ICF (International Classification of Functioning Disability and Health)

It includes Introduction of ICF, Aims, Application of ICF, Principles of ICF, Component of ICF, ICF model, Ethical guidelines for use of ICF, Coding , Qualifiers, Case examples

1. Icf (international classification of functioning DISABILITY and HEALTH) PRESENTED BY: NAINA JOSHI MPT 1 ST YEAR

2. content Introduction Aims Application of ICF Principles of ICF Component of ICF ICF model Ethical guidelines for use of ICF Coding Qualifiers Case examples

3. INTRODUCTION The International Classification of Functioning, Disability and Health ( ICF) is a framework for describing and organising information on functioning and disability . It provides a standard language and a conceptual basis for definition and measurement of health and disability. ICF was approved for use by the World Health Assembly in 2001, after extensive testing across the world involving people with disabilities and people from a range of relevant disciplines.

4. The domains contained in ICF can, therefore be seen as health domains and health related domains. These domains are described from the perspective of the body, the individual and society in two basic lists: Body function and structures. Activities and participation. As a classification, ICF systematically groups different domains for a person in given health condition (what a person with a disease or disorder does do or can do)

5. Functioning is an umbrella term encompassing all body functions, activities and participation. Disability serves as an umbrella term for impairments, activity limitations or participation restriction. ICF also lists environmental factors that interact with all these constructs. In this way, it enables the user to record useful profiles or individual functioning, disability and health in various domains.

6. Aims of icf ICF is a multipurpose classification designed to serve various disciplines and different sectors. Example: education, transportation as well as in health and community services and across different countries and cultures. Its specific aims can be summarised as follows: To provide a scientific basis for understanding and studying health and health related states, outcomes, determinants and changes in health status and functioning.

7. To establish a common language for describing health and health related states in order to improve communication between different users, such as health care workers, researchers, including people with disabilities. To permit comparison of data across countries, health care disciplines, services and time. To provide a systematic coding scheme for health information systems. These aims are interrelated, since the need for and the uses of ICF require the construction of a meaningful and a practical system that can be used by various consumers for health policy, quality assurance and outcome evaluation in different culture.

8. Applications of icf As a research tool – to measure outcomes, quality of life or environmental factors. As a clinical tool – in needs assessment, matching treatments with specific conditions, vocational assessment, rehabilitation and outcome evaluation

9. Principles of icf UNIVERSALITY: A classification of functioning and disability should be applicable to all people irrespective of health condition and in all physical, social and cultural contexts. The ICF achieves this and acknowledges that anyone can experience some disability. It concerns everyone’s functioning and disability and was not designed nor should be used, to label persons with disabilities as a separate social group.

10. PARITY AND AETOLOGICAL NEUTRALITY: In classifying functioning and disability there is not an explicit or implicit distinction between different health conditions, whether ‘mental’ or ‘physical’. It places all health conditions on an equal footing, allowing them to be compared using common metric. NEUTRALITY: Domain definitions are worded in neutral language, wherever possible, so that the classification can be used to record both the positive and negative aspects of functioning and disability.

11. Environmental Influence: In recognition of the important role of environment in people’s functioning. Factors range from physical factors such as climate, terrain or building design

12. COMPONENTS OF ICF Body Function: physiological function of body system. Body Structures: anatomical parts of body. Impairments: problem in body function and structure such as significant deviation or loss. Activity: execution of a task or action by an individual. Participation: involvement in a life situation.

13. Activity limitations: difficulties an individual may have in executing activities. Participation restriction: problems an individual may experience in involvement in life situations.

14. Model of functioning and disability The ICF conceptualises a person’s level of functioning as a dynamic interaction between her or his health conditions, environmental factors and personal factors. There is a dynamic interaction among these entities that is intervention in one entity have the potential to modify the other entities.

15. Ethical guidelines for the use of ICF Respect and confidentiality: ICF should always be used so as to respect the inherent value and autonomy of individual persons. ICF should never be used to label people or otherwise identify them solely in terms of one or more disability categories . In clinical settings, ICF should always be used with the full knowledge, cooperation, and consent of the persons whose levels of functioning are being classified.

16. Clinical use of ICF: The clinician should explain to the individual or the individual's advocate the purpose of the use of ICF and invite questions about the appropriateness of using it to classify the person’s levels of functioning. The person whose level of functioning is being classified (or the person's advocate) should have the opportunity to participate.

