for the ICF

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Grandma Smith loves to spend time with her granddaughter. In recent years, her worsening rheumatoid arthritis has made this increasingly difficult. Both her hands and knees are affected, but her finger joints are what cause the most problems; especially with respect to finger movement. She can hardly perform simple tasks such as helping her granddaughter button her coat.

Functioning & Disability


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Functioning is an umbrella term for

Body structures

Activities

Participation

Joints

Manipulating objects

Taking care of others


Body FunctionsMobility and stability of joints

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Disability is an umbrella term for

Body structures

Activities

Participation


Body Functions

Impairments

Limitations

Restrictions

Disability is an umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between an individual (with a health condition) and contextual factors (environmental and personal factors) that individual.

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Introduction – Need for the ICF

they encompass the human experience at the level of

• body functions and

structures,• activities • and participation

in interaction with the environment.

Functioning & Disability are multidimensional

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Functioning & Disability are also a continuumfor example in Seeing Functions

Mild-Moderate vision impairment:Needs eye glasses, contact lenses…

10/20

Severe vision impairment:Needs operation

2/20

Complete vision impairment (blind): Needs assistance – pension, device, assistantenvironmental modifications

1/20

Introduction – Need for the ICF

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are related to a variety of factors:



• to the person’s health condition

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• to the person’s health condition

•to the person’s resources (both personal abilities and economic resources).



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• the person’s resources

• the environment in which the person lives


• the person’s health condition


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So, the level and nature of functioning and disability may differ:


between people with the same health condition

People with the same disorder may experience functioning differently and at different levels in relation to their disease.

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So, the level and nature of functioning and disability may be similar: between people with different health conditions

For example people with sensory disorders may experience functioning differently than people with motor or mental disorders.


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So, the level and nature of functioning and disability may change


A person‘s experience of functioning and level of functioning may change over the course of the disease.

for the same person over time even though the health condition does not change

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Joseph Jeune from Zambia was diagnosed with „unspecified human immunodeficiency virus (HIV) disease“ in 2002. He had severe limitations in daily activities like moving around or washing himself. He couldn‘t work at all.

In 2003 he was one of the 3 million beneficiaries of the „3by5“ WHO Program for inter-viral treatment in Africa. One year after treatment, he was still HIV positive, but his level of functioning had increased remarkably. His participation restictions in remunerative employment were only moderate.

Medical diagnosis may remain the same, but the experience of functioning changes.


Joseph and his mother, 2003

Joseph and his mother, 2004

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Mr. Sneider has had progressive-relapsing multiple sclerosis (ICD-10 G.35) for 14 years. From that time on, he‘s had a steady neurologic decline and also experiences clear superimposed attacks. His cognitive and orientation functions are severely impaired and he currently requires care 24 hours a day.

A description of functioning complements information on disease. This information is needed to support decisions about resource allocation, services required, level of care or length of hospitalization.

Carol Bauer was diagnosed with relapsing-remitting multiple sclerosis (ICD-10 G.35) three years ago. She had her second relapse two months ago, her seeing functions were impaired and she lost a portion of her field of vision. She needed to take sick leave for three weeks, after that she returned to her regular routine. Currently she has follow up visits with her doctor every six months.


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A description of functioning is fundamental to identify the health problems and needs of individuals and populations. It is the starting point for any approach to achieve or maintain optimal levels of functioning in individuals and populations.

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Hence, the description of functioning of individuals and populations give us the evidence for policies, systems and service provision.

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The International Classification of Functioning, Disability and Health (WHO, 2001) provides a comprehensive, universal and globally accepted model and taxonomy to describe functioning.


Health condition

Environmental factors

Personal factors

Body functions/ Body structures

Activities Participation

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1. Functioning & disability encompass the human experience at the level of body functions and structures activities and participation in the context of environmental and personal factors

1. Introduction – Need for the ICF?

Keep in mind:

3. Functioning may differ between people with the same health condition, may be similar in persons with different health condition

4. The description of functioning is the starting point for any approach to achieve or maintain optimal levels of functioning in individuals and populations

2. Functioning & disability are multi-dimensional and represent a continuum

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Exercises

Handout Page 2

Now go to

To check your knowledge of the content of information from different measures

To check your understanding of the differences in functioning status

To check your understanding of the need for the description of functioning

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Learning ICF

2. Aims of the ICF

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2. Aims of the ICF


• learn the aims of the ICF

• understand the importance of the application of the ICF

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2. Aims of the ICF

The aims of the ICF are:

• to provide a scientific basis for understanding health and health-related states, outcomes and determinants;

• to establish a common language to improve communication between disciplines and sectors;

• to enable data comparison between different countries and health care systems and services;

to provide a systematic coding scheme for health care information systems;

• to stimulate the development of services to increase levels of social participation among people with disabilities.

(WHO 2001:5)

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• to establish a common language to improve communication between disciplines and sectors

ICF is used not just by people in the disability or medical sectors. People do use it across other broad sectors including insurance, social security, employment, education, economics, social policy, and environmental modification.

2. Aims of the ICF

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• to provide a systematic coding scheme for health care information systems

b1b130b134b1801• • s299s710 s730s7301•

d170d230d410 d415 • e110e115e125e150

EQ-5D

Joint mobilityMobility (general)Muscle power / StrengthPainStability of jointsEmotional functionEngergy & Drive functionsGait / AmbulationStiffnessMuscle enduranceSexual functionsSleep

NHPJoint mobilityMobility (general)Muscle power / StrengthPainStability of jointsEmotional functionEngergy & Drive functionsGait / AmbulationStiffnessMuscle enduranceSexual functionsSleep WHODAS

INSTRUCTIONS: This survey asks foryour views about your health. Thisinformation will help keep track of howyou feel and how well you are able to do your usual activities. Answer every question by markingthe answer as indicated. If you ar unsure about how to answer aquestion, please give the best answer you can.

