International Classification of Functioning, Disability and Health (ICF): Difference between revisions

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<div class="editorbox">
'''Original Editors ''' - [[User:Laura Ritchie|Laura Ritchie]]
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  &nbsp;   
</div>
== Introduction ==
== Introduction ==
The International Classification of Functioning, Disability and Health (ICF) is a framework for describing functioning and disability in relation to a health condition. It provides a common language and framework for describing the level of function of a person within their unique environment, as opposed to classifying the person by their having a specific condition or as a 'Yes/No' answer regarding disability.<ref name=":0">Sykes C. Health classifications 1 - An introduction to the ICF. WCPT Keynotes. World Confederation for Physical Therapy. 2006. </ref><ref name=":1" /> The&nbsp;World Confederation of Physical Therapy (WCPT) adopted a motion supporting the implementation of the ICF in physical therapy in 2003.<ref>Escorpizo R, Stucki G, Cieza A, Davis K, Stumbo T, Riddle DL. Creating an interface between the International Classification of Functioning, Disability and Health and physical therapist practice. Phys Ther. 2010;90:1053-63.</ref>   
[https://resources.relabhs.org/resource/a-practical-manual-for-using-the-international-classification-of-functioning-disability-and-health/ The International Classification of Functioning, Disability and Health (ICF)] is a framework for describing functioning and disability in relation to a health condition. It provides a common language and framework for describing the level of function of a person within their unique environment or in other words, what a person with a specific health condition can do in a standard environment '''(their level of capacity)''', and also what they actually do in their usual environment '''(their level of performance)''', as opposed to classifying the person by their having a specific condition or as a 'Yes/No' answer regarding disability.<ref name=":0">Sykes C. Health classifications 1 - An introduction to the ICF. WCPT Keynotes. World Confederation for Physical Therapy. 2006. </ref><ref name=":1" /> World Physiotherapy adopted a motion supporting the implementation of the ICF in physiotherapy in 2003.<ref>Escorpizo R, Stucki G, Cieza A, Davis K, Stumbo T, Riddle DL. Creating an interface between the International Classification of Functioning, Disability and Health and physical therapist practice. Phys Ther. 2010;90:1053-63.</ref>   


The ICF is a framework to approach patient care that shifts the conceptual emphasis away from negative connotations such as disability and places focus on the positive abilities of the individual at the patient level rather than the systems level.    
The ICF is a framework to approach patient care that shifts the conceptual emphasis away from negative connotations such as disability and places focus on function and the positive abilities of the individual at the patient level rather than the systems level. The video below (3.47 minutes) gives a good introduction to the ICF.  {{#ev:youtube|uoEIc4wBaIo|250}} <div class="row"><div class="col-md-6 col-md-offset-3"><div class="text-right"><ref>Pranay Jindal. Video 1 NA: What is the International Classification of Functioning, Disability and Health (ICF)?. Available from: https://youtu.be/uoEIc4wBaIo[last accessed 30/06/21]</ref></div></div></div>


== Components of the ICF ==
== Components of the ICF ==
The ICF focuses on three components: body, activities/participation (at individual and societal levels) and contextual (personal and environmental).<ref name=":0" /> These three components underscore the importance of the interplay and influence of both internal and external factors to each individual’s health status.
The ICF focuses on three components, which underscores the importance of the interplay and influence of both internal and external factors to each individual’s health status.:


<div class="clearfix">[[Image:ICF Generic Model.jpeg|center|thumb|300px|The ICF Model]] </div>
* '''Body Functions and Structures'''
* '''Activities and Participation''' (at individual and societal levels)
* '''Personal and Environmental Factors''' (at a contextual level).<ref name=":0" />
<br>
[[Image:ICF Model Generic (correct version).png|thumb|800x800px|The ICF Model|alt=|center]]


=== Body Functions and Structures ===
=== Body Functions and Structures ===
[[Image:Body with anatomy overlay.jpg|right|border|200px]]
Definitions:<ref name=":1">[https://www.wcpt.org/sites/wcpt.org/files/files/GH-ICF_overview_FINAL_for_WHO.pdf The ICF: An Overview. Available at: https://www.wcpt.org/sites/wcpt.org/files/files/GH-ICF_overview_FINAL_for_WHO.pdf]</ref>
Definitions:<ref name=":1">[https://www.wcpt.org/sites/wcpt.org/files/files/GH-ICF_overview_FINAL_for_WHO.pdf The ICF: An Overview. Available at: https://www.wcpt.org/sites/wcpt.org/files/files/GH-ICF_overview_FINAL_for_WHO.pdf]</ref>
* Body functions: The physiological functions of body systems (including psychological functions)  
* '''Body Functions:''' The physiological functions of body systems (including psychological functions)
* '''Body Structures:''' Anatomical parts of the body such as organs, limbs and their components
* '''Impairments:''' Problems in body function and structure such as significant deviation or loss


* Body structures: Anatomical parts of the body such as organs, limbs and their components
<br>Examples:
* Impairments: Problems in body function and structure such as significant deviation or loss
* ''b28010 Pain in head and neck''
* ''s720 Structure of shoulder region''
* ''s810 Structures of areas of skin''
 
<br>Note that codes relating to body functions start with '''<nowiki/>'b'<nowiki/>''' while codes relating to body structures start with '''<nowiki/>'s.''''


