3. Using the International Classification of Functioning, Disability and Health

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Explore the International Classification of Functioning, Disability and Health (ICF) as a tool to support rehabilitation planning with a participation focus.

About the ICF

The World Health Organization’s ICF provides a holistic, multidimensional and interdisciplinary understanding of health and health-related conditions.1,2 Critically, it is a biopsychosocial model for healthcare.

The ICF facilitates interdisciplinary collaboration because it is used by many healthcare professionals.

Health condition (disorder or disease), Body functions and structure (impairments), Activity (limitations), Participation (restrictions), Contextual factors, Environmental factors, Personal factors
Figure 6: ICF model. Source: World Health Organization. Towards a Common Language for Functioning, Disability and Health ICF. 2002.

As described within the ICF, the problems associated with a health condition may concern body functions and structures as well as performance of activities and participation in life roles.

Body functions and structures.

  • Balance
  • Executive functions
  • Expressive language
  • Gait
  • Impulse control
  • Memory
  • Range of motion at a joint
  • Receptive language
  • Strength
  • Swallowing
  • Vision

Activities are the execution of a task or action by a person.

  • Eating
  • Expressing needs
  • Getting dressed
  • Having a conversation
  • Healthy meal planning
  • Keeping a diary or using a time-management app
  • Transferring
  • Using the toilet
  • Walking

Participation is involvement in a life situation.

  • Carer roles
  • Cultural participation
  • Domestic responsibilities
  • Playing with friends
  • Leisure and recreational pursuits
  • Managing money
  • Socialising
  • Time management
  • Wellness maintenance
  • Work

Contextual factors

The impact of the health condition and the person’s subsequent disability are also influenced by contextual factors. These include both environmental factors and personal factors. Contextual factors can act as facilitators or as barriers to the person’s ability to maximise recovery in body functions, activity and/or participation.

Personal factors are the background of a person’s life and living. They are features of the person that are not part of the health condition (but may be influenced by the health condition).

  • Ability to communicate
  • Acceptance and adjustment
  • Attitude to disability and to future
  • Beliefs
  • Engagement in the rehabilitation process
  • Education
  • Culture
  • Health literacy
  • Hope
  • Life roles (e.g. parent, worker, student, friend)
  • Motivation
  • Pre-health event functional abilities
  • Self-efficacy
  • Values

Environmental factors make up the physical, social and attitudinal environment in which people live their lives. They are external to the person.

  • Attitudes of others (e.g. family, community, cultural group, colleagues, etc.)
  • Availability of communication support (e.g. interpreters or culturally appropriate resources)
  • Availability of services
  • Family expectations
  • Features of the service delivery system
  • Finances
  • Physical environment (e.g. access to home, community, work, school)
  • Proximity and accessibility of rehabilitation services
  • Legal situation
  • Social relationships

References

  1. World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: WHO; [n.d.].
  2. Leonardi M, Fheodoroff K. Goal Setting with ICF (International Classification of Functioning, Disability and Health) and Multidisciplinary Team Approach in Stroke Rehabilitation. In: Platz T, editor. Clinical Pathways in Stroke Rehabilitation: Evidence-based Clinical Practice Recommendations. Cham (CH): Springer; 2021.
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