Ql-I Spitzer


WHOQoL


SF-36

INSTRUCTIONS: This survey asks foryour views about your health. Thisinformation will help keep track of howyou feel and how well you are able to do your usual activities. Answer every question by markingthe answer as indicated. If you ar unsure about how to answer aquestion, please give the best answer you can.

2. Aims of the ICF

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• to provide a scientific basis for understanding health and health-related states, outcomes and determinants

b1b130b134b1801• • s299s710 s730s7301•

d170d230d410 d415 •

e110e115e125e150e460

Outcome measures

For example, ICF provides the framework for the development of research questions and outcome measurements in relation to functioning.

2. Aims of the ICF

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• to enable data comparison between different countries, health care systems and services.

Universality

2. Aims of the ICF

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2. Aims of the ICF

0

10

20

30

40

50

60

70

80

90

Country A Country B Country C Country D

Diagnosis 1 Diagnosis 2 Diagnosis 3

ICF enables data comparison

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• to stimulate the development of services to increase levels of participation among people with disabilities.

Functioning data is essential for identifying the needs of a population.

2. Aims of the ICF

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1. Establishes a common language

2. Provides a systematic coding scheme

Keep in mind:

3. Provides a scientific basis for understanding health

4. Enables data comparison

5. Stimulates the development of services

ICF

2. Aims of the ICF

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Exercises

Handout Page 8 Now go to

To check your knowledge

To check your understanding

To check your understanding

2. Aims of the ICF

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Learning ICF

3. Uses of the ICF

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3. Uses of the ICF

In the following section you will

• learn the uses of the ICF

• understand the benefits of using the ICF for different purposes

• be able to justify the use of ICF for a specific purpose

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Systems and Organizations (Meso level)

Service provision (Micro level)

Policies (Macro level)

ICF can be used in the areas of:

3. Uses of the ICF

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A common language to exchange information is required in different levels and fields like research and statistics; the ICF provides the framework and definitions.

Systems and Orgnizations (Meso level)


Policies (Macro level)

Research

Statistics

ICF facilitates the information flow

3. Uses of the ICF

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• Assessment of population health

• Impact of disability– Economic– Social– Personal

• Policy decision making– Provision of services– Eligibility– Equity and human rights

The ICF is being used in policy for:



Policies (Macro level )

3. Uses of the ICF

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ICF has been accepted as one of the United Nations social classifications.

ICF provides an appropriate instrument for monitoring the implementation of international human rights mandates as well as national legislation




3. Uses of the ICF

The Convention on the Rights of Persons with Disabilities refers to and incorporates the ICF.

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ICF based disability surveys can be used to estimate the number of people with disabilities in a population and the sorts of disabilities they experience. The sorts of services needed can thence be based on the population picture of functioning.




Assessment of population health

ICF as the basis for decision making

3. Uses of the ICF

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Let us take a look at an example of using ICF in social policy…

Specifically ‘participation gap’ policy analysis

‘participation gap’ policy analysis

ICF facilitates description of levels of participation in non-disabled population in employment, education, community life, etc.

ICF facilitates description of levels of participation for persons with disability (stratified by type)

The difference between these two descriptions is a ‘participation

gap’, the use of ICF enables:• Needs assessment• Policy planning• Outcomes research• Cost-effectiveness




3. Uses of the ICF

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Health & Disability Statistics may be used at the Macro and Meso levels:

Differences between health and disability surveys…

While both health and disability surveys collect information on an individual's and population's overall health, the focus of each differs.

Health surveys focus largely on the health condition (e.g. a stroke, classified with ICD), health determinants (e.g. smoking, high blood pressure), prognosis (e.g. permanent damage, possible recovery, recurrence), health interventions (e.g. hospitalization, medication) and satisfaction (e.g. with health care received).

ICF based Disability surveys focus on level of functioning at body, person and societal levels (ICF domains), services received and required (e.g. services such as walking frames or personal assistance), and satisfaction (e.g. with services received) the health condition (e.g. stroke) may or may not be collected.




3. Uses of the ICF

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Health surveys Disability surveys

Health condition Type of disability

Health determinants Facilitators and barriers

Prognosis Impact of disability

Health system interventions

Assistance required

Satisfaction Satisfaction

Level and severity of disability

ICF provides a common conceptual framework that links health and disability statistics




3. Uses of the ICF

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Functional status data is essential for equitable eligibility criteria for state entitlements such as social security benefits, disability pensions, workers’ compensation and insurance.




3. Uses of the ICF

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3. Uses of the ICF - Education

The development of eligibility criteria for educational services for children and youth requires a comprehensive approach and a common language in order: – to provide support in schools for students with

disabilities; and– to follow people across settings and monitor quality and

outcomes.




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ProblemAssess-ment

Assign-ment

Inter-vention

Evalua-tion

Policy perspective

Organisational perspective

Educational perspective

Clinical perspective

Levels

of

Ed

ucati

on

Syste

m

Process of Education

Linking process of education to levels of education system

3. Uses of the ICF - EducationSystems and Organizations

(Meso level)



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Policy decisions can bring reductions in the incidence and severity of disability in a population:

2. By modifying features of the social and physical environment. e.g. accessible

communication, building ramps

Keep in mind:

1. By enhancing person-centered services and programs

e.g. school programs

3. Uses of the ICF

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3. Uses of the ICF - Service management

Working in health management we may ask ourselves some of the following questions:

• What health care and other services will be needed?• How well do we serve our clients? • What basic indicators for quality assurance are valid and

reliable?• How useful are the services we are providing?• How cost-effective are the services we provide? • How can the service be improved for better outcomes at a

lower cost?




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In order to answer those questions, the measurement of health care needs and the performance and effectiveness of health care systems are essential. For these purposes, we necessarily require reliable and comprehensive information.

