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International classification of functioning, disability and health

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International classification of functioning, disability and health

  1. 1. INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) AND ITS APPLICATION IN PATIENTS -HETVI BHATT
  2. 2. CONTENTS  Introduction of ICF  Need for ICF  Aims of ICF  Application of ICF
  3. 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. 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. 5.  Body functions  Body structures  Impairment  Activity  Activity limitations  Participation  Participation restriction  Contextual factors
  6. 6.  Environmental factors  Personal factors  Facilitators  Barriers  Capacity  Performance  Domains  Categories  Levels
  7. 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. 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. 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. 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. 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. 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. 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. 14.  At the institutional level: - Educational and training purpose - Resource planning and development - Quality improvement - Management and outcome evaluation - Research purpose
  15. 15.  At the social level: - Security purpose and insurance benefit - Social policy and legislative purpose - For universal designing - Environmental modification
  16. 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. 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. 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
  19. 19. 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
  20. 20. • 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
  21. 21.  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
  22. 22.  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
  23. 23.  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 %)
  24. 24.  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
  25. 25.  Coding body structures -The impairment of a person with hemiparesis mainly in ankle foot region of lower limb
  26. 26.  Scaling of qualifiers for body structures s75022.
  27. 27. i.e.75022.222
  28. 28.  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
  29. 29. i.e. d4500.3 _ moderate restriction in performance of walking short distances
  30. 30.  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
  31. 31.  Coding environmental factors
  32. 32.  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
  33. 33. 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
  34. 34.  – 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
  35. 35.  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.
  36. 36. Summary  Unique, unified, universal  Applied to all health conditions  Every level  Helpful  Subjective  Versatility  Time consuming  Training
  37. 37. Take home message  Users are strongly recommended to obtain training in the use of the classification through WHO and its network of collaborating centres.
  38. 38. References and links  Physical rehabilitation, fifth edition; Susan B. O’Sullivan, Thomas J. Schimtz  Therapeutic Exercises, 5th edition ; Carolyn Kisner and Lynn Allen Colby
  39. 39.  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.
  40. 40.  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).
  41. 41.  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

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