ICF World Health Organization Classification Assessment Surveys & Terminology Group as the New Member in the WHO Family of International Classifications

Basic Messages ICF has been systematically revised in the last decadeICF has been systematically revised in the last decade –large international and multidisciplinary participation –extensive field testing –guided by scientific principles taxonomic guidelines: logic and terminologytaxonomic guidelines: logic and terminology practical utility: feasibility, ease of use, ethical guidelinespractical utility: feasibility, ease of use, ethical guidelines reliability, validity and comparabilityreliability, validity and comparability When the rubber hits the road...When the rubber hits the road... –ICF can serve as a useful tool for Health Information Systems evaluation: needs, outcomes, costs, quality, satisfactionevaluation: needs, outcomes, costs, quality, satisfaction service provision, social policyservice provision, social policy –Application guidelines, training, tools are needed

World Health Assembly l Endorse and publish ICF l use the ICF in Member States in: Ü research Ü surveillance Ü reporting l Joint use with ICD l Operational subsets: Ü surveys Ü clinical encounters l Periodic revision

Interventions procedures procedures Reasons for encounter ICD-10 ICD-10 International Statistical Classification of Diseases & Related Health Problems ICF International Classification of Functioning, Disability and Health IND Nomenclature of Diseases Specialityadaptations Primary care adaptations WHO Family of International Classifications Associated Products Main Classifications Adaptations

WHO Family of International Classifications Primary Aim: International comparability of health informationPrimary Aim: International comparability of health information Basic principles: scientific and transculturalBasic principles: scientific and transcultural Interrelated use: Coherent, agreed and appropriateInterrelated use: Coherent, agreed and appropriate Versatility: responds to current or developing health information needs of different usersVersatility: responds to current or developing health information needs of different users Foundation classes: categories of conceptual & metric equivalenceFoundation classes: categories of conceptual & metric equivalence Coding Rules: Transparent and reliableCoding Rules: Transparent and reliable Standards: Uniform and meets ISO standardsStandards: Uniform and meets ISO standards

ICF Publications 1. Main volume with glossary - Full version 9999 cat. - Short version 99 cat. 2. Clinical Descriptions & Assessment Guidelines 3. Assessment Criteria for Research 4. Other versions - Specialty adaptations Children and Youth 5. Dedicated Assessment Tools

Aims to provide a scientific basis for consequences of health conditionsto provide a scientific basis for consequences of health conditions to establish a common language to improve communicationsto establish a common language to improve communications to permit comparison of data across:to permit comparison of data across: – countries – health care disciplines – services – time to provide a systematic coding scheme for health information systemsto provide a systematic coding scheme for health information systems

ICIDH-1 ICF Conceptual transformationConceptual transformation User needsUser needs Advocacy scienceAdvocacy science –Service Outcomes: measure to manage –Health Measures: evidence to inform policy –Causality: multi-linear web

Foundations of ICF Human Functioning - not merely disability Universal Model - not a minority model Integrative Model - not merely medical or social Interactive Model - not linear progressive Parity - not etiological causality Context - inclusive - not person alone Cultural applicability - not western concepts Operational - not theory driven alone Life span coverage - not adult driven

Human Functioning not disability alone Body functionsvs impairmentsBody functionsvs impairments Body StructuresBody Structures Activitiesvs activity limitationActivitiesvs activity limitation 1980 disability 1980 disability Participationvs handicapParticipationvs handicap

Participation or Handicap? neutral language “politically correct” “politically correct” correct use correct use – intervention – opportunity –positive aspects

Universal Model vs. Minority Model Everyone may have disability ContinuumMulti-dimensional Certain impairment groups CategoricalUni-dimensional

Medical versus Social Model PERSONAL problem vs SOCIAL problemPERSONAL problem vs SOCIAL problem medical care vs social integrationmedical care vs social integration individual treatment vs social actionindividual treatment vs social action professional help vsindividual & collective responsibilityprofessional help vsindividual & collective responsibility personal vs environmental adjustment manipulationpersonal vs environmental adjustment manipulation behaviour vsattitudebehaviour vsattitude care vs human rightscare vs human rights health care policy vs politicshealth care policy vs politics individual adaptation vs social changeindividual adaptation vs social change

Sequence of Concepts ICIDH 1980 Impairments ImpairmentsDisease or ordisorder Disabilities Disabilities Handicaps

Health Condition ( disorder/disease ) Interaction of Concepts ICF 2001 Environmental Factors Personal Factors Body function&structure (Impairment ) Activities(Limitation)Participation(Restriction)