=== Activities and Participation ===
=== Activities and Participation ===
[[Image:Walking dog.jpg|right|border|300px]]Definitions:<ref name=":1" />
*'''Activity:''' The execution of a task or action by an individual
*'''Activity Limitations:''' Difficulties an individual may have in executing activities
*'''Participation:''' Involvement in a life situation
*'''Participation Restrictions:''' Problems an individual may experience in involvement in life situations
<br>Examples:
* ''d230 Carrying out daily routine''
* ''d420 Transferring oneself''
* ''d475 Driving''
* ''d530 Toileting''
* ''d910 Community life''
* ''d920 Recreation and leisure''


Definitions:<ref name=":1" />
<br>Note that codes relating to both activities and participation start with the letter d.
* Activity: The execution of a task or action by an individual
* Activity limitations: Difficulties an individual may have in executing activities  


* Participation: Involvement in a life situation
=== Environmental Factors ===
* Participation restrictions: Problems an individual may experience in involvement in life situations
[[Image:Busy environment.jpg|right|border|300px]]Definition:<ref name=":1" /> 
The physical, social and attitudinal environment in which people live and conduct their lives. These are either barriers to or facilitators of the person's functioning. 


=== Environmental Factors ===
Examples: 
Definition:<ref name=":1" /> The physical, social and attitudinal environment in which people live and conduct their lives. These are either barriers to or facilitators of the person's functioning.  
* ''e115 Products and technology for personal use in daily living'' 
* ''e155 Design, construction and building products and technology of buildings for private use'' 
* ''e210 Physical geography'' 
* ''e355 Health professionals'' 
<br>
Note that codes relating to environmental factors start with the letter e.


=== Personal Factors ===
=== Personal Factors ===
Line 36: Line 68:
* Chapter ''e.g. Mobility (Chapter 4)''  
* Chapter ''e.g. Mobility (Chapter 4)''  
* Block ''e.g. Walking and Moving (d450-d469)''  
* Block ''e.g. Walking and Moving (d450-d469)''  
* Two level category ''e.g. Moving around in different locations (d460)''  
* Two-level Category ''e.g. Moving around in different locations (d460)''
* Three level category ''e.g.'' ''Moving around within the home (d4600)''  
* Three-level Category ''e.g.'' ''Moving around within the home (d4600)''


== Measurement ==
== Measurement ==
A generic qualifier scale can be used to record the extent of the problem for each identified impairment, activity limitation and participation restriction. Environmental factors can also be qualified as either barriers or facilitators.  
A generic qualifier scale can be used to record the extent of the problem for each identified impairment, activity limitation and participation restriction. Environmental factors can also be qualified as either barriers or facilitators.<ref name=":7">World Health Organization. ICF Checklist Version 2.1a, Clinician Form.  2003. Available at:    http://www.who.int/classifications/icf/training/icfchecklist.pdf</ref>
{| class="wikitable"
{| class="wikitable"
!
!
!Generic Qualifier  
! '''Qualifier for Impairments of Body Functions & Structures'''
! '''Qualifier for Impairments of Activities & Participation'''
|-
|-
|0
|0
|No problem
|No impairment
| No difficulty
|-
|-
|1
|1
|Mild problem
|Mild impairment:
Present <25% of time, with tolerable intensity, occurring rarely over last 30 days
| Mild difficulty
Present <25% of time, with tolerable intensity, occurring rarely over last 30 days
|-
|-
|2
|2
|Moderate problem
|Moderate Impairment
Present <50% of time, with intensity that interferes with day to day lift, occurring occasionally over last 30 days
| Moderate Difficulty
Present <50% of time, with intensity that interferes with day to day lift, occurring occasionally over last 30 days
|-
|-
|3
|3
|Severe problem
|Severe Impairment
Present >50% of time, with intensity that's partially disrupting day to day lift, occurring frequently over last 30 days
| Severe Difficulty
Present >50% of time, with intensity that's partially disrupting day to day lift, occurring frequently over last 30 days)
|-
|-
|4
|4
|Complete problem
|Complete Impairment
Present >95% of time, with intensity that's totally disrupting day to day life, occurring daily over last 30 days
| Complete Difficulty
Present >95% of time, with intensity that's totally disrupting day to day life, occurring daily over last 30 days
|-
|-
|8
|8
|Not specified
|Not Specified
Insufficient information
|Not Specified
|-
|-
|9
|9
|Not applicable
|Not Applicable
| Not Applicable
|}
|}


