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


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: Objective There is a current need for interventions that provide information to stroke survivors in a patient-centred, interactive, personalized and flexible manner. To this purpose, a standardized but content-flexible patient education programme based on the International Classification of Functioning, Disability and Health (ICF) was developed. This study evaluated the effect of this programme on perceived self-efficacy. Design Single-blind, randomized, multi-centre controlled trial. Methods Stroke patients undergoing neurological rehabilitation were enrolled. Perceived self-efficacy was measured with the Liverpool Self-Efficacy Scale. Secondary outcomes were life satisfaction and self-perception of the impact of the stroke on life, measured with the WHOQOL and the Stroke Impact Scale, respectively. Data obtained at baseline, post-intervention and 6-month follow-up were analysed using multi-level models of change. Results Two hundred and thirteen patients received either the ICF-based patient education (n = 110) or an attention-placebo (n = 103) control intervention. Over time, patients' self-efficacy (p <.01) and participation (p <.01) improved, while emotional functioning (p <.01) deteriorated, although no significant between-group differences were observed. Explorative analyses showed that gender, loci of control, difficulty in accessing health services after discharge and life satisfaction were significant predictors of self-efficacy. Conclusion There was no significant benefit of the ICF-based patient education in comparison with an attention-placebo control group. Considering the importance of the programme for the further implementation of the ICF and the need of developing effective health education interventions for stroke, the methodology used was reviewed and an updated version proposed.
    British Journal of Health Psychology 12/2012; 18(4). DOI:10.1111/bjhp.12013 · 2.70 Impact Factor
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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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