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International classification of functioning, disability and health BPT01 – Foundations for successful study and practice ICF Marie Fell - MSK Lecturer [email protected] Slides contri...

International classification of functioning, disability and health BPT01 – Foundations for successful study and practice ICF Marie Fell - MSK Lecturer [email protected] Slides contributed by: Felippe Toledo & Angeliki Kostaki Objectives The objectives of this session are to: - Understand why the ICF is utilized - Explain the concepts of functioning and disability - Describe the ICF and its components - Demonstrate the need for the ICF to record and organize data - Show how the ICF provides a more comprehensive notion of the patient’s health condition - Understand how to apply the components to your clinical practice The ICF International Classification of Functioning, Disability and Health 22nd May, 2001: agreed by all 191 WHO members International framework for scientific classification Organization of patients’ data Facilitate communication across health professionals “worldwide” Assists data gathering for clinical professionals Include personal and environmental factors (patient-centered Vs. disease centered) Sharing information among health care professionals A tool for measuring FUNCTIONING in society rather than just impairment Why should ICF be used? Ensures consistency of application across sectors and levels of health, social and education systems Improves interprofessional communication It enables standardised documentation of clinical information that allows comparisons (e.g. between assessments) ICF categories have a neutral terminology, without a negative connotation​ The classification can express both positive and negative aspects of Image from ICF e-Learning tool (https://www.icf-elearning.com) each aspect of functioning and disability ICF does not categorize people but describes the situation of each person within health domains  It allows to see beyond the diagnosis of Why use the ICF? the health condition Provides a more comprehensive understanding of a patient’s functioning and disability The same diagnosis (e.g. hip osteoarthritis) can be associated to Image from: https://healthydesign.com/faq/best-chair-hip-osteoarthritis/ different levels of disability  The ICF model The ICF biopsychosocial model takes the positive aspects of both the medical and social models into one single framework Recognizes disability has a consequence of the interaction between functioning, personal and environmental factors The ICF model Functioning Disability Body Functions: physiological functions Impairments: Problems in body functions of the body systems or structures Body structures: anatomical parts of the Activity Limitations: Difficulties in the body execution of a task Activity: Execution of a task by a person Participation Restrictions: Problems Participation: Involvement in a life experienced in involvement in life situations situation + Contextual Factors  Diagnosed or suspected medical Using the checklist domains condition Structure refers to the physical aspect of body systems. Functions are physiological working of these Execution of a tasks relevant for the systems, with problems being individual significant deviation or loss Involvement in a life situation Physical, social and Personality, identity, personal history, attitudinal environment trauma…  Case example Two weeks ago, an 18-year-old man was brought to the hospital with lateral pain on the right hip, after falling from his skateboard. The x-ray showed femoral neck fracture. He still experiences significant pain, is struggling to weight bear on the right leg and has reduced movements in hip adduction and abduction. He has just transferred from another city and struggled to find friends, which is why not being able to skate with his group at the moment is leading to difficulties in interpersonal relationships and his mental health. His parents can drive him to school, but because of the pain he struggles to sleep at night, making him tired throughout the day, affecting his ability to pay attention in class and study. The medication he takes for the pain is causing him to have issues with digestion, and he often experience stomach pain. Exercise – apply the Case study using the ICF model Two weeks ago, an 18-year-old man was brought to the hospital with lateral pain on the right hip, after falling from his skateboard. The x-ray showed femoral neck fracture. He still experiences significant pain, is struggling to weight bear on the right leg and has reduced movements in hip adduction and abduction. He has just transferred from another city and struggled to find friends, which is why not being able to skate with his group at the moment is leading to difficulties in interpersonal relationships and his mental health. His parents can drive him to school, but because of the pain he struggles to sleep at night, making him tired throughout the day, affecting his ability to pay attention in class and study. The medication he takes for the pain is causing him to have issues with digestion, and he often experience stomach pain. The ICF model – the components Body Functions Physiological functions of body systems Mental functions Sensory functions and pain Voice and speech Cardiovascular, hematological, immunological, and respiratory functions Digestive, metabolic, and endocrine functions Genitourinary