{| class="wikitable"
{| class="wikitable"
!
!
!Qualifier for Environmental Barriers  
!'''Qualifier for Environmental Barriers'''
!
!
!Qualifier for Environmental Facilitators  
!'''Qualifier for Environmental Facilitators'''
|-
|-
|(.0)
|(.0)
Line 108: Line 157:
|Not applicable
|Not applicable
|}
|}
'''Explaining Walking Activity by using ICF model'''{{#ev:youtube|9BbQCOxq2q0}}


== Core Sets ==
=== Performance versus Capacity ===
The [http://www.icf-research-branch.org/download/viewcategory/5.html ICF Core Sets] were developed as a practical tool to facilitate the systematic and comprehensive description of functioning in clinical practice.<ref>Kesselring J, Coenen M, Cieza A, Thompson A, Kostanjsek N, Stucki G. Developing the ICF Core Sets for multiple sclerosis to specify functioning. Mult Scler. 2008;14:252-4.</ref><ref>Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil. 2008;44(3):329-42.</ref> They are compiled in order to provide health care professionals with a better understanding of the needs of their patient populations.<ref name=":3">Morgan KA, Engsberg JR, Gray DB. Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives. Disabil Rehabil Assist Technol. 2017 Jan;12(1):28-38.  
Definitions;
</ref> Core sets for twelve chronic diseases were initially developed because of their prevalence and the significant impact on function they can cause.<ref name=":2">Sykes C. Health classifications 2 - Using the ICF in clinical practice. WCPT Keynotes. World Confederation for Physical Therapy. 2007.</ref> These twelve diseases are;<ref name=":2" />
* '''Capacity:'''
* [[Breast Cancer]]
** What a person can do in a standardised environment e.g. during clinical assessment.<ref name=":1" /> It indicates the extent of activity limitation as a direct manifestation of a person's health status, without any assistance (assistance of another person, equipment or environmental modification).<ref name=":7" />
* Chronic Ischaemic Heart Disease
* '''Performance:'''
* [[Chronic Pain|Chronic Widespread Pain]]
** What a person actually does in his/her usual environment e.g. at home.<ref name=":1" /> It indicates the extent of participation restriction or the "lived experience" by describing all physical, social and attitudinal environmental factors.<ref name=":7" /> It measures the difficulty a person experiences in doing things, assuming that they want to do them.<ref name=":7" />
* [[Depression]]
* [[Diabetes Mellitus Type 2|Diabetes Mellitus]]
* [[Low Back Pain]]
* [[Obesity]]
* [[COPD (Chronic Obstructive Pulmonary Disease)|Obstructive Pulmonary Diseases]]
* [[Osteoarthritis]]
* [[Osteoporosis]]
* [[Rheumatoid Arthritis]]
* [[Stroke]]


Additional Core Sets have subsequently been developed for various other conditions and populations including;
<br>The gap between these two constructs reflects the impact that different environments can have on activities and participation.<ref name=":1" /> This gap can then guide intervention (e.g. on environmental factors) to help improve a patient's performance.<ref name=":1" />
* [[Ankylosing Spondylitis]] 
* [[MS Multiple Sclerosis|Multiple Sclerosis]]
* [[Cerebral Palsy Introduction|Cerebral Palsy]]
* [[Spinal Cord Injury]]
* [[Traumatic Brain Injury]]
* Neurological conditions in acute and post-acute care
* Musculoskeletal conditions in acute and post-acute care
* Geriatric patients in post-acute care
* Head and neck cancer
* Acute arthritis 


All available core sets can be viewed [https://www.icf-research-branch.org/download/category/4-icf-core-sets here].
== ICF Core Sets ==
The [http://www.icf-research-branch.org/download/viewcategory/5.html ICF Core Sets] were developed as a practical tool to facilitate the systematic and comprehensive description of functioning in clinical practice.<ref>Kesselring J, Coenen M, Cieza A, Thompson A, Kostanjsek N, Stucki G. Developing the ICF Core Sets for multiple sclerosis to specify functioning. Mult Scler. 2008;14:252-4.</ref><ref>Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil. 2008;44(3):329-42.</ref> They are compiled in order to provide health care professionals with a better understanding of the needs of their patient populations.<ref name=":3">Morgan KA, Engsberg JR, Gray DB. Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives. Disabil Rehabil Assist Technol. 2017 Jan;12(1):28-38.
</ref> Core sets for twelve chronic diseases were initially developed because of their prevalence and the significant impact on function they can cause.<ref name=":2">Sykes C. Health classifications 2 - Using the ICF in clinical practice. WCPT Keynotes. World Confederation for Physical Therapy. 2007.</ref> With additional Core Sets subsequently developed for various other conditions and populations. All available ICF Core Sets can be viewed [https://www.icf-research-branch.org/download/category/4-icf-core-sets here].


