The ICF has made a difference to functioning and disability measurement and statistics

Abstract

Aims: Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics.

Methods: In a scoping review, we investigated research published 2001–2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge.

Results: The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation.

Conclusion: The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes.

Implications for Rehabilitation

• The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance.

• Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning.

• Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.

Keywords:

• Functioning
• disability
• measurement
• statistics
• participation
• environment
• ICF applications

Acknowledgements

The authors acknowledge the thoughtful comments of Prof. Gwynnyth Llewellyn of the University of Sydney during the research underlying this article. Dr. Charlotte Scarf assisted greatly with copy editing.

Disclosure statement

The authors report no conflicts of interest.

Notes

Notes

1 Two smaller reviews, using different approaches, and a third source are also worthy of note. Bruyere et al. [170] reviewed the literature three years after ICF publication. The authors focused on articles about the meaning and use of the ICF, and its use in specific fields. They found a wide variety of applications and concluded the results were “encouraging” [170, p.113,119]. Kostanjsek [39], in a descriptive review of some 30 articles, outlined the ICF features and explained its value for disability statistics and health information systems, highlighting applications such as multi-country surveys, national surveys and national data systems. A third source, the ICF practical manual, while providing “how to use” advice about the ICF, also provides an overview of applications and examples of use from around the world [75].

2 The reference list from the thesis is available from the corresponding author.

3 Other more specialised measures have been devised, e.g., for: therapy outcomes [171]; stuttering experience [172]; social security or insurance [173]; and the functional performance of children with autism [174].