International Classification of Functioning, Disability and Health (ICF)
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, as opposed to classifying the person by their having a specific condition or as a 'Yes/No' answer regarding disability.[1][2] The World Confederation of Physical Therapy (WCPT) adopted a motion supporting the implementation of the ICF in physical therapy 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 the positive abilities of the individual at the patient level rather than the systems level.
Components of the ICF[edit | edit source]
The ICF focuses on three components: body, activities/participation (at individual and societal levels) and contextual (personal and environmental).[1] 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[edit | edit source]
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
Activities and Participation[edit | edit source]
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
Environmental Factors[edit | edit source]
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.
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*Note that Personal Factors are also included in this model but are not classified within the actual ICF.[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.
| Generic Qualifier | |
|---|---|
| 0 | No problem |
| 1 | Mild problem |
| 2 | Moderate problem |
| 3 | Severe problem |
| 4 | Complete problem |
| 8 | Not specified |
| 9 | 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) |
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.[4][5] 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.[6] These twelve diseases are;[6]
- 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[edit | edit source]
- 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
References[edit | edit source]
- ↑ 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.
- ↑ 2.0 2.1 2.2 2.3 The ICF: An Overview. Available at: https://www.wcpt.org/sites/wcpt.org/files/files/GH-ICF_overview_FINAL_for_WHO.pdf
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 6.0 6.1 Sykes C. Health classifications 2 - Using the ICF in clinical practice. WCPT Keynotes. World Confederation for Physical Therapy. 2007.
