INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) AND ITS APPLICATION IN PATIENTS

-HETVI BHATT

CONTENTS Introduction of ICF Need for ICF Aims of ICF Application of ICF

Introduction of ICF What is ICF?

unified and standard language framework for the description of

health and health-related states. Domains

- individual body functions and structure

- societal perspectives activity and participation

- Physical rehabilitation, fifth edition; Susan B. O’Sullivan, Thomas J. Schimtz; page no:375

Terminologies used in ICF Well-being Health condition Health states and health

domains Health-related states and health-

related domains Functioning Disability - International classification of functioning, disability and

health : ICF. World Health Organization 2001; page no- 211-219

Body functions Body structures Impairment Activity Activity limitations Participation Participation restriction Contextual factors

Environmental factors Personal factors Facilitators Barriers Capacity Performance Domains Categories Levels

ICF - WHO's framework for health and disability universal classification of

disability and health named to stress health and

functioning, rather than disability.

“consequences of disease” “components of health”

- International classification of functioning, disability and health : ICF. World Health Organization 2001; page no- 1-3

Complimentary to ICD-10 WHO encourages their use

together as ICD-10

- Towards a Common Language for Functioning, Disability and Health ICF World Health OrganizationGeneva2002

Development of ICF1972

• WHO developed a preliminary scheme

1976

• Twenty-ninth World Health Assembly

1980• ICIDH was

published

1993 • Revision of ICIDH- International classification of functioning, disability and health : ICF. World Health Organization 2001; page no- 246-250

1997• Beta-1 draft was

produced

1999• Beta- 2 draft was

produced

2000• Prefinal version of

ICIDH-2

2001

• The Fifty-fourth World Health Assembly,

• Endorsement of the final version

Need for ICF Medical classification of diagnoses

alone not sufficient health planning and management purposes

For basic public health purposes need reliable and comparable data

provides the foundations for country-level disability data

Need a way of classifying domains of areas of life

- Towards a Common Language for Functioning, Disability and Health ICF World Health OrganizationGeneva2002

Aims of ICF: To understand and study health - health-related states - outcomes and determinants to establish a common language to permit comparison of data to provide a systematic coding

scheme

- International classification of functioning, disability and health : ICF. World Health Organization 2001; page no- 3-5

Application of ICF At the individual level : - Personal’s level of functioning - Treatment and outcome measures - Communication - Self evaluation

- Towards a Common Language for Functioning, Disability and Health ICF World Health OrganizationGeneva2002

At the institutional level: - Educational and training

purpose - Resource planning and

development - Quality improvement - Management and outcome

evaluation - Research purpose

At the social level: - Security purpose and

insurance benefit - Social policy and legislative

purpose - For universal designing - Environmental modification

Properties of ICF

1) Universe of ICF - all aspects of human health and

some health-relevant components of well-being

2) Scope of ICFICF

1.Components of Functioning and Disability

Body Functionsand Structures

Activities andParticipation

2. Components of Contextual Factors

Environmental Factors

Personal Factors

•ICF has identified the following generic qualifier scale:– NO problem (none, absent, negligible) 0-4%– MILD problem (slight, low…) 2-24%– MODERATE (medium, fair) 25-49%– SEVERE (high, extreme, …) 50-95%– COMPLETE (total…) 96-100%

3) Unit of classification- Classifies health and health-related

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

4) Presentation of ICF- Full version- Short version

- International classification of functioning, disability and health : ICF. World Health Organization 2001; page no- 3-5

Coding guidelines for ICF

Parts of the Classification

Part 1 - Body Functions and Body Structures - Activities and Participation.  Part 2 - Environmental Factors- Personal Factors (currently not classified in

the ICF)- International classification of functioning, disability and

health : ICF. World Health Organization 2001; page no-219-234

• b for Body Functions and• s for Body Structures• d for Activities and Participation• e for Environmental Factors

34 – chapters 362- second level 1424 - codes, third and fourth

level

Inclusion terms Exclusion terms Other specified Unspecified

General coding rules - Select an array of codes to form

an individual’s profile - Code relevant information - Code explicit information - Code specific information

Component-specific coding rules- Coding body functions -The impairment of a person with

hemiparesis can be described with code b7302 Power of muscles of one side of the body

Once an impairment is present, it can be scaled in severity using the generic qualifier

For example:• b7302.1 (5–24 %)• b7302.2 (25–49 %)• b7302.3 (50–95 %)• b7302.4 (96–100 %)

The absence of an impairment (according to a predefined threshold level) is indicated by the value “0” for the generic qualifier.

