Practice Matters:

What is the ICF?

By Anita Bemis-Dougherty
In June 2008, the APTA House of Delegates officially
endorsed the orld Health !rgani"ation#s $H!%
International &lassification of 'unctioning, Disa(ility and
Heath $I&'%
)
* +any are no, as-ing. /o, ,hat0 hat does
this mean for our 1rofession and ho, might it affect me0
2ome (ac-ground may (e hel1ful in ans,ering these
3uestions*
H! de4elo1ed t,o reference classifications that can (e
used to descri(e the health of a 1erson at a 1articular
1oint in time* Diseases, disorders, and other related health
1ro(lems such as sym1toms and in5ury are classified in
the International &lassification of Diseases, no, in its )0th
re4ision $I&D-)0%* 'unctioning and disa(ility are classified
se1arately in the I&'*
The I&D-)0 and I&' are meant to (e com1lementary* The I&D-)0 1ro4ides a diagnosis of diseases,
disorders, and other health conditions* +ean,hile, the I&' enriches this information (y 1ro4iding additional
information on functioning* In this ,ay, using (oth classification systems 1ro4ides a (roader 1icture of the
health of an indi4idual*
The I&' classification system focuses on human functioning* It 1ro4ides a unified, standard language and
frame,or- that descri(es ho, 1eo1le ,ith a health condition function in their daily li4es rather than focusing
on a la(eled diagnosis or the 1resence or a(sence of disease*
!ther health care disa(ility models or frame,or-s e6ist* hen the Guide to Physical Therapist Practice
2
,as
de4elo1ed, its elements of 1atient7client management ,ere (ased conce1tually on the /agi disa(lement
model* /agi descri(es a 1rocess of disa(ility and focuses on the interrelationshi1 of 1athology, im1airment,
functional limitation, and disa(ility*
In contrast, the I&' model, de4elo1ed (y the H!, uses a uni3ue frame,or- in ,hich human functioning
and disa(ility are descri(ed as a dynamic interaction (et,een 4arious health conditions and en4ironmental
and 1ersonal factors* It recogni"es the im1act of the en4ironment on the 1erson#s functioning*
Ta-e, for e6am1le a 1erson ,ho has a la(eled diagnosis of a cere(ral 4ascular accident $&8A%* The la(eled
diagnosis im1arts no information a(out that 1erson#s functioning* In addition, the mere fact that a 1erson
re3uires an assisti4e de4ice and am(ulates less than 900 feet safely does not 1ro4ide a detailed 1icture of
ho, this 1erson is a(le to function in his or her community and chosen role* Does he li4e alone in a rural
community or does she li4e in an assisted li4ing community ,ith her s1ouse0 The resulting disa(ility in these
different scenarios 1ro4ides rationale for the need to categori"e function (eyond a diagnostic category*
For More Information
To increase a,areness of the I&' among 1hysical
thera1ists and 1hysical thera1ist assistants,
APTA de4elo1ed a e( 1age that includes
educational material and lin-s to multi1le
resources* 'rom APTA#s home 1age, clic- on
:Areas of Interest,: then :Practice,: then
:&linical ;esources*:
And coming soon on the APTA <earning &enter is
a course 1ro4iding an o4er4ie, of the I&'* APTA
,ill (e incor1orating the I&' ,ithin APTA
documents as these documents are re4ie,ed
and re4ised*
In the I&' frame,or-, the em1hasis mo4es a,ay from the notion of an indi4idual as (eing handica11ed (y
his7her diagnosis* Disa(ility and functioning are generic terms descri(ing the (road conce1ts of an
indi4idual#s function or ina(ility to function* :Body 'unctions and 2tructures: and :Acti4ities and
Partici1ation: re1lace 1re4iously used terms of :im1airment,: :disa(ility,: and :handica1*: The ne, terms
allo, 1ositi4e e61eriences to (e descri(ed* Disa(ility is used to indicate 1ro(lems in (ody function and
structures, acti4ity limitations, and 1artici1ation restrictions* /on-1ro(lematic or neutral as1ects of health
are summari"ed under the term :'unctioning*:
By using this system, one can descri(e any changes that occur in the (ody, the ,hole 1erson, the 1erson#s
a(ility to 1erform tas-s, his or her social roles, and the en4ironment that forms the conte6t of a 1erson#s
life*
I&' 1ro4ides a language of function and health that can (e understood (y those ,ho interact ,ith each
other on health-related issues, and hel1s to (ridge ga1s (et,een the 1atient7client, 1ro4ider, 1olicy ma-er
and 1ayers* The I&' frame,or- and its standardi"ed language (etter descri(es the ,or- of reha(ilitation and
can (e a means to facilitate the communication across the health care community, stimulate interdisci1linary
research, and enhance the role of the reha(ilitation 1rofessional ,ith 1atients and other health care
1ro4iders, ,ith the ultimate goal of im1ro4ing clinical care*
In clinical 1ractice, the I&' offers a large area of domains that may (e considered ,hen e4aluating a 1atient
and in determining ,hat other influences may (e affecting the 1atient, such as en4ironmental factors* !nce
these areas are considered, the PT has the o11ortunity to target inter4entions and in4ol4e others ,ho may
(e a(le to 1ro4ide care for the 1atient from a different 1ers1ecti4e $such as 1sychology, occu1ational
thera1y, s1eech-language 1athology, etc% so that all of the 1atient#s needs are met*
==============
Anita Bemis-Dougherty, PT, DPT, MAS, is associate director of APTA's Department of Practice.
References:
)* International &lassification of 'unctioning, Disa(ility and Health, orld Health !rgani"ation, 200),
>ene4a*
2* Guide to Physical Therapist Practice, 2nd ?d* Phys Ther* 200). 8)@A-BCC*
D* /agi 2E* 2ome conce1tual issues in disa(ility and reha(ilitation* In@ 2ussman +B, ed, Sociology and
Rehabilitation* ashington, D&@ American 2ociological Association. )AF9@)00-))D
PT Magazine - February 2009