Evidence based treatment

ResourcesSee

section 7




Functioning status

Environment

Information required


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Comprehensive health information will help optimize the Manager‘s tasks, such as:

– Resource planning and development– Quality improvement– Management and outcome evaluation– Managed care models of health care delivery– Scheduling– Performance monitoring– Target setting– Billing– Statutory reporting





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Keep in mind:

1. Comprehensive health information includes functioning.

2. Comprehensive health information helps in: resource planning, service development, management, scheduling and outcome evaluation.


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It is important to not only treat problems (impairments) but also address people‘s needs in relation to their lived experience and in their own context.

A profile of functioning is the best indicator of treatment needs and service outcomes…

ICF can be useful in different areas of service provision such as clinical practice, education and return to work programs.




3. Uses of the ICF - Service Provision

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A common understanding, language and description of functioning enables:

3. Uses of the ICF - Service provisionSystems and Organizations

(Meso level)



• better understanding of the contribution of each service provider

• effective referral across sectors and disciplines

• patient involvement in assessment and intervention planning • inter-professional collaboration during planning and intervention

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ICF will help:

• Organize the assessment of functioning • Design and coordinate services for individuals with

special needs • Develop and guide interventions to gain, restore or

maintain functioning (e.g. hearing, speech, vision, cognition, and mobility)

• Track changes in functioning and across settings• Monitor the quality and safety of programs and

services and outcomes.• Self-evaluation by consumers

3. Uses of the ICF - Service provisionSystems and Organizations

(Meso level)



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Comprehensive approach to describing functioning

Keep in mind:

2. Personal and environmental factors considered when developing intervention strategies

1. ICF encourages people to look beyond treating problems and towards

addressing people's broader needs

Focus on the individual and his/her context

Looking beyond impairments

3. Uses of the ICF - Service provision

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3. Uses of the ICF - Summary

ICF• Provides a universal framework for

measuring functioning, disability and health

• Enables reliable and valid disability statistics

• Is a planning and policy tool for decision-makers in– Policy– Service management– Service provision

• and increases the likelihood of improved outcomes for people with disabilities.

Health condition

Environmental factors Personal factors



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Exercises


To check your knowledge about the different areas of uses

To check your understanding of the need of using the ICF in these areas

3. Uses of the ICF

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Learning ICF

4. The ICF integrative bio-psycho-social model of

functioning and disability

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• learn the definitions of functioning and disability and the according components within the integrative bio-psycho-social model.

• understand functioning in the context of this model.

4. The ICF integrative Bio-Psycho-Social Model of functioning and disability

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ICF is an universal model and applies to all people irrespective of their culture, health condition, gender, or age. Instead of making disability a distinguishing mark of a discrete minority group, the ICF describes all the domains of functioning and disability that are applicable to everyone.


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ICF espouses a neutral etiological perspective of disability


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ICF has moved away from being a consequence of disease classification to become a components of health classification.

Disability = Consequences of disease

Health condition

Medical model

Health condition




Integrative Bio-Psycho-Social model

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The conceptual basis of ICF provides a multi-dimensional approach to describing human functioning and disability and serves as a framework to organize this information.

This integrative bio-psycho-social approach of functioning and disability is depicted with this model:


Health condition


Personal factors



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Health condition


Personal factors

Functioning and disability=

results of the interaction between a person with a health condition and both personal and environmental factors


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Health condition


Personal factors

Functioning=

umbrella term for body functions, body structures, activities and participation




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• integrates medical and social models

• integrates various perspectives of functioning (biological, individual and social)

• is a multidimensional model (Body functions and structures, Activities, Participation)

• is an interactive model rather than a linear progressive model

• reflects dynamic interaction among the components

Health condition


Personal factors



The ICF integrative Bio-Psycho-Social Model of functioning and disability:

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1. Functioning and disability is the result of the interaction between a person with health condition and both personal and environmental factors

2. Functioning and disability is an umbrella term for body functions, body structures, activities and participation


Keep in mind:

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Learn the definitions of the components of the ICF model with the example of Mr. Wun.

Health condition


Personal factors




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A health condition is an umbrella term for disease, disorder, injury or trauma.

A health condition may also include other circumstances, such as ageing, stress, pregnancy, congenital anomaly, or genetic predisposition

Health conditions may be coded using the ICD-10.


Health condition


Personal factors



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Health condition


Personal factors



„I was driving my car at night somewhere close to Bangkok. I was so tired that I fell asleep while driving. …I didn‘t wear the safety belt…. The next thing I remember is being at the hospital and not being able to move my legs and arms. I was wearing a brace around my neck to stabilize my broken vertebra. This is nearly two years ago. I still can‘t move my legs and parts of my hands.“

Tetraplegia

G83.5

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Body functions are physiological functions of body systems, including psychological functions

Body structures are anatomical parts of the body, such as organs, limbs and their components

Impairments are problems in body functions or structure such as a significant deviation or loss


Health condition


Personal factors



Tetraplegia

G83.5

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Physical Therapist: Beside Mr. Wun‘s complete problems in the lower extremity, he has partial deficits of muscle power in the arms. Due to his loss of lower limb movement, he demonstrates stiffness in the muscles as well as reduced mobility in the ankle joints. As a consequence of the loss of muscle power he has also problems with his respiratory functions


Health condition


Personal factors



Tetraplegia

G83.5

muscle power

movements in his legs

stiffness in the musclesmobility in the ankle joints

respiratory functions

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Health condition


Personal factors


Activity is the execution of a task or action by an individual

Participation is involvement in a life situation.

