1. Conceptual Foundations for Health Measurements

2. WHO Classifications International Classification of Diseases (ICD)
Etiological framework
Diagnosis of health condition
Disease process, signs & symptoms
International Classification of Impairments, Disabilities & Handicaps (ICIDH)
How people live; body functions
Activities & participation

3. Disability and Handicap

4. Conceptions of Disability
“a disability is any restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being” (WHO ICIDH, 1980.)

5. ICIDH - 1 Impairment Disability Handicap Body Society
(N.b. dotted arrows indicate that one stage may, but need not, influence the next)

6. ICIDH Classification of health domains
Framework to study health and health-related outcomes
Covers non fatal outcomes

7. Issues in the Definition
Defining disability in terms of activity limitations is neat, but what activities?
What level of limitation should be used?
Same expectations for everyone, or relative to age, sex, etc.?
Threshold: does not perform an activity, versus cannot perform it? Doesn’t but could??

8. ICIDH - 2 Appeared March, 2001 Conceptual changes:
From consequences of disease (1980) to components of health (2000)
Uses more positive language (‘activity’ & ‘participation’ instead of ‘disability’ & ‘handicap’)
Broadens concept of disability
More on environmental factors in which the person lives

9. ICIDH - 2 Health Condition (disorder / disease) Body Functions
& structures
Activities
Participation
BODY
Structure &
Function
PERSON
Activities
SOCIETY
Participation
impairment
limitation
restriction

10. Body Functions Mental functions Sensory Voice & speech
CVD, hematological, etc.
Digestive, metabolic & endocrine
Genitourinary
Neuro-musculoskeletal
Skin

11. Activities & Participation
Learning
Communication
Movement
Self-care
Domestic activities
Interpersonal
Major life activities
Community
Exchanging information
Communicating
Mobility
Personal maintenance
Home life
Social relationships
Work & employment
Social & civic life

12. Health-Related Quality of Life

13. Quality of Life Quality of life is subjective & value-specific
Invented in the USA; ¿not universal?
Definition will at least vary across cultures (naïve enthusiasm for QoL)
Handicap reflects impairment + environment, so measures may perform differently in different environments

14. Quality of Life (from a consumer’s perspective)
Quality of life is…
Having the important people in your life see your strengths and talents
A good night’s sleep
Validation of worth and affirmation of experience
Having control of your own life
Taking control of your condition
Life free from stigma
Having a ‘real’ job
Having a purpose
Being free to come and go
Carne, B. A consumer perspective. Can J Community Mental Health 1998, Suppl 3: 21.

15. The Deceptive Simplicity of HRQOL…
Health-Related Quality of Life
Or Quantity?
(How would we
we measure
quality?)
Definition?
What model?
(Caused by
Associated with?
or ?)
Of life or
Living?

16. Mapping Physical Measures onto Quality of Life
Clinical / Physical Markers
Disease-Specific Dysfunction
Health-Related Quality of Life
Overall Quality of Life
Source: SH Kaplan et al. Medical Care, 2000