== The ICF in Relation to Wheelchair Users ==
{| width="100%" border="1" cellpadding="1" cellspacing="1"
 
The following table suggests some factors that should be considered when evaluating a patient and his/her wheelchair using the ICF.
 
{| class="wikitable sortable"
|
! Body Structures and Functions
! Activities
! Participation
! Environmental Factors
! Personal Factors
|-
|-
| Global & mental function
! scope="col" | Chronic Diseases
| Mobility in the home
! scope="col" | Additional Core Sets
| Quality of Life
| Assistive equipment
| Age
|-
|-
| Sensory function & pain
|  
| Mobility in the community
* [https://www.icf-research-branch.org/icf-core-sets-projects2/cancer/icf-core-set-for-breast-cancer Breast Cancer]
| Community participation
 
| Seating system
*
| Understanding & performance of WC skills
*[https://www.icf-research-branch.org/icf-core-sets-projects2/cardiovascular-and-respiratory-conditions/icf-core-set-for-chronic-ischaemic-heart-disease Chronic Ischaemic Heart Disease]
|-
*[https://www.icf-research-branch.org/icf-core-sets-projects2/cardiovascular-and-respiratory-conditions/icf-core-set-for-obstructivepulmonary-diseases Chronic Obstructive Pulmonary Diseases]
| Voice & speech function
*[https://www.icf-research-branch.org/icf-core-sets-projects2/musculoskeletal-conditions/icf-core-set-for-chronic-widespread-pain Chronic Widespread Pain]
| ADLs
*[https://www.icf-research-branch.org/icf-core-sets-projects2/mental-health/icf-core-set-for-depression Depression]
| Social engagement
*[https://www.icf-research-branch.org/icf-core-sets-projects2/cardiovascular-and-respiratory-conditions/icf-core-set-for-diabetes-mellitus Diabetes Mellitus]
| Environmental control
*[https://www.icf-research-branch.org/icf-core-sets-projects2/musculoskeletal-conditions/icf-core-set-for-low-back-pain Low Back Pain]
| BMI
*[https://www.icf-research-branch.org/icf-core-sets-projects2/cardiovascular-and-respiratory-conditions/icf-core-set-for-obesity Obesity]
|-
*[https://www.icf-research-branch.org/icf-core-sets-projects2/musculoskeletal-conditions/icf-core-set-for-osteoarthritis Osteoarthritis]
| Seating position
*[https://www.icf-research-branch.org/icf-core-sets-projects2/musculoskeletal-conditions/icf-core-set-for-osteoporosis Osteoporosis]
| Physical activity & exercise
*[https://www.icf-research-branch.org/icf-core-sets-projects2/musculoskeletal-conditions/icf-core-set-for-rheumatoid-arthritis Rheumatoid Arthritis]
| Self-care
*[https://www.icf-research-branch.org/icf-core-sets-projects2/cardiovascular-and-respiratory-conditions/icf-core-set-for-stroke Stroke]
| Wheelchair design & seating configuration
| Duration of impairment
|-
|  Wheelchair & seating assessment
|
|
| Self-esteem
*[https://www.icf-research-branch.org/icf-core-sets-projects2/other-health-conditions/icf-core-set-for-persons-following-an-amputation Amputation]
| Home, community & work barriers
*[https://www.icf-research-branch.org/icf-core-sets-projects2/musculoskeletal-conditions/development-of-the-icf-core-sets-for-ankylosing-spondylitis Ankylosing Spondylitis (Axial Spondyloarthritis)]
| Marital & socio-economic status
*[https://www.icf-research-branch.org/icf-core-sets-projects2/other-health-conditions/icf-core-set-for-adhd Attention Deficit Hyperactivity Disorder (ADHD)]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/other-health-conditions/icf-core-set-for-autism-spectrum Autism Spectrum Disorder]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/mental-health/development-of-the-icf-core-sets-for-bipolar-disorders Bipolar Disorder]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/neurological-conditions/686-icf-core-set-for-adults-with-cerebral-palsy Cerebral Palsy]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/other-health-conditions/development-of-icf-core-sets-for-hand-conditions Hand Conditions]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/other-health-conditions/icf-core-set-for-hearing-loss Hearing Loss]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/other-health-conditions/icf-core-sets-for-inflammatory-bowel-diseases Inflammatory Bowel Disease]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/neurological-conditions/development-of-icf-core-sets-for-multiple-sclerosis-ms Multiple Sclerosis]
*[https://www.icf-research-branch.org/images/ICF%20Core%20Sets%20Download/icf_rehabilitation_set.pdf Rehabilitation]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/mental-health/icf-core-set-for-schizophrenia Schizophrenia]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/other-health-conditions/development-of-icf-core-sets-for-sleep Sleep]
*[[Spinal Cord Injury]]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/neurological-conditions/development-of-icf-core-sets-for-traumatic-brain-injury-tbi Traumatic Brain Injury]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/other-health-conditions/icf-core-set-for-vertigo Vertigo]
*[https://www.icf-research-branch.org/icf-core-sets-projects2/diverse-situations/icf-core-sets-for-vocational-rehabilitation Vocational Rehabilitation]
 