Activity limitations are difficulties an individual may have in executing activities

Participation restrictions are problems an individual may experience in involvement in life situation


Tetraplegia

G83.5

movements in his legsstiffness in the muscles

muscle power

mobility in the ankle jointsrespiratory functions

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„ My problems in daily living are that I need much more time for eating, and I can‘t go to the toilet. To maintain sitting is difficult, I always need my arms to prop up. I can‘t go out to meet my friends, but I still communicate to them by phone or E-Mail. I also started to work on the computer, doing translations from English to Thai ….“


Health condition


Personal factors


Tetraplegia

G83.5eating

maintain sitting

meet my friends

work on the computer

go to the toilet


muscle power

mobility in the ankle jointsrespiratory functions

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Health condition


Personal factors


Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.

These factors are external to individuals and can have a positive or negative influence on the individual’s performance as a member of society, on the individual’s capacity to execute actions or tasks, or on individual’s body function or structure


Tetraplegia

G83.5


muscle power

mobility in the ancle jointsrespiratory functions

eating

maintain sittinggo to the toilet

meet my friendswork on the computer

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„My wheelchair is very heavy, that makes it difficult for me to move it. Most of the buildings outside are not adapted for disabled. The streets are full of obstacles; impossible to overcome.The support of my mother is most important for me, additionally we have two housekeepers who help me all the time.My health insurance pays for all my hospital stays, that helps also.


Health condition


Personal factors


Tetraplegia

G83.5


muscle power


eating



wheelchair

buildings

streets are full of obstacles

support of my mother

housekeepers

health insurance

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Health condition


Personal factors


Personal factors are the particular background of an individual’s life and living, and comprises features of the individual that are not part of a health condition or health state.

These factors may include gender, race, age, other health conditions, fitness, lifestyle, habits, coping styles, social background, education, profession, past and current experience,…


Tetraplegia

G83.5


muscle power


eating



housekeepers

wheelchairbuildings

streets are full of obstaclessupport of my mother

health insurance

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Medical Doctor:„Mr Wun is 24 years old, he finalized his university degree for engeneering last year. Although his disease is severe he is motivated to improve his situation.


Health condition


Personal factors


Tetraplegia

G83.5


muscle power


eating



housekeepers

wheelchairbuildings


health insurance

motivated

engeneering

university degree24 years old

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Health condition


Personal factors


Functioning is the result of the interaction between a person with


Tetraplegia

G83.5


muscle power


eating

maintain sittinggo to the toilet meet my friends

work on the computer

housekeepers

wheelchairbuildings


health insurance

and the contextual factorshealth condition

engeneering

24 years olduniversity degree

motivated

Functioning

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Summary of the concept of the ICF integrative bio-psycho-social model of functioning and disability:

– Integrative model: not just medical or social

– Interactive model: not linear progressive

– Multi-dimensional: limitations are not necessarily caused by one factor, e.g. health condition, personal- or environmental factor or participation restriction

– Essentially context is included: not the person alone but impact of environment and personal factors


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1. A health condition is an umbrella term for disease, disorder, injury or trauma. Health conditions are coded using the ICD-10

2. Body functions are physiological functions of body systems, including psychological functions

3. Body structures are anatomical parts of the body, such as organs, limbs and their components

4. Impairments are problems in body functions or structure as a significant deviation or loss

Keep in mind:

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5. Activity is the execution of a task or action by an individual. Participation is involvement in a life situation.

6. Activity limitations are difficulties an individual may have in executing activities Participation restrictions are problems an individual may experience in involvement in life situation

Keep in mind:

8. Personal factors are the particular background of an individual’s life and living, and comprises features of the individual that are not part of a health condition or health state.

7. Environmental factors make up the physical, social and attitudinal environment in which people live and conduct their lives.Environments may be either facilitate functioning or be a barrier to functioning.

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Task:

To check your ability to identify components of functioning In the following slide you will be shown the assignment of

components of the bio-psycho-social model of functioning to a given short case description.

Follow the presentation in this slide and go afterwards to your handout and work on the case example. Add the components of the model behind the underlined terms.

Questions:

To check your knowledge of the definitions of functioningTo check your understanding of functioning

Exercises

Handout Page 3Afterwards go to

4. The integrative Bio-Psycho-Social Model of functioning and disability

85

A 57 year old farmer was suffering a stroke eight months ago. Since

this time he is not able to move his right arm and leg as he would

like to do. Spasticity is increasing in the last months and hinders him

more and more, especially in walking. Due to the loss of his motor

functions in his right hand and arm he is not able to wash and dress

himself independently. Therefore he requires support by a nurse

since his wife has also a severe degree of disability. For walking the

farmer requires a walking aid, but in spite of this it is very difficult for

him to move around since he is living in a rural area with only very few

land development. To be able to drive a car he would need an

adapted car what he can‘t afford. Consequently he is severely limited

in his social activities. He used to play games with his friends from

his village twice the week, but walking to the bar is impossible for him

now.

Personal factor Health condition

Body function

Impairment

Activity and Participation


Environmental factor






The integrative Bio-Psycho-Social Model of functioning and disability

86

Learning ICF

5. The structure and codes of the classification

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5. The structure and codes of the ICF


• learn the organization of the structure and codes of the classification

• understand the benefit of describing functioning at different levels in the hierarchical structure

• be able to find codes in the ICF Browser

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Typically, classification is the placing of similar objects into groups


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Frequently, the objects are organized in a hierarchical structure:


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1. Classification is the placing of similar objects into groups

2. Objects are organized in a hierarchical structure


Keep in mind:

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Health condition




493 384

253

310

0


An integrative bio-psycho-social model of functioning and disability is the basis for the ICF classification.

There are large numbers of factors grouped into the components of the ICF model (except the personal factors).

classified within ICD

Body functions

Body structures

Activites & participation


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Unit of the classification:

“ICF does not classify people, but describes the situation of each person within an array of health or health-related domains.” (WHO 2001:8)

The classification provides a standard language and a common framework for the description of health and health related domains

The unit of classification is, therefore, categories within health and health-related domains.

