All Talk, No Action? The Global Diffusion and Clinical Implementation of the International Classification of Functioning, Disability, and Health

Department of Health Sciences and Health Policy at University of Lucerne, Nottwil, Switzerland.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists (Impact Factor: 2.2). 05/2012; 91(7):550-60. DOI: 10.1097/PHM.0b013e31825597e5
Source: PubMed

ABSTRACT We aimed to review the global diffusion and clinical implementation of the International Classification of Functioning, Disability, and Health (ICF) endorsed by the World Health Assembly in 2001.
First, we analyzed the diffusion process of the ICF, with a special focus on clinical rehabilitation. This was done by researching the spread of ICF-related terms in Pubmed and Google from 2001 to 2010. Second, we examined the clinical implementation of the ICF in rehabilitation settings by a systematic review of the literature in the databases Pubmed and Embase. Eligible were studies evaluating the current application and impact of the ICF in the daily practice of clinical rehabilitation.
We found that the diffusion of the ICF as a mere term and concept in the area of rehabilitation is successful. However, the implementation in clinical rehabilitation practice is highly idiosyncratic and rarely evaluated appropriately. The question arises whether this idiosyncratic implementation can be regarded as a process toward standardization at all. Evidence of concrete benefits of a clinical ICF implementation for team members or even patients is at best weak.
We suggest more comprehensive and comparable multicenter studies to solve the urgent need for best practice recommendations on ICF implementation in clinical rehabilitation.

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    • "Similarly, implementation of the ICF in a psychiatric framework (Álvarezz, 2012) is not an immediately viable option, as must first be adjusted to correspond to the contents and goals of psychiatric rehabilitation . A recent literature review (Wiegand et al, 2012) found that the diffusion of the ICF as a mere term and concept in the area of rehabilitation was successful ; however, its implementation in clinical rehabilitation practice was highly idiosyncratic and the requirements for implementation were often underestimated . The authors concluded that evidence of any concrete benefits of ICF's clinical implementation for team members, or even for patients, was weak at best. "
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    ABSTRACT: The extent of the implementation of the International Classification of Functioning, Disability and Health (ICF), developed by the WHO, in rehabilitation units and in physical therapy (PT) departments is unknown. The study aims to describe the extent to which the ICF has been implemented in PT services within rehabilitation units in Israel. To update data on ICF implementation since its inception. An online semi-structured survey was administered to 25 physiotherapists in charge of PT departments in all rehabilitation units throughout Israel. Rehabilitation units were grouped into three categories: general, geriatric and pediatric. The questionnaire included items regarding the ICF implementation, its strengths, and weaknesses. Twenty two physiotherapists (88%) completed the questionnaire. The majority was familiar with the ICF and nearly two thirds reported partial implementation in their units. Implementation focused mostly on adopting the biopsychosocial concepts and using ICF terms. The ICF was not used either for evaluating patients, or for reporting or encoding patient information. Physiotherapists, directors of most Israeli PT departments in rehabilitation units are familiar with the ICF; however, its clinical implementation is very limited. There is need for further research into the processes of knowledge transfer and implementation of the ICF, in order to better understand the factors that facilitate and those that impede ICF implementation.
    Physiotherapy Theory and Practice 03/2013; 29(7). DOI:10.3109/09593985.2013.765935
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    ABSTRACT: Purpose: To investigate how well Finnish specialists in PRM are familiar with ICF-based concepts of functioning, capacity, and performance. Methods: In February 2013, the 5-minute survey was carried amongst participants at the annual meeting of the Finnish Society of PRM. The 54 participants (response rate 81%) were asked to define the difference between concepts of functioning and capacity/performance. They were also asked to give some examples on tests related to these concepts. Results: Of respondents, 83% were able to define the concept of functioning accordingly to the ICF framework as a complex relationship between health condition and contextual factors. Instead, only 24% were capable to describe concept of capacity/performance as an ability to execute single tasks in a standard or current environment. Of respondents, 40% emphasized the physical dimension of performance. Over 80% of respondents suggested at least one test for assessment of the level of performance, but only 57% introduced an example of tests for measuring limitation of functioning. Conclusions: The ICF-based concepts of functioning and performance were not widely used amongst Finnish physicians specialized in PRM even if the responses to survey reflected the biopsychosocial way of understanding the functioning.
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    ABSTRACT: To evaluate the adequacy of abbreviated versions of International Classification of Functioning, Disability and Health (ICF) (the WHO ICF Checklist and the ICF Comprehensive Core Set for Stroke) with respect to the specific clinical needs of a stroke rehabilitation unit before their implementation at a practical level. Common descriptions of functional limitations were identified from patient records of 10 subsequent subacute stroke patients referred to an inpatient multiprofessional rehabilitation unit of a university hospital. These descriptions were then converted into ICF categories, and the list was compared with the ICF Checklist of the WHO and the ICF Comprehensive and Brief Core Sets for Stroke developed by the ICF Research Branch. From the study population (50% women), 71 different, second-level ICF categories were identified, averaging 36.4 categories/patient (SD 5.8, range 28-46). Except for one category, all of the categories identified were also found in the ICF Comprehensive Core Set for Stroke. Of the categories identified, 49 (69%) were found in the WHO ICF Checklist. All except one category included in the ICF Brief Core Set for Stroke were also in our list. The Comprehensive Core Set for Stroke was found to be a good potential starting point for the practical implementation of the ICF in a stroke rehabilitation unit.
    International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 02/2013; 36(2). DOI:10.1097/MRR.0b013e32835e9c4f · 1.28 Impact Factor
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