International Classification of
Functioning, Disability and Health
(ICF)
KNR 365
WHO
• Who is WHO?
▫ World Health Organization
▫ United Nations’ agency
▫ Established in 1948
▫ Objective is attainment by all peoples of the
highest level of health (not just absence of disease)
WHO Family of International
Classifications
• International Classification of Diseases (ICD-10)
 Codes diagnoses and mortality causes
• International Classification of Functioning,
Disability and Health (ICF)
 Classification system of functioning
 Over 1,400 classifications
• International Classification of Health
Intervention (ICHI)
 Currently being developed
 Different professions developed own (our text)
International Classification of Functioning,
Disability and Health (ICF)
• Provides standard language & framework for
description of health & disability
▫ Across disciplines, service delivery settings,
countries, disabilities
• TR will need to learn the content & language of
ICF to talk/work with other professions
▫ Interventions
▫ Outcomes
ICF
• 1st version was 1980
▫ Focused on impairment, disability & handicap
• Revised in 2001
▫ Focuses on health & functioning vs. disability
▫ Endorsed by 191 nations including US
▫ Endorsed by PT, OT, TR and other healthcare
organization
ICF
• Classification of health and health-related
domains, that help to describe:
▫ Changes in body function and structure
▫ What a person can do in a standard environment
(level of capacity)
▫ What a person can do in their usual environment
(level of performance)
ICF Applications (Individual level)
• For the assessment of individuals: What is the person's
level of functioning?
• For individual treatment planning: What
treatments or interventions can maximize
functioning?
• For the evaluation of treatment and other
interventions: What are the outcomes of the
treatment? How useful were the interventions?
• For communication among physicians, nurses,
physiotherapists, and other health works, social service
works and community agencies
• For self-evaluation by consumers: How would I rate my
capacity in mobility or communication?
Conceptual Models of Disability
• What is the Medical Model?
▫ Views disability as feature of person
▫ Disability is directly caused by disease, trauma, or
other health conditions
▫ Requires medical care provided by professionals
▫ Call for medical treatment or intervention to
“correct” the problem
Conceptual Models of Disability
• What is the Social Model?
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Views disability as a socially created problem
It is not just an attribute of a person
Disability demands a political response
Problems are created by unaccommodating
physical environment brought about by attitudes
& other features of the social environment
Conceptual Models of Disability
• What is the Biopsychosocial Model?
▫ ICF based on this model
▫ Integration of medical & social models
▫ Disability and function viewed as outcomes of
interaction between health conditions (disease,
disorders, injuries) and contextual factors
Conceptual Models of Disability
• Contextual factors
▫ External environmental factors
 Social attitudes, architectural barriers, legal & social
structures, climate, etc.
▫ Internal personal factors
 Gender, age, coping skills, social background,
education, past & present experiences, etc.
 Factors that influence how disability is experienced
by the individual
Biopsychosocial Model:
ICF Interactions
Key ICF Definitions
• Body functions: physiological functions of body
systems
• Body structures: anatomical parts of the body
• Impairments: problems in body function or
structure
• Activity: execution of a task or action
• Participation: involvement in a life situation
• Participation restrictions: problems in
involvement in life situations
• Environmental factors: make up the physical,
social and attitudinal environment in which people
live.