This description is always made within the context of environmental and personal factors and health condition.


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Structure of the classification:ICF has two parts, each with two components:

Part 1: Functioning and Disabilitya) Body Functions and Structuresb) Activities and Participation

Part 2: Contextual Factorsc) Environmental Factorsd) Personal Factors

Each component consists of various chapters and, within each chapter, categories, which are the unit of classification.


In the following you will learn the structure of the ICF.

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ICF


Functioning and Disability Contextual factors

Body functions and Structures

Activities and Participation


Personal factors

Body functions

Body structures

PartsComponents

b11420 -b51059

s11000 -s76009

Fourth-level classification

b1100 -b7809

s1100 -s8309

d1550 -d9309

e1100 -e5959

Third-level classification

b110 -b899

s110 -s899

d110 -d999

e110 -e599

Second-level classification

b1 – b8 s1 – b8 d1 – d9 e1 – e5

Chapters

ICF code = Prefixes + Numeric codes + ICF Qualifiers

bb ss dd ee

Not classified

yet!

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ICF






Personal factors

Body functions

Body structures

PartsComponents

b11420 -b51059

s11000 -s76009

Fourth-level classification

b1100 -b7809

s1100 -s8309

d1550 -d9309

e1100 -e5959

Third-level classification

b110 -b899

s110 -s899

d110 -d999

e110 -e599

Second-level classification

b1 – b8 s1 – b8 d1 – d9 e1 – e5

Chapters

ICF code = Prefixes + Numeric codes + ICF Qualifiers

bb ss dd ee110110 5400254002 44014401 11011101

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An ICF code is composed of a prefix, the numeric code and an ICF Qualifier.

The letter denotes the place in the classification and the number of digits indicates the level of detail of the category.

Component sChapter

7

2nd level

30

3rd level

2

4th level

0


(N.B. This slide shows the code without a qualifier.)

97

In the following you will find an overview of the chapters of the ICF.


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ICF

b3

b5

b8

b2

b4

b7

b6

b1






Personal factors

Body functions

Body structures

Chapters

Body functions

Mental functions

Sensory functions and pain

Voice and speech functions

Functions of the cardiovascular, haematological, immunological and respiratory functions

Functions of the digestive, metabolic and endocrine system

Genitourinary and reproductive functions

Neuromusculoskeletal and movement-related functions

Functions of the skin and related structures

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ICF

s2

s3

s4

s5

s6

s7

s8

s1






Personal factors

Body functions

Body structures

Structures of the nervous system

The eye, ear and related structures

Structures involved in voice and speech

Structures of the cardiovascular, immunological and respiratory system

Structures related to the digestive, metabolic and endocrine system

Structures related to the genitourinary and reproductive system

Structures related to movement

Skin and relates structures

Body structures

Chapters

100

ICF






Personal factors

Body functions

Body structuresd1

d2

d3

d4

d5

d6

d7

d8

d8

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

Activity and participation

Chapters

101

ICF






Personal factors

Body functions

Body structures

e2

e1

e3

e4

e5

Products and technology

Natural environment/human-made changes to the environment

Support and relationship

Attitudes

Services, systems and policies


Chapters

102

The hierarchical structure of the classification allows either a broader (chapter or 2nd level classification) or a more specific (3rd or 4th level classification) description of functioning. Broader categories include the more detailed categories of the parent category.

Within each domain, the specificity of the description of an ICF category increases.

For each category (2nd, 3rd or 4th level) you can find a definition (except in the component of Body structures) together with inclusion and exclusion criteria.


In the following you will find examples for the 2nd, 3rd and 4th levels of the classification.

103

ICF

b3

b5

b8

b2

b4

b7

b6

b1






Personal factors

Body functions

Body structures

b280

b210

b215

b220

b229

b230

b235

b240

b249

b250

b255

b260

b265

b270


b210 Seeing functionsb210 Seeing functions

b215 Functions of structures adjoining the eye

b220 Sensations associated with the eye and adjoining structures

b229 Seeing and related functions, other specified and unspecified

b230 Hearing functions

b235 Vestibular functions

b240 Sensations associated with the hearing and vestibular functions

b249 Hearing and vestibular functions, other specified or unspecifiedb250 Taste functionb255 Smell functionb260 Proprioceptive functionb265 Touch functionb270 Sensory functions related to temperature and other stimulib280 Sensation of pain

104

ICF

b3

b5

b8

b2

b4

b7

b6

b1






Personal factors

Body functions

Body structures

b280

b210

b215

b220

b229

b230

b235

b240

b249

b250

b255

b260

b265

b270


b210 Seeing functions

Sensory functions related to sending the presence of light and sensing the form, size and shape and color of the visual stimuli.

Inclusions: visual acuity functions; visual field functions; quality of vision; functions of sensing light and color, visual acuity of distant and near vision, monocular and binocular visions; visual picture quality; impairments such as myopia, hypermetropia, astigmatismus, hemianopia, color-blindness, tunnel vision, central and peripheral scotoma, diplopia, night blindness and impaired adaptability to light.

