Commentary on “ICF from an occupational therapy perspective in adult care: An integrative literature review”

Abstract

This letter to the editor is in response to the article by Pettersson, Pettersson and Frisk entitled, “ICF from an occupational therapy perspective in adult care: an integrative literature review”. Given the breadth of this topic, the authors have done an admirable job in their survey of the topic. One area we felt deserved additional attention was the inadequate way the ICF classification system codes mobility assistive technology use. We also offer a point of clarification about the Wheelchair Outcome Measure, which was identified incorrectly as the only wheelchair specific measure that could measure activity and participation

Key words::

• activity
• participation
• wheeled mobility

We would like to commend Pettersson, Pettersson and Frisk (1) for their extensive review exploring the International Classification of Functioning, Disability and Health (ICF) from an occupational therapy perspective. The focus of ICF on activity and participation is largely congruent with occupational therapy and offers us a common language to help make our profession better understood by the larger international community. However, we would like to offer two comments concerning this paper that we feel are warranted.

First, we wanted to draw attention to one of the limitations of the ICF, which was not identified explicitly in the manuscript. In a review of wheelchair-specific activity and participation outcome measures (2), it was noted that the ICF did a poor job differentiating items related to mobility using assistive technology. For example, walking can be classified using a variety of fourth-level codes: walking short distances (d4500), walking long distances (d4502), walking on different surfaces (d4502), and walking around obstacles (d4503), but most mobility using an assistive device is coded as d465 (moving around with equipment). This latter code includes propelling on different surfaces, and negotiating environmental features, irrespective of distance travelled or device used (e.g. walkers, canes, crutches, scooters, power wheelchairs, and manual wheelchair). In this regard, the ICF provides limited in-depth information about assistive technology-related mobility and simultaneously seems to betray an ableist and normative perspective, which privileges those who ambulate without devices.

Second, we wanted to make a point of clarification. On page 263, the authors erroneously indicate that the Wheelchair Outcome Measure (WhOM) was the only wheelchair-specific measure that could measure activity and participation: “Mortensson [sic] et al. reviewed 11 wheelchair-specific instruments; only one instrument (WhOM) could potentially measure activity and participation.” Instead, as the only client-centred, wheelchair-specific activity and participation outcome measure, the WhOM is the only measure that could potentially capture any of the activities and participations identified in the ICF. Given the inclusion criteria, all of the measures in the review by Mortenson et al. could capture some aspect of ICF activity or participation.

We appreciate the opportunity to respond to this paper.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.