International Classification of Functioning, Disability and Health (ICF)

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 documenting information on the level of function and functional change of a person within their own environment, as opposed to classifying the actual person e.g. according to a specific condition or disease. (WCPT keynote). The World Confederation of Physical Therapy (WCPT) adopted a motion supporting the implementation of the ICF in physical therapy in 2003.

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.

Components of the ICF

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

Body Functions and Structures

Definitions:

• 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

Activities and Participation

Definitions:

• 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

Environmental Factors

Definition: 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.

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*Note that Personal Factors are also included in this model but are not classified within the actual ICF.

Contents of ICF Components

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;

• 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)

Core Sets

The ICF Core Sets were developed as a practical tool to facilitate the systematic and comprehensive description of functioning in clinical practice. Twelve chronic diseases were the initial focus of the development of these core sets because of their prevalence and the significant impact on function they can cause. These twelve diseases are;

• Breast Cancer
• Chronic Ischaemic Heart Disease
• Chronic Widespread Pain
• Depression
• Diabetes Mellitus
• Low Back Pain
• Obesity
• Obstructive Pulmonary Diseases
• Osteoarthritis
• Osteoporosis
• Rheumatoid Arthritis
• Stroke

Additional Core Sets have subsequently been developed for various other conditions and populations including;

• Ankylosing Spondylitis
• Multiple Sclerosis
• 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

Resources

• An introduction to the International Classification of Functioning, Disability and Health (ICF) from the WCPT
• Using the ICF in Clinical Practice from the WCPT
• World Health Organization ICF Resources, a summary from the WCPT
• ICF Core Sets