*
|-
|-
| Neuromusculoskeletal and movement-related functions
|}
|
=== Families and the ICF ===
| Work / employment
{{#ev:youtube|yyt0rxxYGH4|250}} <div class="row"><div class="col-md-6 col-md-offset-3"><div class="text-right"><ref>Jennifer Johannesen. Families and the ICF. Available from: https://youtu.be/yyt0rxxYGH4[last accessed 30/06/21]</ref></div></div></div>
| Transportation
| Gender
|-
|  Severity of condition
|
|
|
| Ethnicity
|-
|  Cognition
|
|
|
|
|-
|  Fitness level
|
|
|
|
|-
|  Upper extremities & trunk
|
|
|
|
|-
|} 
=== Uses of the ICF in Research and Clinical Practice ===
The ICF has been used in various ways in relation to research and clinical practice involving users of wheelchairs.  


For example, Morgan et al (2017) recommended the ICF as a useful tool for identifying key wheelchair skills that needed to be taught during initial rehabilitation versus those that can be addressed once a patient has returned to community life.<ref name=":3" /> Using the ICF, the authors identified three areas in which there was a disconnect between what was actually being taught during initial wheelchair rehabilitation and what should ideally be taught;<ref name=":3" />
=== ICF in Relation to Wheelchair Users ===
# Use of the environment for training
Please see [[ICF in Relation to Wheelchair Users|this page]] for information on use of the ICF in relation to users of wheelchairs.
# Addressing and accommodating for a psychological adjustment period
# Teaching how to care for and maintain the wheelchair 


Similarly, Requejo et al (2015) noted that limitations and restrictions imposed by possible pain and dysfunction in wheelchair users can be defined using the ICF. The authors stated that the ICF can be used both to identify key elements that must be addressed during rehabilitation and also for guiding the provision and classification of assistive technology.<ref name=":5">Requejo PS, Furumasu J, Mulroy SJ. Evidence-Based Strategies for Preserving Mobility for Elderly and Aging Manual Wheelchair Users. Top Geriatr Rehabil. 2015 Jan-Mar;31(1):26-41.
== Resources  ==
</ref> Thus, using the ICF can reduce the risk of a mismatch between the needs and capacities of the patient versus the type of wheelchair he is provided, which can in turn decrease the risk of pain, fatigue, pressure ulcers and increase quality of life, confidence and community participation.<ref name=":5" /> 
=== WHO Resources ===
#[https://resources.relabhs.org/resource/international-classification-of-functioning-disability-and-health-icf-beginners-guide/ Towards a Common Language for Functioning, Disability and Health: A guide for beginners]
#[https://resources.relabhs.org/resource/a-practical-manual-for-using-the-international-classification-of-functioning-disability-and-health/ A Practical Manual for using the International Classification of Functioning, Disability and Health]
#[https://www.icf-elearning.com/ ICF e-Learning Tool]
#*The introductory module of the ICF e-Learning Tool is online and is available in several languages. The introductory module is ideal for anyone interested in learning about the ICF.
#[http://apps.who.int/classifications/icfbrowser/ ICF Browser]&nbsp;
#*Using this online browser you can see the structure of the classification, look up the codes and definitions, create your own shortlists of ICF codes and view the classification in more than one language.
#[https://www.icf-research-branch.org/icf-core-sets ICF Core Sets]
#*Access to all current ICF Core Sets
#[https://cdn.who.int/media/docs/default-source/classification/icf/icfchecklist.pdf?sfvrsn=b7ff99e9_4&download=true ICF Checklist]&nbsp;
#*The user–friendly display of the most relevant ICF categories for clinical purposes. The checklist allows the user to identify and qualify the individuals functioning profile in a simple and time-efficient manner.
#[https://www.icf-research-branch.org/icf-case-studies ICF Case Studies]
#*To illustrate the use of the International Classification of Functioning, Disability and Health (ICF) in rehabilitation practice, Swiss Paraplegic Research initiated the project "Case studies" in 2007. Using ICF tools within the framework of the "Rehab-Cycle", it follows the rehabilitation journey of a number of individuals with a spinal cord injury.


