Chapter 10: Introduction to Documentation Using the International Classification of Functioning, Disability, and Health (ICF) System

Introduction

Practicing clinicians have seen firsthand that patients with identical diagnoses, such as left hemispheric stroke, can have different clinical presentations and functional abilities. In light of this, the therapist must view each patient from a multifactorial approach, including such factors as the accessibility of the patient's environment, financial status, and the social support system, in addition to all of the classic objective measurements. All of these factors can have a profound impact on a patient's recovery and ultimate functional outcome. To achieve the most accurate whole picture of the patient's current functional status and potential for recovery, the therapist must be privy to as much information as possible regarding the total person in front of her.

Background on ICF

For many years, most medical thought had been grounded in the medical model, which focused on disability as the basis for classification. This had been reflected in documentation of medical conditions in a variety of fields. However, new technology and a subsequent increase in medical diagnoses and treatments have created a cultural shift in how we as clinicians look at diagnoses and the patients that they affect. As a result, focus has been placed on adopting the World Health Organization's (WHO) International Classification of Functioning, Disability and Health, or ICF, as “a classification of human functioning and disability.”¹

Initially proposed by the WHO in 1980 for trial purposes as the International Classification of Impairments, Disabilities, and Handicaps (ICIDH), and then unanimously adopted by all WHO member states in 2001 at the 54th World Health Assembly, ICF was designed to establish a framework for comprehensive health measurement.

The ICF framework uses a biopsychosocial model of health that acknowledges the interaction of biological, social, and personal factors to provide a nuanced description of a person's health experience.¹ By acknowledging that every human being can experience a decline in health and, in turn, experience some form of disability, the ICF model views disability as a “universal human experience.”²

The ICF Model and Terminology

Description or classification of a person's health status using ICF is based on the multifactorial framework shown in Figure 10-1.²

All of the factors or classifications surround the factor of Activity, which is defined as a person's execution of a task or action. A person's ability to perform activities is presumably affected by all the factors that surround it. Participation appears as a factor distinct from activity and is defined as involvement in a life situation. However, clinical practice and the evolving ICF literature show the factors of Activity and Participation as one factor: Activity and Participation. There is some concern about the practical usefulness and need to differentiate the two factors.^1...