International classification of functioning, disability and health

1. International classification of functioning, disability and health ( icf ) and its application in patients HETVI BHATT

2. CONTENTS Introduction of ICF Need for ICF Aims of ICF Application of ICF

3. Introduction of ICF What is ICF? unified and standard language framework for the description of health and health-related states. Domains - individual body functions and structure - societal perspectives activity and participation - Physical rehabilitation, fifth edition; Susan B. O’Sullivan, Thomas J. Schimtz ; page no:375

4. Terminologies used in ICF Well-being Health condition Health states and health domains Health-related states and health-related domains Functioning Disability - International classification of functioning, disability and health : ICF. World Health Organization 2001 ; page no- 211-219

5. Body functions Body structures Impairment Activity Activity limitations Participation Participation restriction Contextual factors

6. Environmental factors Personal factors Facilitators Barriers Capacity Performance Domains Categories Levels

7. ICF - WHO's framework for health and disability universal classification of disability and health named to stress health and functioning, rather than disability. “consequences of disease” “components of health” International classification of functioning, disability and health : ICF. World Health Organization 2001 ; page no- 1-3

8. Complimentary to ICD-10 WHO encourages their use together as ICD-10 - Towards a Common Language for Functioning, Disability and Health ICF World Health OrganizationGeneva2002

9. Development of ICF - International classification of functioning, disability and health : ICF. World Health Organization 2001 ; page no- 246-250

10. Need for ICF Medical classification of diagnoses alone not sufficient health planning and management purposes For basic public health purposes need reliable and comparable data provides the foundations for country-level disability data Need a way of classifying domains of areas of life - Towards a Common Language for Functioning, Disability and Health ICF World Health OrganizationGeneva2002

11. Aims of ICF: To understand and study health - health-related states - outcomes and determinants to establish a common language to permit comparison of data to provide a systematic coding scheme - International classification of functioning, disability and health : ICF. World Health Organization 2001 ; page no- 3-5

12. Application of ICF At the individual level : - Personal’s level of functioning - Treatment and outcome measures - Communication - Self evaluation Towards a Common Language for Functioning, Disability and Health ICF World Health OrganizationGeneva2002

13. At the institutional level: - Educational and training purpose - Resource planning and development - Quality improvement - Management and outcome evaluation - Research purpose

14. At the social level: - Security purpose and insurance benefit - Social policy and legislative purpose - For universal designing - Environmental modification

15. Properties of ICF Universe of ICF - all aspects of human health and some health-relevant components of well-being 2) Scope of ICF

16. ICF has identified the following generic qualifier scale: – NO problem (none, absent, negligible) 0-4% – MILD problem (slight, low…) 2-24% – MODERATE (medium, fair) 25-49% – SEVERE (high, extreme, …) 50-95% – COMPLETE (total…) 96-100%

17. 3) Unit of classification - Classifies health and health-related states. The unit of classification is, therefore, categories within health and health-related domains. 4) Presentation of ICF Full version Short version - International classification of functioning, disability and health : ICF. World Health Organization 2001 ; page no- 3-5

18. Coding guidelines for ICF Parts of the Classification Part 1 - Body Functions and Body Structures - Activities and Participation.   Part 2 - Environmental Factors Personal Factors (currently not classified in the ICF) International classification of functioning, disability and health : ICF. World Health Organization 2001 ; page no-219-234

19. b for Body Functions and s for Body Structures d for Activities and Participation e for Environmental Factors 34 – chapters 362- second level 1424 - codes, third and fourth level

20. Inclusion terms Exclusion terms Other specified Unspecified General coding rules - Select an array of codes to form an individual’s profile - Code relevant information - Code explicit information - Code specific information

21. Component-specific coding rules Coding body functions -The impairment of a person with hemiparesis can be described with code b7302 Power of muscles of one side of the body

22. Once an impairment is present, it can be scaled in severity using the generic qualifier For example: b7302.1 (5–24 %) b7302.2 (25–49 %) b7302.3 (50–95 %) b7302.4 (96–100 %)

23. The absence of an impairment (according to a predefined threshold level) is indicated by the value “0” for the generic qualifier. * For example: b7302.0 If there is insufficient information to specify the severity of the impairment, the value “8” should be used. b7302.8

24. Coding body structures -The impairment of a person with hemiparesis mainly in ankle foot region of lower limb

25. Scaling of qualifiers for body structures s75022.

26. i.e.75022.222

27. Coding the Activities and Participation component - For example, the performance of a person who is having less power in his left leg due to hemiparesis and since then has used a cane but faces moderate difficulties in walking around because the sidewalks in the neighbourhood are very steep and have a very slippery surface

28. i.e. d4500.3 _ moderate restriction in performance of walking short distances

29. For the capacity qualifier , this domain refers to the an individual’s ability to walk around without assistance. For example, the true ability of the above-mentioned person to walk without a cane in a standardized environment (such as one with flat and non-slippery surfaces) will be very limited. d4500._ 3

30. Coding environmental factors

31. for example: - e430: individual attitudes of people in positions of authority General or specific opinions and beliefs of people in positions of authority about the person or about other matters (e.g. social, political and economic issues), that influence individual behaviour and actions.  e 430.2

32. ICF Core Sets • Clinicians and researchers have identified that more than 1,400 ICF categories is not practical in daily use. To facilitate a systematic and comprehensive description of functioning and the use of the ICF in clinical practice and research, ICF Core Sets have been developed. - PT, OT, and SLP Services and the International Classification of Functioning, Disability, and Health (ICF) Mapping Therapy Goals to the ICF - www.icf-research-branch.org/publications/publications

33. – help users better define high-risk populations by limiting the number of potential ICF categories reported for similar groups of individuals. – help users continually improve their quality processes. – reduce variability in describing the health condition of similar patient. – support outcomes research for targeted populations

34. Type of Core Sets Comprehensive – Guide for multi-professional comprehensive assessment. Brief – Minimal standard for assessment and reporting of functioning for clinical studies and clinical reports and encounters. Numerous Core Sets have been developed and validated for specific outpatient therapy patient populations.

35. Summary Unique, unified, universal Applied to all health conditions Every level Helpful Subjective Versatility Time consuming Training

36. Take home message Users are strongly recommended to obtain training in the use of the classification through WHO and its network of collaborating centres.

37. References and links Physical rehabilitation, fifth edition; Susan B. O’Sullivan, Thomas J. Schimtz Therapeutic Exercises, 5 th edition ; Carolyn Kisner and Lynn Allen Colby

38. ICF home page: www.who.int/classifications/icf/ ICF Training Beginner’s Guide (18 pages) – At ICF home page, click on ‘Application and Training Tools link in the MORE INFORMATION section. The full text link is in the TRAINING MATERIALS section. International Classification of Functioning, Disability and Health: ICF (299 pages): http://www.handicapincifre.it/documenti/ICF _18.pdf – Comprehensive ICF manual.

39. ICF Research Branch: www.icf-research-branch.org – Information about ongoing ICF research and publications including the development of ICF Core Sets. ICF Online: Contains interactive ICF Browser tool: http://apps.who.int/classifications/icfbrowser/ – Can search all ICF categories by the stem/branch/leaf scheme within each component or by keyword (next slide).

40. APTA: www.apta.org – From home page ‘Areas of Interest’ section, click on ‘Practice’ link, then ‘Clinical Practice Resources’ link, then ‘ICF Resources’ link. AOTA: www.aota.org ASHA: www.asha.org/slp/icf.htm