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Abstract
The World Health Organization produced the International Classification of Impairments, Disabilities and Handicaps (ICIDH), in 1980 to assist the study of the consequences of diseases. It is the Logical complement to the International Classification of Disease (ICD), which classifies the causes of disease. The three dimensions includes in the ICIDH are validated by criteria already widely used in the rehabilitation field and make it possible, in conjunction with financial data, to improve the management and planning of human and material resources in rehabilitation units.
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The purpose of this study is to emphasize the meaningfulness of a global, functional rather than a narrow medical view in the efficacy evaluation of chronic pain treatment. Therefore, the 'Biopsychosocial Disease Consequence (BPSDC) model' to assess function more globally than before, is presented in this article. The model is based on two theories: (1) the biopsychosocial approach and (2) WHO's classification of impairments, disabilities and handicaps. In addition to the presentation of the conceptual model, the development of the hypothetical criteria and assessment models for psychological impairments, disabilities and handicaps, and the validity testing of the psychological assessment axis are described. Within each of the three classes, i.e. psychological impairments, disabilities and handicaps, the results supported the independence of the hypothetical criteria from each other. On the other hand, results suggested that some changes to the hypothetical assessment models for some of the criteria might be valuable. It was concluded that although the most adequate psychological assessment models for function, found in this study, can be considered as robust and recommendable as one set of tools for functional assessment, the main aim of this article is to encourage multidisciplinary team efforts to develop and systematize the assessment procedures of function in patients suffering from chronic diseases.
An 11-class patient classification system (PCS) has been built on a recode of two dimensions of the handicap code of the ICIDH: physical independence and mobility handicaps. The proposed system, called MAC XI, explains 78% of the variance of nursing care hours required by nursing-home residents and extended-care hospital patients. This percentage of variation is higher than the one explained by traditional dependency grids such as the Exton-Smith, Murphy, Kuntzmann and SMAF. MAC XI, based on two dimensions of the handicap code, is thus a powerful tool for predicting intensity of nursing care for staffing and budgeting purposes in long-term care institutions.
Research on disablement highlights a wide variability in the impact of disabling conditions on individuals' lives. However, in most of this work, the relationships between impairment/disability and features of individuals' social and physical environments are not specified conceptually. Recent conceptual work in the context of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) suggests that the impact of impairment/disability on individuals' lives is contingent on levels of resources and other aspects of social context. The research question addressed in this paper is whether selected social factors affect the impact of impairment/disability on mobility handicap, defined as 'the individual's ability to move about effectively in his/her surroundings'. Two types of social factors are considered: resources such as help from others or having a car available; and social role obligations such as having a job or visiting relatives. Data are derived from a 1986 probability sample of 570 individuals with disabilities living in communities in Calderdale, Yorkshire, England. Multiple-regression models indicate that the impact of walking disability on mobility handicap was reduced by availability of a car in the household and school or job obligations. Other impairments/disabilities, resources and social role demands examined did not act on mobility outcomes in this manner. Implications for conceptualizing and testing relationships between impairment, disability, handicap and social and physical environments are discussed. A critical task for future research is the investigation of personal and social resources and barriers that may moderate the impact of disability on individuals' lives.
The measurements of disability and environmental barriers have received growing nationwide attention and dissemination in the United States, particularly since the 1990 passage of the Americans with Disabilities Act (ADA). This article presents a brief overview of selected ICIDH uses and applications in the USA. Potential contributions of the ICIDH for ADA implementation are discussed, and parallel definitions of disability in the ICIDH and the ADA are cited. © 1995 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
The International Classification of Impairments, Disabilities, and Handicaps (ICIDH) is gaining wide acceptance inside and outside the field of rehabilitation medicine. Impairment and disability are concepts which are often used interchangeably or defined differently. The World Health Organization (WHO) has defined impairment and disability in the ICIDH. In this article an analysis is made of these definitions and the characteristics that are given for the definitions. Based on this analysis, modifications for the definitions and characteristics of impairment and disability are suggested.