Equity / Parity Loss of limb Loss of limb landmines = diabetes = thalidomide Missed days at usual activities Missed days at usual activities flu = depression = back pain = angina Stigma Stigma leprosy = schizophrenia = epilepsy = HIV

Contextual Factors Person Ýgender Ýage Ýother health conditions Ýcoping style Ýsocial background Ýeducation Ýprofession Ýpast experience Ýcharacter style Environment ÝProducts ÝClose milieu ÝInstitutions ÝSocial Norms ÝCulture ÝBuilt-environment ÝPolitical factors ÝNature

Cultural Applicability Conceptual and funtional equivalence of Classification Conceptual and funtional equivalence of Classification Translatability Translatability Usability Usability International Comparisons International Comparisons

Comparability: equivalence across cultures Conceptual equivalence: Conceptual equivalence: similar understanding /meaning of concepts similar understanding /meaning of concepts Functional equivalence: Functional equivalence: similar domains similar domains Metric equivalence:Metric equivalence: similar measurement characteristics similar measurement characteristics

ICF Field Testing 7 years years countries61 countries ICF drafts translated into / tested in 27 languagesICF drafts translated into / tested in 27 languages 38 National Consensus Conferences38 National Consensus Conferences 7 International Consensus Conf.7 International Consensus Conf Live Case evaluations2000 Live Case evaluations 3500 Case Summary evaluations3500 Case Summary evaluations

Structure Classification Parts Components Constructs/qualifiers Domains and categories at different levels at different levels ICF Part 1: Functioning and Disability Part 2: Contextual Factors Body Functions and Structures Activities and Participation EnvironmentalFactorsPersonalFactors Change in Body Structures StructuresCapacityPerformanceFacilitator/Barrier Item levels: 1 st 2 nd 3 rd 4 th Item levels: 1 st 2 nd 3 rd 4 th Item levels: 1 st 2 nd 3 rd 4 th Change in Body Functions Functions Item levels: 1 st 2 nd 3 rd 4 th Item levels: 1 st 2 nd 3 rd 4 th

ICF Components Body Functions &StructuresActivities&Participation Environmental Factors BarriersFacilitatorsFunctionsStructuresCapacityPerformance

Body Functions and Structures Skin and related structures Functions of the skin and related structures Structures related to movement Neuromusculoskeletal and movement-related functions Structures related to the genitourinary and reproductive systems Genitourinary and reproductive functions Structures related to the digestive, metabolic and endocrine systems Functions of the digestive, metabolic and endocrine systems Structures of the cardiovascular, immunological and respiratory systems Functions of the cardiovascular, haematological, immunological and respiratory systems Structures involved in voice and speech Voice and speech functions The eye, ear and related structures Sensory functions and pain Structures of the nervous system Mental functions

Activities and Participation 1Learning &Applying Knowledge 2General Tasks and Demands 3Communication 4Movement 5Self Care 6Domestic Life Areas 7Interpersonal Interactions 8Major Life Areas 9Community, Social & Civic Life

Environmental Factors 1. Products and technology 2. Natural environment and human- made changes to the environment 3. Support and relationships 4. Attitudes 5. Services, systems and policies

ICF Applications Health sectorHealth sector Social securitySocial security Education sectorEducation sector Labour sectorLabour sector Economics & development sectorEconomics & development sector Legislation & lawLegislation & law Other ….Other ….

ICF in health & disability statistics Common DomainsCommon Domains –Mobility- Cognition- Mood –Self Care- Usual Activities... link data from both health and disabilitylink data from both health and disability Multiple ComponentsMultiple Components overcomes the “impairment” focusovercomes the “impairment” focus Environmental FactorsEnvironmental Factors ComparabilityComparability

Needs assessmentNeeds assessment Outcome assessmentOutcome assessment Utilization patternsUtilization patterns Comparison of different interventionsComparison of different interventions Consumer satisfactionConsumer satisfaction Service performanceService performance –outcomes –cost-effectiveness Electronic recordsElectronic records Clinical terminologyClinical terminology ICF in clinical practice & management

ICF in policy making assessment of population healthassessment of population health impact of disabilityimpact of disability –economic –social evidence-base for policy makers on different policy interventionsevidence-base for policy makers on different policy interventions –responsiveness of services –efficiency –performance assessment

ICF research applications joint assessment of disease and functioningjoint assessment of disease and functioning –description of association –intervention response & synchrony of change –explanatory power on: utilizationutilization needsneeds costscosts outcomesoutcomes –Cost-effectiveness of interventions –Unified approaches