Conceptual Model of ICF
Part 1. Functioning and Disability
(a) Body Functions and Structures
- Changes in body functions (physiological)
- Changes on body structures (anatomical)
(b) Activities and Participation
- Capacity: Executing tasks in a standard
environment
- Performance: Executing tasks in the current
environment
Conceptual Model of ICF
Part 2. Contextual Factors
(c) Environmental factors
- Facilitating or hindering impact of features
of the physical, social, and attitudinal world
(d) Personal factors
- Impact of attributes of person
See Porter & burlingame, p. 4
Body Functions (b – many TR scope)
(relates to function in isolation)
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Mental functions
Sensory functions and pain
Voice and speech functions
Functions of cardiovascular, hematological,
immunological and respiratory systems
Functions of the digestive, metabolic and endocrine
systems
Genitourinary and reproductive functions
Neuromusculoskeletal and movement related
functions
Functions of skin and related structures
Body Structures (s – doctor score)
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Structures of the nervous system
Eye, ear and related structures
Structures involved in voice and speech
Structures of the cardiovascular, immunological and
respiratory systems
Structures related to the digestive, metabolic and
endocrine systems
Structures related to the genitourinary and
reproductive system
Structures related to movement
Skin and related structures
Activities and Participation (d – TR scope)
(relates to ability to do an activity)
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Learning and applying knowledge
General tasks and demands
Communication
Mobility
Self-care
Domestic life
Interpersonal interactions and relationships
Major life areas
Community, social and civic life
Environmental Factors (e – TR scope)
• Products and technology
• Natural environment and human-made changes
to environment
• Support and relationships
• Attitudes
• Services, systems and policies
Personal Factors
• Not coded in ICF because of wide international
variability
• Still included because of importance to
understanding functioning & disability
Age
Race
Gender
Food preferences
Race
Fitness
Lifestyle
Habits
Upbringing
Coping styles
Education
Social background
ICF Coding Example
Level
Example
Coding
Chapter
Chapter 2: Sensory
Functions and Pain
b2
2nd level
Seeing Functions
b210
3rd level
Quality of vision
b2102
4th level
Colour vision
b21021
ICF Qualifiers
• ICF domain becomes a classification when
qualifiers are used
▫ Qualifiers record presence and severity of a
problem in functioning at the body, person, and
societal levels
▫ 1 or 2 qualifiers may apply per ICF domain
ICF Qualifiers (cont.)
Scale
Descriptor
%
0
No problem (none, absent, negligible)
0-4
1
Mild problem (slight, low)
2-24
2
Moderate (medium, fair)
25-49
3
Severe (high, extreme)
50-95
4
Complete (total)
96-100
ICF Qualifiers (cont.)
Construct
First Qualifier
Second Qualifier
Body Functions (b)
Generic qualifier with
None
the negative
scale used to indicate the
extent or
magnitude of an
impairment
Example: b167.3 to
indicate a severe
impairment in specific
mental functions of
language
ICF Qualifiers (cont.)
Construct
First Qualifier
Second Qualifier
Body Structure (s)
Generic qualifier with
the negative
scale used to indicate the
extent or
magnitude of an
impairment
Example: s730.3 to
indicate a severe
impairment of the upper
extremity
Used to indicate the nature of
the
change in the respective body
structure
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
Example: s7300.32 to indicate
the partial
absence of the upper extremity
ICF Qualifiers (cont.)
Construct
First Qualifier
Second qualifier
Activity &
Participation (d)
PERFORMANCE
Generic qualifier
Problem in the person's
current
environment
Example: d5101.1_ to
indicate mild difficulty
with bathing the whole
body with the use of
assistive devices that are
available to the
person in his or her
current environment
CAPACITY
Generic qualifier
Limitation without
assistance
Example: d5101._2 to
indicate moderate
difficulty
with bathing the whole
body and implies that
there is moderate
difficulty without the use
of assistive devices or
personal help
ICF Qualifiers (cont.)
Construct
First Qualifier
Second Qualifier
Environmental
Factors (e)
Generic qualifier, with negative
and positive scale to denote
extent of
barriers and facilitators
respectively
Example: e130.2 to indicate
that products for
education are a moderate
barrier.
Conversely, e130+2 would
indicate that
products for education are a
moderate
facilitator
None
ICF Core Sets
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Brain injury rehabilitation
Breast cancer
Cardiopulmonary conditions
Depression
Multiple Sclerosis
Stroke
▫ Etc.
• Also ICF-CY (children)
ICF TR Resources
• Howard, D., Browning, C., & Lee, Y. (2007). The
International Classification of Functioning,
Disability, and Health: Therapeutic recreation code
sets and salient diagnostic core sets. Therapeutic
Recreation Journal, 41(1), 61-81.
• Porter, H. R., & VanPuymbroeck, M. (2007).
Utilization of the International Classification of
Functioning, Disability, and Health within
therapeutic recreation practice. Therapeutic
Recreation Journal, 41(1), 47-60.