International Classification of Functioning, Disability and Health (ICF) KNR 365

WHO Who is WHO? World Health Organization United Nations’ agency Established in 1948 Objective is attainment by all peoples of the highest level of health (not just absence of disease)

WHO Family of International Classifications International Classification of Diseases (ICD-10) Codes diagnoses and mortality causes International Classification of Functioning, Disability and Health (ICF) Classification system of functioning Over 1,400 classifications International Classification of Health Intervention (ICHI) Currently being developed Different professions developed own (our text)

International Classification of Functioning, Disability and Health (ICF) Provides standard language & framework for description of health & disability Across disciplines, service delivery settings, countries, disabilities TR will need to learn the content & language of ICF to talk/work with other professions Interventions Outcomes

ICF 1st version was 1980 Revised in 2001 Focused on impairment, disability & handicap Revised in 2001 Focuses on health & functioning vs. disability Endorsed by 191 nations including US Endorsed by PT, OT, TR and other healthcare organization

ICF Classification of health and health-related domains, that help to describe: Changes in body function and structure What a person can do in a standard environment (level of capacity) What a person can do in their usual environment (level of performance)

ICF Applications (Individual level) For the assessment of individuals: What is the person's level of functioning? For individual treatment planning: What treatments or interventions can maximize functioning? For the evaluation of treatment and other interventions: What are the outcomes of the treatment? How useful were the interventions? For communication among physicians, nurses, physiotherapists, and other health works, social service works and community agencies For self-evaluation by consumers: How would I rate my capacity in mobility or communication?

Conceptual Models of Disability What is the Medical Model? Views disability as feature of person Disability is directly caused by disease, trauma, or other health conditions Requires medical care provided by professionals Call for medical treatment or intervention to “correct” the problem

Conceptual Models of Disability What is the Social Model? Views disability as a socially created problem It is not just an attribute of a person Disability demands a political response Problems are created by unaccommodating physical environment brought about by attitudes & other features of the social environment

Conceptual Models of Disability What is the Biopsychosocial Model? ICF based on this model Integration of medical & social models Disability and function viewed as outcomes of interaction between health conditions (disease, disorders, injuries) and contextual factors

Conceptual Models of Disability Contextual factors External environmental factors Social attitudes, architectural barriers, legal & social structures, climate, etc. Internal personal factors Gender, age, coping skills, social background, education, past & present experiences, etc. Factors that influence how disability is experienced by the individual

Biopsychosocial Model: ICF Interactions

Key ICF Definitions Body functions: physiological functions of body systems Body structures: anatomical parts of the body Impairments: problems in body function or structure Activity: execution of a task or action Participation: involvement in a life situation Participation restrictions: problems in involvement in life situations Environmental factors: make up the physical, social and attitudinal environment in which people live.

Conceptual Model of ICF Part 1. Functioning and Disability (a) Body Functions and Structures - Changes in body functions (physiological) - Changes on body structures (anatomical) (b) Activities and Participation - Capacity: Executing tasks in a standard environment - Performance: Executing tasks in the current environment

Conceptual Model of ICF Part 2. Contextual Factors (c) Environmental factors - Facilitating or hindering impact of features of the physical, social, and attitudinal world (d) Personal factors - Impact of attributes of person See Porter & burlingame, p. 4

Body Functions (b – many TR scope) (relates to function in isolation) Mental functions Sensory functions and pain Voice and speech functions Functions of cardiovascular, hematological, immunological and respiratory systems Functions of the digestive, metabolic and endocrine systems Genitourinary and reproductive functions Neuromusculoskeletal and movement related functions Functions of skin and related structures

Body Structures (s – doctor score) Structures of the nervous system Eye, ear and related structures Structures involved in voice and speech Structures of the cardiovascular, immunological and respiratory systems Structures related to the digestive, metabolic and endocrine systems Structures related to the genitourinary and reproductive system Structures related to movement Skin and related structures

Activities and Participation (d – TR scope) (relates to ability to do an activity) 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

Environmental Factors (e – TR scope) Products and technology Natural environment and human-made changes to environment Support and relationships Attitudes Services, systems and policies

Personal Factors Not coded in ICF because of wide international variability Still included because of importance to understanding functioning & disability Age Race Gender Food preferences Fitness Lifestyle Habits Upbringing Coping styles Education Social background

ICF Coding Example Level Example Coding Chapter Chapter 2: Sensory Functions and Pain b2 2nd level Seeing Functions b210 3rd level Quality of vision b2102 4th level Colour vision b21021

ICF Qualifiers ICF domain becomes a classification when qualifiers are used Qualifiers record presence and severity of a problem in functioning at the body, person, and societal levels 1 or 2 qualifiers may apply per ICF domain

ICF Qualifiers (cont.) Scale Descriptor % No problem (none, absent, negligible) 0-4 1 Mild problem (slight, low) 2-24 2 Moderate (medium, fair) 25-49 3 Severe (high, extreme) 50-95 4 Complete (total) 96-100

ICF Qualifiers (cont.) Construct First Qualifier Second Qualifier Body Functions (b) Generic qualifier with the negative scale used to indicate the extent or magnitude of an impairment Example: b167.3 to indicate a severe impairment in specific mental functions of language None

ICF Qualifiers (cont.) Construct First Qualifier Second Qualifier Body Structure (s) Generic qualifier with the negative scale used to indicate the extent or magnitude of an impairment Example: s730.3 to indicate a severe impairment of the upper extremity Used to indicate the nature of the change in the respective body structure 0 no change in structure 1 total absence 2 partial absence 3 additional part 4 aberrant dimensions 5 discontinuity 6 deviating position 7 qualitative changes in structure, including accumulation of fluid 8 not specified 9 not applicable Example: s7300.32 to indicate the partial absence of the upper extremity

ICF Qualifiers (cont.) Construct First Qualifier Second qualifier Activity & Participation (d) PERFORMANCE Generic qualifier Problem in the person's current environment Example: d5101.1_ to indicate mild difficulty with bathing the whole body with the use of assistive devices that are available to the person in his or her current environment CAPACITY Limitation without assistance Example: d5101._2 to indicate moderate difficulty with bathing the whole body and implies that there is moderate difficulty without the use of assistive devices or personal help

ICF Qualifiers (cont.) Construct First Qualifier Second Qualifier Environmental Factors (e) Generic qualifier, with negative and positive scale to denote extent of barriers and facilitators respectively Example: e130.2 to indicate that products for education are a moderate barrier. Conversely, e130+2 would indicate that products for education are a moderate facilitator None

ICF Core Sets Brain injury rehabilitation Breast cancer Cardiopulmonary conditions Depression Multiple Sclerosis Stroke Etc. Also ICF-CY (children)

ICF TR Resources Howard, D., Browning, C., & Lee, Y. (2007). The International Classification of Functioning, Disability, and Health: Therapeutic recreation code sets and salient diagnostic core sets. Therapeutic Recreation Journal, 41(1), 61-81. Porter, H. R., & VanPuymbroeck, M. (2007). Utilization of the International Classification of Functioning, Disability, and Health within therapeutic recreation practice. Therapeutic Recreation Journal, 41(1), 47-60.