* For example:• b7302.0

If there is insufficient information to specify the severity of the impairment, the value “8” should be used.

• b7302.8

Coding body structures -The impairment of a person

with hemiparesis mainly in ankle foot region of lower limb

Scaling of qualifiers for body structures

s75022.

i.e.75022.222

Coding the Activities and Participation component

- For example, the performance of a person who is having less power in his left leg due to hemiparesis and since then has used a cane but faces moderate difficulties in walking around because the sidewalks in the neighbourhood are very steep and have a very slippery surface

i.e. d4500.3 _ moderate restriction in performance of walking short distances

For the capacity qualifier, this domain refers to the an individual’s ability to walk around without assistance.

For example, the true ability of the above-mentioned person to walk without a cane in a standardized environment (such as one with flat and non-slippery surfaces) will be very limited.

d4500._ 3

Coding environmental factors

for example: - e430: individual attitudes of

people in positions of authority General or specific opinions and

beliefs of people in positions of authority about the person or about other matters (e.g. social, political and economic issues), that influence individual behaviour and actions. 

e 430.2

ICF Core Sets • Clinicians and researchers have

identified that more than 1,400 ICF categories is not practical in daily use.

To facilitate a systematic and comprehensive description of functioning and the use of the ICF in clinical practice and research, ICF Core Sets have been developed.

- PT, OT, and SLP Services and the International Classification of Functioning, Disability, and Health (ICF) Mapping Therapy Goals to the ICF

- www.icf-research-branch.org/publications/publications

– help users better define high-risk populations by limiting the number of potential ICF categories reported for similar groups of individuals.

– help users continually improve their quality processes.

– reduce variability in describing the health condition of similar patient.

– support outcomes research for targeted populations

Type of Core Sets Comprehensive– Guide for multi-professional

comprehensive assessment. Brief– Minimal standard for assessment and

reporting of functioning for clinical studies and clinical reports and encounters.

Numerous Core Sets have been developed and validated for specific outpatient therapy patient populations.

Summary

Unique, unified, universal Applied to all health conditions Every level Helpful Subjective Versatility Time consuming Training

Take home message

Users are strongly recommended to obtain training in the use of the classification through WHO and its network of collaborating centres.

References and links

Physical rehabilitation, fifth edition; Susan B. O’Sullivan, Thomas J. Schimtz

Therapeutic Exercises, 5th edition ; Carolyn Kisner and Lynn Allen Colby

ICF home page: www.who.int/classifications/icf/

ICF Training Beginner’s Guide (18 pages)– At ICF home page, click on ‘Application

and Training Tools link in the MORE INFORMATION section. The full text link is in the TRAINING MATERIALS section.

International Classification of Functioning, Disability and Health: ICF (299 pages):

http://www.handicapincifre.it/documenti/ICF_18.pdf

– Comprehensive ICF manual.

ICF Research Branch: www.icf-research-branch.org

– Information about ongoing ICF research and publications including the development of ICF Core Sets.

ICF Online: Contains interactive ICF Browser tool:

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

– Can search all ICF categories by the stem/branch/leaf scheme within each component or by keyword (next slide).

APTA: www.apta.org– From home page ‘Areas of Interest’

section, click on ‘Practice’ link, then ‘Clinical Practice Resources’ link, then ‘ICF Resources’ link.

AOTA: www.aota.org ASHA: www.asha.org/slp/icf.htm