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

2. 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)

3. 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)

4. 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

5. 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

6. 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)

7. 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?

8. 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

9. 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

10. 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

11. 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

12. Biopsychosocial Model: ICF Interactions

13. 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.

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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: s to indicate the partial
absence of the upper extremity

26. 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

27. 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

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

29. 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),
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),