and reproductive functions Neuromusculoskeletal and movement related functions Skin and related structures e.g. Memory, Speaking, Breathing, Muscle strength, Balance, ROM… The ICF model – the components Body Structures Anatomical parts of the body such as organs, limbs and their components. (Image from Chahla et al, 2017) Nervous system Eye, ear, and related structures Voice and speech Cardiovascular, immunological, and respiratory systems Digestive, metabolism, and endocrine systems Genitourinary and reproductive systems Structure related to movement Skin and related structures The ICF model – the components Activity The execution of a task or action by an individual. Represents the individual perspective of functioning 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 Activity continued… Instrumented activities of daily Activities of daily living (ADLs) living (IADLs) Activities necessary for basic functional living Activities that allow an individual to live (Guo & Sapra, 2020) independently in a community (Guo & Sapra, 2020) Using phone Dressing Shopping Bathing Food preparation Toileting Housekeeping Transferring Laundry Continence Transportation Feeding Taking medication Handling finances The ICF model – the components Participation Person’s involvement in a life situation. Social perspective of functioning. 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 Rotator cuff tendinopathy- DASH Outcome measure Patient 1 Score: 25 / 100 Mild impairment of the arm Patient 2 Score: 75 / 100 Severe impairment of the arm The ICF model Contextual Factors Environmental Personal The ICF model – the components Environmental factors Physical, social and attitudinal environment Products and technology Natural environment and human made changes to environment Support and relationships Attitudes Services, systems, and polices e.g. social attitudes, physical barriers, climate… The ICF model – the components Personal factors The background of the person’s life; their living situation, level of comprehension, level of motivation, fitness levels, coping levels Features that are not part of a health condition such as: age, gender, race, habits, education level, profession…  ICF Organisation, Structures and Codes Number of categories within each component; ❖ Body Functions = b ❖ Body Structure = s ❖ Activity & Participation = d ❖ Environmental = e Examples: b710 = Mobility of joint function s7502 = Structure of the ankle and foot d450 = Walking e115 = Products & technology for personal use in daily living Interpretation of the ICF code ICF – Chapters ICF - Chapters Interpretation of the ICF code explained s = Body structure Component s7 = Structures related to movement Chapter s730 = Structure of upper extremity 2nd level s7302 = Structure of the hand 3rd level s73020 = bones of the hand 4th level ICF – Code explained Environmental Factor = e Wheelchair = e1 Product for indoor or outdoor mobility and transportation = e120 Assistive product = e1201 ICF - Qualifiers ICF – First qualifiers The FIRST Qualifier explains the EXTENT/MAGNITUDE of an impairment Scale xxx.0 – xxx.9 b = body structure b7 = neuromusculoskeletal and movement related functions b710 = mobility of joint functions b7102 = mobility of joints generalized b7102.3 = Ankle joint mobility is Severely impaired = First Qualifier  ICF – Second Qualifiers The SECOND Qualifier explains the NATURE of the impairment Scale xxx.y0 – xxx.y9 s = body structure s7 = structures related to movement s750 = structure of the lower extremity s7502 = structure of the ankle & foot s75021 = ankle joint and joints of foot & toes s75021. 3 = the ankle joint is severely impaired S75021.36 = the ankle joint has a deviated position = Second qualifier Exercise What does the first and second qualifier mean in this ICF code?  ICF – Qualifiers in Activity and Participation The FIRST Qualifier explains the EXTENT/MAGNITUDE of Activity limitations and Participation restrictions, measured as PERFORMANCE. Scale xxx.0 – xxx.9 The SECOND qualifier explains the EXTENT/MAGNITUDE of Activity limitations and Participation restrictions, measured as CAPACITY. Scale xxx.y0 – xxx.y9 d = activity/participation d5 = self care d550 = eating d550.1 = eating with mild difficulty d550.13 = eating with severe difficulty (without the use of an assistive device) ICF Qualifiers in Environmental Factors The first qualifier explains: if the environmental factor has a POSITIVE effect = Facilitator If the environmental factor has a NEGATIVE effect = Barrier ICF Qualifiers in Environmental Factors The FIRST Qualifier explains the EXTENT/MAGNITUDE of the Barrier or Facilitator Scale xxx.0 – xxx.9 Barrier Scale xxx+1 – xxx+8 Facilitator e = environmental factor e3 = Support & Relationships e310 = Immediate family e310+4 = Mother is a complete facilitator Exercise Pick someone you know who has seen a physio Share within your group what was their condition and any information that fits into the ICF Keep it anonymous, names are not required Feedback to the group your findings Can you add an ICF code to your anonymous person? Recommended Reading - ICF practical manual (available at: https://cdn.who.int/media/docs/default- source/classification/icf/drafticfpracticalmanual2.pdf?sfvrsn=8a214b01_4 ) - ICF beginners’ guide (available at: https://cdn.who.int/media/docs/default- source/classification/icf/icfbeginnersguide.pdf?sfvrsn=eead63d3_4) - ICF eLearning tool (available at: https://www.icf-elearning.com)