Exclusion: perceptual functions (b156)

105

b2102 Quality of vision

b2100 Visual acuity functions

b2101 Visual field functions

b2108 Seeing functions, other specified

b2109 Seeing functions, unspecified

ICF

b3

b5

b8

b2

b4

b7

b6

b1






Personal factors

Body functions

Body structures

b280

b210

b215

b220

b229

b230

b235

b240

b249

b250

b255

b260

b265

b270


b210 Seeing functions

b2102 Quality of vision

Seeing functions involving light sensitivity, color vision, contrast sensitivity and the overall quality of picture

106

b210b210 Seeing functions

b2102b2102 Quality of vision

b2100

b2101

b2108

b2109

ICF

b3

b5

b8

b2

b4

b7

b6

b1






Personal factors

Body functions

Body structures

b21020 Light sensitivity

b21021 Colour vision

b21022 Contrast sensitivity

b21023 Visual picture quality

b21028 Quality of vision, other specified

b21029 Quality of vision, unspecified

b280

b215

b220

b229

b230

b235

b240

b249

b250

b255

b260

b265

b270


b21020 Light sensitivity

Seeing functions of sensing a minimum amount of light (light minimum), and the minimum difference in intensity (light difference)

Inclusion: functions of dark adaptation; impairments such as night blindness (hyposensitivity to light) and photophobia (hypersensitivity to light)

107

s710 Structure of head an neck region

s720 Structure of shoulder region

s730 Structure of upper extremity

s740 Structure of pelvic region

s750 Structure of lower extremity

s760 Structure of trunk

s770 Additional musculoskeletal structures related to movement

s798 Structures related to movement, other specifieds799 Structures related to movement, unspecified

ICF






Personal factors

Body functions

Body structures

s2

s3

s4

s5

s6

s7

s8

s1


s710

s720

s730

s740

s750

s760

s770

s798

s799


108

s7508

s7300

s7301

s7508

s7302

s7508 Structure of upper extremity, other specified

s7300 Structure of upper arm

s7301 Structure of forearm

s7302 Structure of hand

s7508 Structure of upper extremity, unspecified

ICF






Personal factors

Body functions

Body structures

s2

s3

s4

s5

s6

s7

s8

s1


s710

s720

s730

s740

s750

s760

s770

s798

s799

s730 Structure of upper extremitys7302 Structure of hand

109

ICF






Personal factors

Body functions

Body structures

s2

s3

s4

s5

s6

s7

s8

s1


s710

s720

s730

s740

s750

s760

s770

s798

s799


s7508

s7300

s7301

s7508

s7302s7302 Structure of hand

s73020 Bones of the hand

s73021 Joints of hand and fingers

s73022 Muscles of hand

s73023 Ligaments and fasciae of hand

s73028 Structure of hand, other specified

s73029 Structure of hand, unspecified

110

ICF

d1

d2

d3

d4

d5

d6

d7

d8

d9






Personal factors

Body functions

Body structures

d9 Community, social and civic life

d910 Community life

d920 Recreation and leisure

d930 Religion and spirituality

d940 Human rights

d950 Political life and citizenship

d998 Community, social and civic lifeother specified

d999 Community, social and civic life, unspecified


111

ICF

d1

d2

d3

d4

d5

d6

d7

d8

d9






Personal factors

Body functions

Body structures


d910


d930

d940

d950

d998

d999

Engaging in any form of play, recreational or leisure activity, such as informal or organized play and sports, programs of physical fitness, relaxation, amusement or diversion, going to art galleries, museums, cinemas or theatres; engaging in craft of hobbies, reading for enjoyment, playing musical instruments; sightseeing, tourism and traveling for pleasure.

112

ICF

d1

d2

d3

d4

d5

d6

d7

d8

d9






Personal factors

Body functions

Body structures


d910


d930

d940

d950

d998

d999

Inclusion: play, sports, arts and culture, crafts, hobbies and socializing

Exclusion: riding animals for transportation (d480); remunerative and non-remunerative work (d850 and d855); religion and spirituality (d930); political life and citizenship (d950)

113

ICF

d1

d2

d3

d4

d5

d6

d7

d8

d9






Personal factors

Body functions

Body structures


d910


d930

d940

d950

d998

d999

d9200 Play

d9201 Sports

d9202 Arts and culture

d9203 Crafts

d9204 Hobbies

d9205 Socializing

d9208 Recreation and leisure,other specifiedd9209 Recreation and leisure, unspecified

d9200 Play

114

ICF

d1

d2

d3

d4

d5

d6

d7

d8

d9






Personal factors

Body functions

Body structures


d910


d930

d940

d950

d998

d999

d9200 Playd9200 Play

Engaging in games with rules or unstructured or unorganized games and spontaneous recreation, such as playing chess or cards or children‘s play

115

ICF

e2

e1

e3

e4

e5






Personal factors

Body functions

Body structures

e1 Products and technologye110 Products or substances for personal consumption

e115 Products and technology for personal use in daily livinge120 Products and technology for personal indoor and outdoormobility and transportation

e125 Products and technology for communication

e130 Products and technology for education

e135 Products and technology for employment

e140 Products and technology for culture, recreation and sport

e145 Products and technology for the practice of religion and spirituality

e150 Design, construction and building products and technology of buildings for public use

e155 Design, construction and building products and technologyof buildings for private use

e160 Products and technology of land development

e165 Assets

e198 Products and technology, other specified

e198 Products and technology, unspecified

116

e110

e115

e120

e125

e130

e135

e140

e145

e150

e155

e160

e165

e198

e198

e110 Products or substances for personal consumption

e115 Products and technology for personal use in daily livinge120 Products and technology for personal indoor and outdoormobility and transportation

e125 Products and technology for communication

e130 Products and technology for education

e135 Products and technology for employment

e140 Products and technology for culture, recreation and sport

e145 Products and technology for the practice of religion and spirituality

e150 Design, construction and building products and technology of buildings for public use

e155 Design, construction and building products and technologyof buildings for private use

e160 Products and technology of land development

e165 Assets

e198 Products and technology, other specified

e198 Products and technology, unspecified

ICF

e2

e1

e3

e4

e5






Personal factors

Body functions

Body structures

e1 Products and technologye120 Products and technology for personal indoor and outdoormobility and transportation

117

e110

e115

e120

e125

e130

e135

e140

e145

e150

e155

e160

e165

e198

e198

ICF

e2

e1

e3

e4

e5






Personal factors

Body functions

Body structures


Equipment, products and technology used by people in activities of moving inside and outside buildings, including those adapted or specially designed, located in, on or near the person using them.