The disabilities experienced by a large cohort of 18-year-olds have been reported in the previous paper of this series. In this paper, we present the results of a detailed examination of the extent to which the disabilities caused limitation in the everyday activities of this group of young people. The results showed that nearly three-quarters of the members of the sample reported having one or more difficulties in performing activities in their daily lives, though the extent of limitation on their activities was low for most adolescents. Of this group who reported any type of disablement, 23% indicated it imposed very little general limitation on their lives (on a five point scale) and 6% rated it at the highest degree of limitation. Approximately half those with a disability felt the condition was improving, but 28% required an aid or help from another person. From 8% to 11% of those with a disability rated it as serious in relation to aspects of their daily living (education, leisure, social and work) and about half of those with a serious degree of limitation had sought help. The most common disabilities related to behaviour, communication and situations, for example environmental factors. As part of an ongoing study, the results provide a base from which to examine the extent and severity of disability among young people and change in disability as a result of the ageing process.
The diagnosis and classification of children with disabilities are persistent concerns in paediatric and habilitative services. These concerns are magnified in international contexts and restrict comparative research and policy development. Even within classifications such as mental retardation, hearing impairment and physical impairment, children can vary widely in the nature and severity of manifested conditions. In the fields of disability and rehabilitation there is a growing interest in functional measurement. Accompanying this awareness is a corresponding recognition of the value of classification approaches which are compatible with the WHO framework of the International Classification of Impairments, Disabilities, and Handicaps. This paper examines issues pertaining to the classification of children with disabilities and describes the development of the ABILITIES Index, a functional assessment measure yielding a profile of individual characteristics. The cross-cultural applicability of the measure is documented on the basis of data for children in the People's Republic of China.
In rehabilitation centres for visually impaired and blind people the need for a common, conceptual framework was felt by the various disciplines working there. As a consequence an interdisciplinary model has been developed. This article gives a brief description of the two elements of the model: the concepts of the ICIDH and the path of rehabilitation. The classifications of the ICIDH have been adapted to suit our purposes better. The concepts of impairment, disability, and handicap can serve as a framework during an interdisciplinary consultation. In this context a visual profile, which contains information gained from the assessments done by the various disciplines, will be discussed. The visual profile makes it possible to gain general insight into the client's visual problems from all perspectives, which enables the team to draw up an interdisciplinary rehabilitation diagnosis. At present the model is being tested by practical experience in three regional rehabilitation centres for visually impaired and blind people. The model gives an outline of the application of the ICIDH concepts, and leaves open the possibility of working on the various aspects in more detail.
The consequences of asthma are described in accordance with the definitions of the three levels of the International Classification of Impairments, Disabilities and Handicaps (ICIDH). Because asthma is a chronic disease, health care should emphasize how to cope with it. The goal of physical activities for persons with asthma is the learning of skills which can be used to control the physical situation. Breathing therapy and therapeutic drugs make it possible for the person to control the physical condition. In physical education and sport training, patients are taught to use these means in physically strenuous situations.
This retrospective study describes the nature and severity of disablement resulting from motorcycle crashes (both traffic and non-traffic). Two hundred and fifty motorcycle crash victims were randomly selected from the total population of motorcycle crash victims (n = 1510) who had received compensation for disablement in the year ending 31 March 1990. Information on the nature and extent of disablement was obtained from official accident compensation files and coded according to the International Classification of Impairments, Disabilities, and Handicaps. Extremity injuries predominated, especially to the lower limb. The majority of these were fractures. Most commonly impairments occurred in the areas of 'skeletal', 'disfiguring' and 'generalized' impairment. Mechanical impairment of a limb was reported in 68% of cases, often with associated disfigurement. Disability mostly involved problems with locomotion and problems coping with physical stresses at work. Occupational handicap was the most common handicap reported, with mobility handicap the next most common. The shortcomings of this study included its retrospective design and the variable quality of the information on disablement. It was most likely, though, that these factors contributed to an underestimation of disablement in the study group.
As consequences of disease and disorders cannot be expressed with the International Classification of Diseases (ICD), the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) was tested on a data sample of 1800 persons from the Croatian Register of Psychophysical Development Disorders and Other Disabilities (CRPDOD). Persons with either a visceral impairment, skeletal impairment, disfiguring impairment or one from the group of generalized, sensory and other impairments, were selected. Despite favourable results some amendments are suggested. These involve several examples of coding practice, modified elaboration of consciousness and continence impairments, newly created categories and subcategories in classifications I and D, as well as common codes for cases having several disability categories simultaneously.