17. coding ICF components are denoted by prefixes in each code. b for Body Functions and s for Body Structures d for Activities and Participation e for Environmental Factors

18. The letters b, s, d and e are followed by a numeric code that starts with the chapter number (one digit), followed by the second level (two digits), and the third and fourth level21 (one digit each). For example, in the Body Functions classification there are these codes: b2 Sensory functions and pain b210 Seeing functions b2102 Quality of vision b21022 Contrast sensitivity

19. qualifiers The ICF codes require the use of one or more qualifiers, which denote, for example, the magnitude of the level of health or severity of the problem at issue. Qualifiers are coded as one, two or more numbers after a point. Use of any code should be accompanied by at least one qualifier. Without qualifiers codes have no inherent meaning (by default, WHO interprets incomplete codes as signifying the absence of a problem -- xxx.00).

20. BODY FUNCTIONS Qualifier Generic qualifier with the negative scale, used to indicate the extent or magnitude of an impairment: .0 NO impairment (none, absent, negligible,… ) .1 MILD impairment (slight, low,…) .2 MODERATE impairment (medium, fair,...) .3 SEVERE impairment (high, extreme, …) .4 COMPLETE impairment (total,…) .8 not specified .9 not applicable

21. EXAMPLE: The impairment of a person with hemiparesis can be described with code b7302 it can be scaled: b7302.1 MILD impairment of power of muscles of one side of body b7302.2 MODERATE impairment of power of muscles of one side of body b7302.3 SEVERE impairment of power of muscles of one side of body b7302.4 COMPLETE impairment of power of muscles of one side of body b7302.0 NO impairment in power of muscles of one side of body

22. BODY STRUCTURES Body structures are coded with three qualifiers. The first qualifier describes the extent or magnitude of the impairment, the second qualifier is used to indicate the nature of the change, and the third qualifier denotes the location of the impairment

23. First qualifier (Extent of impairment ) .0 NO impairment .1 MILD impairment .2 MODERATE impairment .3 SEVERE impairment .4 COMPLETE impairment .8 not specified .9 not applicable

24. Second qualifier (Nature of impairment) .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

25. Third qualifier (suggested) Location of impairment .0 more than one region .1 right .2 left .3 both sides .4 front .5 back .6 proximal .7 distal .8 not specified .9 not applicable

26. Example: patient having periarthritis shoulder S = Body Structure 730 = structure of upper extremity Extent of impairment (first qualifier) Nature of impairment (second qualifier) Location of impairment (third qualifier ) Example: s730.1 = Mild impairment in structure of upper extremity s730.10 = Mild impairment along with no change in structure s730.101= Mild impairment on right side along with no change in strucuture

27. ACTIVITIES AND PARTICIPATION The two qualifiers for the Activities and Participation component are the performance qualifier and the capacity qualifier. The performance qualifier describes what an individual does in his or her current environment. This context includes the environmental factors – all aspects of the physical, social and attitudinal world, which can be coded using the Environmental Factors component.

28. The capacity qualifier describes an individual’s ability to execute a task or an action. This qualifier identifies the highest probable level of functioning that a person may reach in a given domain at a given moment. Capacity is measured in a uniform or standard environment, and thus reflects the environmentally adjusted ability of the individual. The Environmental Factors component can be used to describe the features of this uniform or standard environment.

29. ENVIRONMENTAL FACTORS The first qualifier indicates the extent to which a factor is a facilitator or a barrier. For facilitators, the coder should keep in mind issues such as the accessibility of a resource, and whether access is dependable or variable, of good or poor quality, and so on. In the case of barriers, it might be relevant how often a factor hinders the person, whether the hindrance is great or small, or avoidable or not.

30. First qualifier The following is the negative and positive scale for the extent to which an environmental factor acts as a barrier or a facilitator. A point or separator alone denotes a barrier, and the + sign denotes a facilitator, as indicated below: .0 NO barrier +0 NO facilitator .1 MILD barrier +1 MILD facilitator .2 MODERATE barrier +2 MODERATE facilitator .3 SEVERE barrier +3 SUBSTANTIAL facilitator .4 COMPLETE barrier +4 COMPLETE facilitator .8 Barrier, not specified +8 Facilitator, not specified .9 Not applicable +9 Not applicable

31. Application of icf in physiotherapy For example: The patient is 67 year old woman with major complain of 6 months history of pains and stiffness of both knees. She reported insidious onset of symptoms that had become worsened and constant for about 3 mont hs. Pain intensity was measured using visual analogue scale, and at onset was rated 5/10 on the right knee and 6/10 on the left knee. When pain intensity is at worst, patient rated it to be 7/10 on the right and 9/10 on the left knee

32. Lifting, bending forward, prolong sitting for more than 20 minutes aggravates the pain . S ymptoms as varying from day to day, but typically worse at the start of the day with associated stiffness and disturbed sleep

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