Inclusions: general and assistive products and technology for personal indoor and outdoor mobility and transportation

118

e110

e115

e120

e125

e130

e135

e140

e145

e150

e155

e160

e165

e198

e198

ICF

e2

e1

e3

e4

e5






Personal factors

Body functions

Body structures


e1200 General products and technology for personalindoor and outdoor mobility and transportation

e1201 Assistive products and technology for personalinddor and outdoor mobility and transportation

e1208 Products and technology for personal indoor and outdoor mobility and transportation, other specified

e1209 Products and technology for personal indoor and outdoor mobility and transportation, unspecified

e1201 Assistive products and technology for personal indoor and outdoor mobility and transportation

119

e110

e115

e120

e125

e130

e135

e140

e145

e150

e155

e160

e165

e198

e198

ICF

e2

e1

e3

e4

e5






Personal factors

Body functions

Body structures


e1201 Assistive products and technology for personalinddor and outdoor mobility and transportatione1201 Assistive products and technology for personal indoor and outdoor mobility and transportation

Adapted or specially designed equipment, products and technologies that assist people to move inside and outside buildings, such as walking devices, special cars and vans, adaptations to vehicles, wheelchairs, scooters and transfer devices

120

1. The classification is organized in parts, components, chapters (1st level) and categories on 2nd, 3rd and 4th level

3. The specificity of the definition of an aspect of functioning increases from the 1st to the 4th level


Keep in mind:

2. The chapters (1st level) and categories on 2nd, 3rd and 4th level comprise definitions with inclusion and exclusion criteria (not for Body structures)

121

The WHO provides an online ICF Web-Browser where the classification can be searched for ICF categories:

http://www.who.int/classifications/icfbrowser


122

Exercises


To check your knowledge of the structure and codes of the classification

To check your understanding of the hierarchical structure with regard to the specificity of the definitions of ICF categories

To check your ability to search the ICF Web- Browser for ICF categories to ‚translate‘ health information into the standard language of the ICF.


123

Learning ICF

6. Coding with the ICF

124


In the following section you will

• learn the ICF Qualifiers to complete an ICF code

• understand the purpose and uses of the ICF Qualifiers

• be able to document health information using the ICF within an example

125


Remember: An ICF code is composed of a prefix, the numeric code and an ICF Qualifier:

ICF code =

.4

. ICF Qualifiers

Component

Prefixes

sChapter

+ Numeric codes

7

2nd level

30

3rd level

2

4th level

0

Qualifiers complete an ICF code

126


The use of any ICF category should be accompanied by at least one qualifier. Without qualifiers, codes have no inherent meaning.

Qualifiers denote the magnitude of the level of health or severity of the problem at issue. Qualifiers are coded as one, two or more numbers after a point.

Having a problem may mean an impairment, limitation or restriction or barrier depending on the ICF construct.

Broad ranges of percentages are provided for those cases in which calibrated assessment instruments or other standards are available to quantify the problem.

However there are many categories for which there are no such standards. For these categories assessment procedures need to be developed.

127

ICF





Personal factors

Body functions

Body structures


The ICF Qualifiers for the Body Functions and Structures, Activities and Participation components classified in the ICF are quantified using the same generic scale.

In the case of environmental factors the first qualifier can be used to denote either the extent of positive effects of the environment, i.e. facilitators, or the extent of negative effects, i.e. barriers. To denote facilitators the point is replaced by a plus sign.

128

ICF

Functioning and Disability



Body functions

Body structures


XXX.0 NO problem (none, absent, negligible,…) 0 – 4%

XXX.1 MILD problem (slight, low,...) 5 – 24%

XXX.2 MODERATE problem (medium, fair...) 25 – 49%

XXX.3 SEVERE problem (high, extreme,...) 50 – 95%

XXX.4 COMPLETE problem (total,...) 96 – 100%

XXX.8 not specified (the available information does not suffice to specify the

severity of the problem)

XXX.9 not applicable (it is inappropriate or not possible to apply the code)

Contextual factors


129

ICF





Personal factors

Body functions

Body structures


XXX.0 NO barrier

XXX.1 MILD barrier

XXX.2 MODERATE barrier

XXX.3 SEVERE barrier

XXX.4 COMPLETE barrier

XXX+0 NO facilitator

XXX+1 MILD facilitator

XXX+2 MODERATE facilitator

XXX+3 SEVERE facilitator

XXX+4 COMPLETE facilitator

XXX.8 barrier, not specified XXX+8 facilitator, not specifiedXXX.9 not applicable XXX+9 not applicable

130


Here are some examples of the use of ICF Qualifier:

Eating is a fair problem, it takes much more time

My mother is an extreme support for me

The mobility in the ankle joints is severely impaired

I am able to work only part-time as a translator

d550.2 b7101.3

d850.2 e310+4

131


Using the ICF Qualifiers a functioning profile can be created. This gives a description of the complete experience of functioning.

132

1. The ICF Qualifier is needed to complete an ICF Code

2. The ICF Qualifier denotes the extent of a problem in the respective component or category


Keep in mind:

3. For environmental factors ICF Qualifiers denote the existence of facilitators, signed with a + instead a . behind the ICF category.

133

Exercises


To check your knowledge about ICF Qualifiers

To check your understanding of the use of ICF Qualifiers

To check your ability to assign ICF Qualifiers to ICF categories


134

Learning ICF

7. WHO Family of International Classifications

(FIC) ICD and ICF

135

7. WHO-FIC / ICD and ICF


• learn which classifications are in the WHO Family of International Classifications

• understand the relationship of the ICF to other classifications in the family

• be able to select appropriate classifications to complement ICF use

136

The aim of the WHO Family of International Classifications is to improve health through sound health information and to support decision making.

