The ICF Disability and Health in Practice, Care and Research
The ICF Disability and Health in Practice, Care and Research
Purpose of review: The aim of this article is to review the recent literature on the use of the International Classification of Functioning, Disability and Health (ICF) in practice in rheumatological care and research. The specific aims were to explore how the ICF has been used as a frame of reference for identifying functional problems of patients using qualitative and quantitative research methods; determining typical problem areas of functioning; and measuring functioning of people with rheumatic diseases.
Recent findings: The ICF was used as a frame of reference for formulating interview questions and for analysing data in qualitative research. The majority of experiences of patients could be linked to the ICF. In quantitative surveys and by reviewing medical records, the ICF could be used as a model to identify problem areas of patients from the perspective of experts. The ICF served as a frame of reference for performing content comparisons of several health-status instruments.
Summary: In rheumatological care and research, the translation of aspects of functioning important to patients and of the content of health-status instruments to ICF terms enables researchers and clinicians to condense and compare the meaning of patients' experiences and the content of the instruments.
Functioning is a key concept in rheumatological care and outcome research in that it can help to better understand, evaluate and measure people's daily experiences, limitations and resources. In rehabilitation, functioning not only represents an outcome, but it is also the starting point of clinical assessment and intervention management.
The International Classification of Functioning, Disability and Health (ICF) offers a comprehensive understanding of functioning. In the ICF, functioning is described as the complex interplay of the so-called health components - body functions, body structures, activities and participation, environmental and personal factors. The health components are linked to each other in the model of the ICF (Fig. 1). The health components are subclassified in the model of the ICF into more than 1400 categories. In order to find the most suitable ICF category for each concept, specific rules for the linking have been developed. Linking concepts to the ICF means to 'translate' concepts from instruments, theoretical models or from interviews with patients into ICF terms in order to have a common frame of reference for comparing the content.
(Enlarge Image)
The model of the International Classification of Functioning, Disabilities and Health (ICF)
Before the introduction of the ICF, two major models have been used in the field of functioning and disability: the International Classification of Impairment, Disability and Handicap (ICIDH) and the 'functional limitation' or Nagi framework. In contrast to the ICIDH, the Nagi framework was not accompanied by a classification. In contrast to both the ICIDH and the Nagi framework, the ICF now focuses on functioning instead of impairment and is based on a biopsychosocial model. While the biomedical model focuses on the physical dimension of the body, the biopsychosocial model takes a holistic perspective of disability and functioning of a human being. Due to this underlying approach, the ICF establishes the beginning of a new era of patient-oriented clinical practice, research and teaching. Within this context, the approval of the ICF by the World Health Assembly in May 2001 can be considered a landmark event. Being a member of the family of classifications from the WHO, the ICF should therefore be preferentially applied in rehabilitation all over the world. The overall aim of the ICF classification is to provide a unified and standard framework and language for the description of health and health-related states and a common framework for all health professions.
Disability is a term which is commonly used in the medical literature. Disability is an umbrella term for impairments, limitations in activities, and restrictions in participation. From the perspective of the biopsychosocial model in the ICF, functioning is implicitly addressed when disability is studied and vice versa. While professionals have traditionally been using the term 'disability' in medical texts, for people with a certain disease the complement of 'disability', namely 'functioning' in daily life, may be of greater interest. The ICF acknowledges this perspective by including 'activity and participation' in the model of functioning and in the classification. Activity is defined in the ICF as the execution of a task or action by an individual, whereas participation is the person's involvement in a daily life situation.
The aim of this article is to review the recent literature on the use of the ICF in practice in rheumatological care and research. The specific aims were to explore how the ICF has been used as a frame of reference for the identification of functional problems of patients using qualitative and quantitative research methods; determining typical problem areas of functioning; and measuring functioning of people with rheumatic diseases.
Purpose of review: The aim of this article is to review the recent literature on the use of the International Classification of Functioning, Disability and Health (ICF) in practice in rheumatological care and research. The specific aims were to explore how the ICF has been used as a frame of reference for identifying functional problems of patients using qualitative and quantitative research methods; determining typical problem areas of functioning; and measuring functioning of people with rheumatic diseases.
Recent findings: The ICF was used as a frame of reference for formulating interview questions and for analysing data in qualitative research. The majority of experiences of patients could be linked to the ICF. In quantitative surveys and by reviewing medical records, the ICF could be used as a model to identify problem areas of patients from the perspective of experts. The ICF served as a frame of reference for performing content comparisons of several health-status instruments.
Summary: In rheumatological care and research, the translation of aspects of functioning important to patients and of the content of health-status instruments to ICF terms enables researchers and clinicians to condense and compare the meaning of patients' experiences and the content of the instruments.
Functioning is a key concept in rheumatological care and outcome research in that it can help to better understand, evaluate and measure people's daily experiences, limitations and resources. In rehabilitation, functioning not only represents an outcome, but it is also the starting point of clinical assessment and intervention management.
The International Classification of Functioning, Disability and Health (ICF) offers a comprehensive understanding of functioning. In the ICF, functioning is described as the complex interplay of the so-called health components - body functions, body structures, activities and participation, environmental and personal factors. The health components are linked to each other in the model of the ICF (Fig. 1). The health components are subclassified in the model of the ICF into more than 1400 categories. In order to find the most suitable ICF category for each concept, specific rules for the linking have been developed. Linking concepts to the ICF means to 'translate' concepts from instruments, theoretical models or from interviews with patients into ICF terms in order to have a common frame of reference for comparing the content.
(Enlarge Image)
The model of the International Classification of Functioning, Disabilities and Health (ICF)
Before the introduction of the ICF, two major models have been used in the field of functioning and disability: the International Classification of Impairment, Disability and Handicap (ICIDH) and the 'functional limitation' or Nagi framework. In contrast to the ICIDH, the Nagi framework was not accompanied by a classification. In contrast to both the ICIDH and the Nagi framework, the ICF now focuses on functioning instead of impairment and is based on a biopsychosocial model. While the biomedical model focuses on the physical dimension of the body, the biopsychosocial model takes a holistic perspective of disability and functioning of a human being. Due to this underlying approach, the ICF establishes the beginning of a new era of patient-oriented clinical practice, research and teaching. Within this context, the approval of the ICF by the World Health Assembly in May 2001 can be considered a landmark event. Being a member of the family of classifications from the WHO, the ICF should therefore be preferentially applied in rehabilitation all over the world. The overall aim of the ICF classification is to provide a unified and standard framework and language for the description of health and health-related states and a common framework for all health professions.
Disability is a term which is commonly used in the medical literature. Disability is an umbrella term for impairments, limitations in activities, and restrictions in participation. From the perspective of the biopsychosocial model in the ICF, functioning is implicitly addressed when disability is studied and vice versa. While professionals have traditionally been using the term 'disability' in medical texts, for people with a certain disease the complement of 'disability', namely 'functioning' in daily life, may be of greater interest. The ICF acknowledges this perspective by including 'activity and participation' in the model of functioning and in the classification. Activity is defined in the ICF as the execution of a task or action by an individual, whereas participation is the person's involvement in a daily life situation.
The aim of this article is to review the recent literature on the use of the ICF in practice in rheumatological care and research. The specific aims were to explore how the ICF has been used as a frame of reference for the identification of functional problems of patients using qualitative and quantitative research methods; determining typical problem areas of functioning; and measuring functioning of people with rheumatic diseases.
