Transcript The Role of the International Classification of

The Role of the International
Classification of Functioning,
Disability, and Health (ICF) in TR
Practice, Research, and Education
Chapter 4
HPR 453
Earlier Models of Disability, Health and
Functioning
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Original Disability Model (Linear)
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If active pathology was present, impairment,
functional limitation, disability would follow
ICIDH for trial purposes
WHO (1980) – no support due
to lack of cross-cultural applicability – no international support
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Nagi (1965)
Described 3 concepts of disease and health:
Impairments, Disabilities, Handicaps
NCMRR
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(1993) To guide outcome measurement and research
Linear to show course of disease or pathology but
acknowledged that social policies and barriers limited
participation in society = Society could impose disability
ICIDH revised from 1997-1999 and
renamed International Classification of
Functioning, Disability, and Health (ICF)
 Overall aim…to provide a unified and
standardized language and framework for
the description of health and healthrelated states.
 WHO endorsed as international standard
in 2001
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Shift from Medical Model 
Social Model
From medical model that focused on
disability  holistic model of health and
well-being
 From disability needing an intervention to
“fix the problem”  a more complete
picture of health status by describing
behavioral aspects of chronic diseases
 Social Model – Individuals experience
disability as a result of their interaction
with barriers in their environment (i.e.
stairs) ICF is biopsychosocial model
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Endorsed by ATRA and NTRS
ICF provides a model for clinical practice,
professional education and research
 Endorsed by ATRA in 2005 and NTRS in
2008 – ATRA has an ICF Team
 Comparable with recreational therapy
practice and should be used in Practice
Guidelines, Standards of Practice,
Curriculum Development, Public policy,
International Relations, and Research
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ICF Model
WHO (2001)
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4 primary purposes
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Provide scientific basis for understanding and studying
health and health-related states, outcomes, and
determinants
Common language to improve communication between
users (h.c. workers, researchers, policy-makers, the
public, including people with disabilities
Permit comparison of data across countries, healthcare
disciplines and time
Provide systematic coding system for health information
systems
ICF Model
ICF has 2 Parts
Each Part has 2 components
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Functioning and Disability
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Body Functions and Structures
Activity and Participation
Contextual Factors and Components
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WHO (2001)
Environmental Factors
Personal Factors
Not linear – Arrows indicate interaction
after a change in health condition to
improve well-being (Important for TR – we
restore well-being)
Coding the ICF
Will be used soon by healthcare
professionals to collect functional data
 Classification system and not assessment
 Data will pertain to a particular session
 Contextual factors will result in variability
because each session is a snapshot in the
big picture (i.e. more alert in morning
than afternoon – contextual factors play a
role)
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Definitions of key concepts and terms
Body Function – physiological and
psychological functions of body systems
 Body Structures – anatomical – organs,
limbs and their components
 Impairments – problems in function or
structure (i.e. significant deviation or loss)
 Activity – Execution of a task or action
 Participation – involvement in a life
situation
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Activity Limitations – difficulties an
individual may have in executing activities
 Participation Restrictions – problems
experienced in involvement in life
activities
 Environmental Factors – physical,
social, and attitudinal components in
which live and conduct their lives
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CODING
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BS – “s” (anatomical)
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structure of brain, structure of heart, etc
3 qualifiers to describe extent of impairment, nature of
the change and location of the impairment
CTRS won’t code much in BS but must understand codes
BF – “b”
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Physiological and psychological functions
1 qualifier to describe level of impairment with b.f.
CTRS will code (i.e. temperament and personality,
attention, exercise tolerance, etc)
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A&P – “d”
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Activities commonly performed in life (daily
routine, conversation, climbing, managing diet
and meals, forming relationships, play, taking
care of animals, crafts, etc) Meaningful activity
4 qualifiers (2 capacity and 2 performance)
Capacity = Ability in standard environment
Performance = in real life situations
Coding more complex than previous categories
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EF – “e”
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Things in environment which facilitate or
hinder health and functioning
Equipment, attitudes, social policies
Codes attached to A&P to reflect effect on a
specific activity or participation
PF – recognized but not currently included
due to large cultural and social variance
(i.e. gender, coping styles)
Why you need to know this….
Will soon be used by clinicians for payers
because functional status is much better
predictor of health system usage than
diagnostic information
 ICF includes a chapter related to
social, civic, and community
functioning that recognizes recreation
and leisure as an important aspect of
functioning
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Related to TR Practice
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Functional status and holistic approach to
individual and his/her environment
Inter-professional communication
CTRSs will use same language as other
disciplines (i.e. cognitive domain)
Core sets related to health conditions – 12
developed – more being developed – Table 4.2
See case study on pgs 53-55