Mortenson et al (2008) used the ICF to evaluate wheelchair-specific outcome measures in relation to wheelchair activity and participation. They found two issues when using the ICF for this purpose. First, the majority of items in the outcome measures were coded as d465 (''Moving around with equipment'') on the ICF, thus the authors suggested that without a subsequent level to break this category down further, this code provides insufficient detail.<ref name=":4">Mortenson WB, Miller WC, Auger C. Issues for the selection of wheelchair-specific activity and participation outcome measures: a review. Arch Phys Med Rehabil. 2008 Jun;89(6):1177-86.
=== Videos ===
</ref> For example, there is no way to specify the type of equipment being used, the surface in question or whether the patient has to negotiate kerbs, inclines or thresholds. Second, the ICF does not include any subjective elements related to activity and participation.<ref name=":4" />
<div class="row">
 
  <div class="col-md-3"> {{#ev:youtube|O2pRqr-THMs|150}} <div class="text-right"><ref>Pranay Jindal. Video 2 NA: What is “Body Structure and Function”?. Available from: https://youtu.be/O2pRqr-THMs[last accessed 30/06/21]</ref></div></div>
McDonald et al (2016) suggested that the ICF in itself would be a useful outcome measure in relation to wheelchair seating, positioning and mobility. <ref name=":6">McDonald R, Rushton P, Giesbrecht E, Kirby RL, Viswanathan P, Casey J.Outcome measurement in wheelchair seating, positioning and mobility. European Seating Symposium, Dublin, Ireland. European Seating Symposium. 2016. 4 pp. [Conference contribution]</ref> The authors note that wheelchairs have two main purposes; 1) compensating for or improving body functions and structure and 2) enhancing performance in seating, function and wheeled mobility. Thus, determining the overall success of wheelchair prescription can be a complicated task when reconciling these two purposes. In addition, these two purposes do not include social or environmental factors.<ref name=":6" /> By using the ICF as an outcome measure for wheelchair prescription, all contextual factors would be considered and, importantly, given equal weight when determining the suitability of a given wheelchair for a given patient.<ref name=":6" />    
  <div class="col-md-3">{{#ev:youtube|mwYxs567Cg0|150}} <div class="text-right"><ref>Pranay Jindal. Video 3 NA: What are “Activity and Participation”?. Available from: https://youtu.be/mwYxs567Cg0[last accessed 30/06/21]</ref></div></div>
 
<div class="col-md-3">{{#ev:youtube|-j0495iwCX0|150}} <div class="text-right"><ref>Pranay Jindal. Video 4 NA: What are “contextual factors”?. Available from: https://youtu.be/-j0495iwCX0[last accessed 30/06/21]</ref></div></div>
== Resources  ==
<div class="col-md-3">{{#ev:youtube|Vj7cF63egGU|150}} <div class="text-right"><ref>Pranay Jindal. Video 5 NA: How do different parts of the ICF work together?. Available from: https://youtu.be/Vj7cF63egGU[last accessed 30/06/21]</ref></div></div>
* [http://www.wcpt.org/sites/wcpt.org/files/files/KN-ICF-Intro-eng.pdf An introduction to the International Classification of Functioning, Disability and Health (ICF)] from the WCPT
</div>
* [http://www.wcpt.org/sites/wcpt.org/files/files/KN-ICF-Clinical_practice.pdf Using the ICF in Clinical Practice]&nbsp;from the WCPT
* [http://www.wcpt.org/node/100042 World Health Organization ICF Resources], a summary from the WCPT
* [http://www.icf-research-branch.org/download/viewcategory/5.html ICF Core Sets]
* [http://www.who.int/classifications/icf/icfchecklist.pdf ICF Checklist Version 2.1a Clinician Form]


== References  ==
== References  ==
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<references />


  [[Category:Assessment]]
[[Category:Assessment]]
[[Category:Course Pages]]
[[Category:Wheelchair Service Provision Content Development Project]]
[[Category:Rehabilitation]]
[[Category:Understanding Rehabilitation Content Development Project]]
[[Category:ReLAB-HS Course Page]]

Latest revision as of 12:04, 15 November 2022

Original Editors - Laura Ritchie

Top Contributors - Laura Ritchie, Naomi O'Reilly, Kim Jackson, Admin, Shaimaa Eldib, Oyemi Sillo, WikiSysop, Lucinda hampton, Merinda Rodseth, Rachael Lowe, Tarina van der Stockt, Simisola Ajeyalemi, Lauren Kwant, Nicole Hills and Ewa Jaraczewska      

Introduction[edit | edit source]

The International Classification of Functioning, Disability and Health (ICF) is a framework for describing functioning and disability in relation to a health condition. It provides a common language and framework for describing the level of function of a person within their unique environment or in other words, what a person with a specific health condition can do in a standard environment (their level of capacity), and also what they actually do in their usual environment (their level of performance), as opposed to classifying the person by their having a specific condition or as a 'Yes/No' answer regarding disability.[1][2] World Physiotherapy adopted a motion supporting the implementation of the ICF in physiotherapy in 2003.[3]

The ICF is a framework to approach patient care that shifts the conceptual emphasis away from negative connotations such as disability and places focus on function and the positive abilities of the individual at the patient level rather than the systems level. The video below (3.47 minutes) gives a good introduction to the ICF.

