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
1972
• WHO developed a
preliminary scheme
1976
• Twenty-ninth World Health
Assembly
1980
• ICIDH was published
1993
• Revision of ICIDH
- International classification of functioning, disability and health : ICF. World
Health Organization 2001; page no- 246-250

10. 1997
• Beta-1 draft was produced
1999
• Beta- 2 draft was produced
2000
• Prefinal version of ICIDH-2
2001
• The Fifty-fourth World Health Assembly,
• Endorsement of the final version

11. 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

12. 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

13. 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

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

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

16. Properties of ICF
1) Universe of ICF
- all aspects of human health and some
health-relevant components of well-being
2) Scope of ICF
ICF
1.Components
of Functioning
and Disability
Body Functions
and Structures
Activities and
Participation
2. Components
of Contextual
Factors
Environmental
Factors
Personal
Factors

17. •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%

18. 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

22. 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

23. • 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

29.  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

30.  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

32.  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 %)

33.  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

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

36.  Scaling of qualifiers for body structures
s75022.

37. i.e.75022.222

38.  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

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

40.  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

42.  Coding environmental factors

43.  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

44. 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

45.  – 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

46.  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.

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

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

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

50.  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.

51.  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).

55.  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