ICF: A Comprehensive Model for Health and Functioning

International Classification of Function

The International Classification of Functioning, Disability and Health

In 2001 the World Health Organization (WHO) published a revised model of the International Classification of Functioning, Disability and Health (ICF)

The ICF is the result of an international and multidisciplinary effort to provide a common language for the classification and consequences of health conditions. Rather than focusing on disability, the intent of the ICF is to describe how people live with their health condition.

A. The Model of Disablement

As described by Nagi, showing the relationship among pathology, impairments, functional limitations and disability.

ICF MODEL

A comprehensive representation of health and health-related domains based on the relationships among health condition:

• body functions and structures
• activities and
• participation.

The ICF holds a parallel to the disablement model.

Which better Nagi model or ICF model?

The ICF may be more useful, however, to understand and measure health outcomes, looking beyond mortality and disease.

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It shifts the focus to "life," and describes how people live with their health condition.

This context makes the model useful for health promotion as well as illness and disability.

The ICF has been evaluated in a variety of patient populations, cultures, age groups and diagnoses. Each of the components of the ICF can be described in positive or negative terms:

• body systems or anatomical structures will be intact or impaired.
• Individuals will be able to perform specific activities or they will demonstrate difficulties in executing specific tasks, described as activity limitations.
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• They will either be able to participate in life roles or they may experience participation restrictions.
• Environmental and personal factors will either facilitate function or create barriers.
• capacity to act versus actual performance.

The activity and participation domains can be further conceptualized in terms of an individual's capacity to act versus actual performance; that is, what one is able to do versus what one actually does.

• These elements are defined with reference to the environment in which assessment is taking place.
• Performance relates to the "current" or actual environment in which the individual participates.
• Capacity relates to a "standardized“ optimum environment, the gap between capacity and performance reflects the impact of the environment on an individual's ability to perform.

an individual with rheumatoid arthritis may

• have joint deformities (impairments),
• have difficulty walking (activity limitation) and
• unable to perform work activities because of inappropriate height of furniture (participation restriction and environmental barrier).

The individual may have the capacity to do the work, but cannot perform the activities in the current environment. However, if the office environment is modified, this individual may be able to perform activities without pain, and therefore, her performance and participation level will improve.