Hence, a full picture of health information is needed

• For complete understanding of health and the health system information, functioning is only part of the story.

• Standardized information about diseases, occupations, interventions, services and settings may be useful to complete the picture


137

Policy

Changing health through good information

Statistics

RTA

Documentation


138

The purpose of the WHO-FIC is to establish common languages to improve communication, across a range of information domains.

g35 (ICD-10)

d830 (ICF)

e1201 (ICF)

12.12 (ISO9999)

Multiple sclerosis

Participation in higher education

Wheelchair facilitator

Powered wheelchair


139

Health and wellbeing

Life expectancy, mortality

Subjective health

Functioning, disability

Illness, disease, injury

Determinants

Biomedical and genetic factors

Health behaviors

Socioeconomic factors


Interventions

Prevention and health promotion

Treatment and care

Rehabilitation

WHO uses a conceptual framework for health to indicate the range of information domains needed to for a well functioning health information system.


Resources and systems

Human

Material

Financial

Research

Evaluation

Monitoring

Surveillance

Technology

Other information

140

The WHO Family of International Classifications is a suite of classification products that can be used in an integrated fashion to compare health information

0

10

20

30

40

50

60

70

80

90

Country A Country B Country C Country D

Diagnosis 1 Diagnosis 2 Diagnosis 3

internationally,

nationally,

locally.

Disease + functioning + interventions + environment + occupation = a more complete picture


141

a set of endorsed classifications which promote appropriate selection for particular purposes defined within the framework.New classifications are developed or endorsed to fill the gaps in the family.

There are three types of classification in the WHO-FIC:– Reference classifications;– Related classifications; and– Derived classifications …and others


The WHO Family of International Classifications provides:

142

International Classification of

Diseases (ICD)


Functioning, Disability and Health

(ICF)


Health Interventions (ICHI)

(Under development)

Reference classificationsRelated classifications

• International Classification of Primary Care (ICPC)

• International Classification of External Causes of Injury (ICECI)

• The anatomical Therapeutic Chemicals classification system with Defined Daily Doses (ATC)

• ISO9999 Technical aids for persons with disabilities

• International Classification of Nursing Practice (ICNP)

Derived classifications

• ICD for Oncology, Third Edition (ICD-O-3)

• The ICD-10 Classification of Mental and Behavioural Disorders

• Application of the ICD to Dentistry and Stomatology (ICD-DA)

• Application of the ICD to Neurology (ICD-10-NA)

• ICF Version for Children and Youth (ICF-CY)


The WHO Family of International Classifications

143

Reference classifications

International Classification of Health Interventions

Under development


•are the classifications that cover the main parameters of health and the health system, such as death, disease, functioning, disability, health and health interventions.

•are a product of international agreements. •have achieved broad acceptance and official agreement for

use •are approved and recommended as guidelines for

international reporting on health.

144

Derived classifications Derived classifications

ICD for Oncology, Third Edition (ICD-O-3)

The ICD-10 Classification of Mental

and Behavioural Disorders

Application of the ICD to Dentistry and

Stomatology (ICD-DA)

Application of the ICD to Neurology (ICD-10-NA)

ICF Version for Children and Youth(ICF-CY)


• are based upon one or more reference classifications

• are consistent with them• may be designed to provide

additional detail• rearrangement or aggregation of

items from one or more reference classifications.

145

The ICF for Children and Youth (ICF-CY)

The manifestations of disability and disease in children and adolescents are different in nature, intensity and impact from those in adults.

ICF-CY includes expanded categories related to development, such as play; and categories for environments specific for children and young people.

The ICF-CY is for recording information on functioning of the developing person in the first two decades of life and the influence of the surrounding environment.


146

Related classificationsRelated classifications


Primary Care (ICPC)


External Causes of Injury (ICECI)

The anatomical Therapeutic Chemicals

(ATC) classification system with Defined

Daily Doses

ISO9999 Technical aids for persons with

disabilities

International Classification of Nursing Practice

(ICNP)


• cover important aspects of health or the health system

• are a platform for seeking maximum consistency across classifications

• include aspects of the reference classifications, for example functioning and environmental factors are included in many of the related classifications in the Family

147

The International Standard establishes a classification of technical aids for persons with disabilities. It is restricted to technical aids intended mainly for the use of an individual.

Chapter 1 of the ICF Environmental factors component includes broad classes of technical aids. The ISO9999 provides a greater level of detail for users who need it.

Technical aids for persons with disabilities (ISO9999)

ICF Products and technology for mobility (e1201)

ISO9999 Portable ramps(18.30.15)


148

The broader United Nations Family of Classifications includes classifications that can also be used to describe information domains of health and the health system, such as:

– International standard classification of occupation (ISCO),– International standard industry classification (ISIC), and– Central product classification (CPC).


149

Health condition


Personal factors



7. WHO FIC / ICD and ICF

ICD-10 and ICF complement each other

150

Health conditions (disease, injury, disorder) and associated health problems

Functioning at the level of the body (impairments), the person (activities) and the person in society (participation) as well as environmental factors


151

Single or few codes Functioning profile


M05 Seropositive Rheumatoid arthritis

152

1. The Family of Classifications can provide classifications for many aspects of health and health systems

3. The ICF and ICD are used together as complementary classifications to describe the health condition and associated functional status and environmental factors.

2. The ICF has a derived classification – the ICF-CY and related classifications

Keep in mind:


153

Exercises


To check your knowledge about the classifications in the WHO Family

To check your understanding of the application area of the different classifications

To check your understanding the relation between the ICF and ICD


the international classification of functioning, disability and health (icf)

Documents

functionsintroduction

functioning disabilityare

nature of functioning

functioning disability1

description of functioning

icffunctioning disability

persons health conditionare

social model of functioning