[4]

Components of the ICF[edit | edit source]

The ICF focuses on three components, which underscores the importance of the interplay and influence of both internal and external factors to each individual’s health status.:

  • Body Functions and Structures
  • Activities and Participation (at individual and societal levels)
  • Personal and Environmental Factors (at a contextual level).[1]


The ICF Model

Body Functions and Structures[edit | edit source]

Body with anatomy overlay.jpg

Definitions:[2]

  • Body Functions: The physiological functions of body systems (including psychological functions)
  • Body Structures: Anatomical parts of the body such as organs, limbs and their components
  • Impairments: Problems in body function and structure such as significant deviation or loss


Examples:

  • b28010 Pain in head and neck
  • s720 Structure of shoulder region
  • s810 Structures of areas of skin


Note that codes relating to body functions start with 'b' while codes relating to body structures start with 's.'

Activities and Participation[edit | edit source]

Walking dog.jpg

Definitions:[2]

  • Activity: The execution of a task or action by an individual
  • Activity Limitations: Difficulties an individual may have in executing activities
  • Participation: Involvement in a life situation
  • Participation Restrictions: Problems an individual may experience in involvement in life situations


Examples:

  • d230 Carrying out daily routine
  • d420 Transferring oneself
  • d475 Driving
  • d530 Toileting
  • d910 Community life
  • d920 Recreation and leisure


Note that codes relating to both activities and participation start with the letter d.

Environmental Factors[edit | edit source]

Busy environment.jpg

Definition:[2]

The physical, social and attitudinal environment in which people live and conduct their lives. These are either barriers to or facilitators of the person's functioning.

Examples:

  • e115 Products and technology for personal use in daily living
  • e155 Design, construction and building products and technology of buildings for private use
  • e210 Physical geography
  • e355 Health professionals


Note that codes relating to environmental factors start with the letter e.

Personal Factors[edit | edit source]

Personal Factors should also be considered in this model but are not classified within the actual ICF framework.[1]

Contents of ICF Components[edit | edit source]

Each component is divided into a hierarchy with an additional digit added to the classification code for each subsequent layer in the hierarchy. The hierarchy is as follows;[1]

  • Component e.g. Activities and participation
  • Chapter e.g. Mobility (Chapter 4)
  • Block e.g. Walking and Moving (d450-d469)
  • Two-level Category e.g. Moving around in different locations (d460)
  • Three-level Category e.g. Moving around within the home (d4600)

Measurement[edit | edit source]

A generic qualifier scale can be used to record the extent of the problem for each identified impairment, activity limitation and participation restriction. Environmental factors can also be qualified as either barriers or facilitators.[5]

Qualifier for Impairments of Body Functions & Structures Qualifier for Impairments of Activities & Participation
0 No impairment No difficulty
1 Mild impairment:

Present <25% of time, with tolerable intensity, occurring rarely over last 30 days

Mild difficulty

Present <25% of time, with tolerable intensity, occurring rarely over last 30 days

2 Moderate Impairment

Present <50% of time, with intensity that interferes with day to day lift, occurring occasionally over last 30 days

Moderate Difficulty

Present <50% of time, with intensity that interferes with day to day lift, occurring occasionally over last 30 days

3 Severe Impairment

Present >50% of time, with intensity that's partially disrupting day to day lift, occurring frequently over last 30 days

Severe Difficulty

Present >50% of time, with intensity that's partially disrupting day to day lift, occurring frequently over last 30 days)

4 Complete Impairment

Present >95% of time, with intensity that's totally disrupting day to day life, occurring daily over last 30 days

Complete Difficulty

Present >95% of time, with intensity that's totally disrupting day to day life, occurring daily over last 30 days

8 Not Specified

Insufficient information

Not Specified
9 Not Applicable Not Applicable
Qualifier for Environmental Barriers Qualifier for Environmental Facilitators
(.0) No barrier (+0) No facilitator
(.1) Mild barrier (+1) Mild facilitator
(.2) Moderate barrier (+2) Moderate facilitator
(.3) Severe barrier (+3) Substantial facilitator
(.4) Complete barrier (+4) Complete facilitator
(.8) Barrier, not specified (+8) Facilitator, not specified
(.9) Not applicable (+9) Not applicable

Explaining Walking Activity by using ICF model

Performance versus Capacity[edit | edit source]

Definitions;

  • Capacity:
    • What a person can do in a standardised environment e.g. during clinical assessment.[2] It indicates the extent of activity limitation as a direct manifestation of a person's health status, without any assistance (assistance of another person, equipment or environmental modification).[5]
  • Performance:
    • What a person actually does in his/her usual environment e.g. at home.[2] It indicates the extent of participation restriction or the "lived experience" by describing all physical, social and attitudinal environmental factors.[5] It measures the difficulty a person experiences in doing things, assuming that they want to do them.[5]