In this paper the use of the ICIDH in the field of calculating health expectancies is examined. The health indicator 'health expectancy' is an adaptation of the indicator 'life expectancy'; health expectancies reflect the expected number of years lived in good health in a population. To date, health expectancies have been calculated for many countries. However, many different concepts of health have been used. The theoretical framework of the ICIDH has been proposed to harmonize the calculations of health expectancy. In this paper we explore this idea. To examine the possibility to use the ICIDH framework, we calculated health expectancies for The Netherlands, trying to follow the ICIDH. Subsequently, we reviewed the health expectancies calculated for other countries, and tried to fit those into the ICIDH framework. Much of the work done could be fitted into this framework. An important exception, however, are those health expectancies that try to capture a concept of health that is more compassing than impairments, disabilities and handicaps. Although it is possible to classify different health expectancies according to the ICIDH, this does not make health expectancies within a certain class comparable. Both the calculations carried out for The Netherlands, and the comparison of instruments used internationally, show that the instruments used to measure, for example, disabilities, yield results which are not comparable. Continuing efforts to standardize measurement instruments are needed.
The Mitchells Plain Disability Survey was undertaken primarily to expand a community-based rehabilitation programme in an underprivileged South African urban community. This descriptive survey used a proportional stratified random cluster sampling strategy (sample size 2424), with stratification by suburb and clusters consisting of 15 adjacent plots. A household screening questionnaire (based on the WHO disability questionnaire), identified people who reported health problems affecting their functional ability, while a second follow-up interview confirmed disablement status and obtained a medical, disablement and demographic profile of the disabled and ascertained their needs. This paper discusses different methodological issues related to the survey design and emphasizes the need for standardization of methods in the disablement field. Sampling issues include sample loss in a multi-staged data collection strategy as well as the non-independence of observations when sampling entire house- holds. The trade-off between studying disability across diagnostic, disablement and age categories, and wide confidence intervals for specific prevalence rates, is discussed. Because of the prohibitive costs validation of disablement status is often omitted in a low-budget project (as this one was), weakening the design of such studies. Even if the 'disabled' are correctly identified, the criteria for identifying respondents determine what type of disablement prevalence will be obtained, Different diagnoses reported on screening yielded different positive predictive values of disability--the most debilitating conditions yielding the highest proportion of disabled people. The quality of the data--evaluated through comparisons of initial and repeat screening interviews, and proxy and self-reporting--is described. There is a need for disability research to continue developing suitable methods for a wide range of purposes. One such is a 'good-enough' survey design which can be implemented rapidly, at relatively low cost, to yield useful results at local level.
The ICIDH definition of disability has ensured that disability is treated as a continuous variable and therefore as a measurable concept. Even though the suggestions made in the ICIDH for the measurement of severity of disability are applicable only in certain contexts, the ICIDH classification of disabilities, when used flexibly, contributes greatly to the identification of the disabilities whose severities should be measured in both rehabilitation medicine and health interview surveys. There is still a great need to identify and devise instruments which measure the severity of many particular disabilities to an appropriate level of accuracy. Nevertheless, as the reduction of handicap is the ultimate aim of both health service planning and rehabilitation medicine, it is fight that the description and measurement of handicap should be the first priority.
This study aimed to compare the prevalence of hearing impairment, disability and handicap in the elderly living in residential care with those living in the community, and to examine the relationship between impairment, disability and handicap in both groups. Fifty community-based and 129 residential subjects were assessed using pure-tone audiometry as a measure of impairment, and a self-assessment questionnaire as a measure of disability and handicap. Community-based subjects were also assessed using a test of speech discrimination as an objective measure of disability. Results indicated 95% of residential subjects and 70% of community-based subjects were hearing-impaired, while 27% of residential subjects and 42% of community-based subjects demonstrated significant disability/handicap. Significant correlations were obtained between impairment, disability and handicap in both subject groups. The implications of the findings for the aural rehabilitation of the elderly are discussed.