The gap between these two constructs reflects the impact that different environments can have on activities and participation.[2] This gap can then guide intervention (e.g. on environmental factors) to help improve a patient's performance.[2]

ICF Core Sets[edit | edit source]

The ICF Core Sets were developed as a practical tool to facilitate the systematic and comprehensive description of functioning in clinical practice.[6][7] They are compiled in order to provide health care professionals with a better understanding of the needs of their patient populations.[8] Core sets for twelve chronic diseases were initially developed because of their prevalence and the significant impact on function they can cause.[9] With additional Core Sets subsequently developed for various other conditions and populations. All available ICF Core Sets can be viewed here.

Chronic Diseases Additional Core Sets

Families and the ICF[edit | edit source]

[10]

ICF in Relation to Wheelchair Users[edit | edit source]

Please see this page for information on use of the ICF in relation to users of wheelchairs.

Resources[edit | edit source]

WHO Resources[edit | edit source]

  1. Towards a Common Language for Functioning, Disability and Health: A guide for beginners
  2. A Practical Manual for using the International Classification of Functioning, Disability and Health
  3. ICF e-Learning Tool
    • The introductory module of the ICF e-Learning Tool is online and is available in several languages. The introductory module is ideal for anyone interested in learning about the ICF.
  4. ICF Browser 
    • Using this online browser you can see the structure of the classification, look up the codes and definitions, create your own shortlists of ICF codes and view the classification in more than one language.
  5. ICF Core Sets
    • Access to all current ICF Core Sets
  6. ICF Checklist 
    • The user–friendly display of the most relevant ICF categories for clinical purposes. The checklist allows the user to identify and qualify the individuals functioning profile in a simple and time-efficient manner.
  7. ICF Case Studies
    • To illustrate the use of the International Classification of Functioning, Disability and Health (ICF) in rehabilitation practice, Swiss Paraplegic Research initiated the project "Case studies" in 2007. Using ICF tools within the framework of the "Rehab-Cycle", it follows the rehabilitation journey of a number of individuals with a spinal cord injury.

Videos[edit | edit source]

[11]
[12]
[13]
[14]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Sykes C. Health classifications 1 - An introduction to the ICF. WCPT Keynotes. World Confederation for Physical Therapy. 2006.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 The ICF: An Overview. Available at: https://www.wcpt.org/sites/wcpt.org/files/files/GH-ICF_overview_FINAL_for_WHO.pdf
  3. ↑ Escorpizo R, Stucki G, Cieza A, Davis K, Stumbo T, Riddle DL. Creating an interface between the International Classification of Functioning, Disability and Health and physical therapist practice. Phys Ther. 2010;90:1053-63.
  4. ↑ Pranay Jindal. Video 1 NA: What is the International Classification of Functioning, Disability and Health (ICF)?. Available from: https://youtu.be/uoEIc4wBaIo[last accessed 30/06/21]
  5. ↑ 5.0 5.1 5.2 5.3 World Health Organization. ICF Checklist Version 2.1a, Clinician Form. 2003. Available at: http://www.who.int/classifications/icf/training/icfchecklist.pdf
  6. ↑ Kesselring J, Coenen M, Cieza A, Thompson A, Kostanjsek N, Stucki G. Developing the ICF Core Sets for multiple sclerosis to specify functioning. Mult Scler. 2008;14:252-4.
  7. ↑ Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil. 2008;44(3):329-42.
  8. ↑ Morgan KA, Engsberg JR, Gray DB. Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives. Disabil Rehabil Assist Technol. 2017 Jan;12(1):28-38.
  9. ↑ Sykes C. Health classifications 2 - Using the ICF in clinical practice. WCPT Keynotes. World Confederation for Physical Therapy. 2007.
  10. ↑ Jennifer Johannesen. Families and the ICF. Available from: https://youtu.be/yyt0rxxYGH4[last accessed 30/06/21]
  11. ↑ Pranay Jindal. Video 2 NA: What is “Body Structure and Function”?. Available from: https://youtu.be/O2pRqr-THMs[last accessed 30/06/21]
  12. ↑ Pranay Jindal. Video 3 NA: What are “Activity and Participation”?. Available from: https://youtu.be/mwYxs567Cg0[last accessed 30/06/21]
  13. ↑ Pranay Jindal. Video 4 NA: What are “contextual factors”?. Available from: https://youtu.be/-j0495iwCX0[last accessed 30/06/21]
  14. ↑ Pranay Jindal. Video 5 NA: How do different parts of the ICF work together?. Available from: https://youtu.be/Vj7cF63egGU[last accessed 30/06/21]
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