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The WHO construct of health-related functioning (HrF) and its implications for health policy.

Salvador-Carulla L, Garcia-Gutierrez C - BMC Public Health (2011)

Bottom Line: The curtailed taxonomy of ICF and its unclear distinction from other approaches have had significant implications for research, policy and legislation, as illustrated by the case of the legislation and services for functional dependency in Spain and other examples.The ICF model of functioning is more comprehensive and usable than previous alternatives, but a full taxonomy of the HrF construct is needed to avoid further confusions in this field.This should also comprise harmonization with other classifications of the WHO Family of International Classifications and other models of health functioning.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Unit, Fundació Villablanca, Grup pere Mata, Reus, Spain. luis.salvador@telefonica.net

ABSTRACT

Background: The International Classification of Functioning (ICF) has acquired a central role in the WHO Family of International Classifications and it has been extensively adopted as the reference framework for health-related functioning (HrF). This review aims to provide a description of the ICF/HrF to contextualise ICF/HrF in relation to other approaches to health functioning and to describe its application in policy and legislation with a special focus on Spain.

Methods: Narrative review based on the scientific literature and prior expert knowledge.

Results: ICF is both a coding system and a conceptual framework of HrF, which is framed as a unidimensional, bipolar and asymmetric construct with a negative pole (disability) and a positive pole (good functioning) with higher complexity. Other models of HrF include health promotion, quality of life and activities of daily living (ADL). The curtailed taxonomy of ICF and its unclear distinction from other approaches have had significant implications for research, policy and legislation, as illustrated by the case of the legislation and services for functional dependency in Spain and other examples.

Conclusions: The ICF model of functioning is more comprehensive and usable than previous alternatives, but a full taxonomy of the HrF construct is needed to avoid further confusions in this field. This should also comprise harmonization with other classifications of the WHO Family of International Classifications and other models of health functioning.

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Hierarchical map of health conditions and health-related functioning including several perspectives from WHO: Health promotion, Health-related Quality of Life, and Health-related functioning based on ICF A) health conditions and B) health-related functioning.
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Figure 1: Hierarchical map of health conditions and health-related functioning including several perspectives from WHO: Health promotion, Health-related Quality of Life, and Health-related functioning based on ICF A) health conditions and B) health-related functioning.

Mentions: Functioning and disability (D&F) are two related domains of the construct “health-related functioning”. We recently made a comprehensive review of this construct and a series of related concepts in ICF and other WHO documents [4] . D&F may be initially regarded as a unidimensional bipolar construct with a positive pole (good functioning) and a negative pole (disability) in ICF. However, there is a clear asymmetry between the two poles, as positive functioning involves many more alternatives than negative functioning. On the other hand, the analysis of the hierarchical structure and the conceptual relationship between the terms ‘functioning’ and ‘disability’ in the WHO family of classifications and related documents may indicate that ‘disability’ is actually a subcategory of ‘functioning’, as ‘disease’ is a subcategory of ‘health condition’ (Figure 1). The current definition of ‘functioning’ in ICF should incorporate the wording ‘positive functioning’ and “health-related” functioning as the global term, as health-related quality of life is regarded as a subcategory of well-being.


The WHO construct of health-related functioning (HrF) and its implications for health policy.

Salvador-Carulla L, Garcia-Gutierrez C - BMC Public Health (2011)

Hierarchical map of health conditions and health-related functioning including several perspectives from WHO: Health promotion, Health-related Quality of Life, and Health-related functioning based on ICF A) health conditions and B) health-related functioning.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104222&req=5

Figure 1: Hierarchical map of health conditions and health-related functioning including several perspectives from WHO: Health promotion, Health-related Quality of Life, and Health-related functioning based on ICF A) health conditions and B) health-related functioning.
Mentions: Functioning and disability (D&F) are two related domains of the construct “health-related functioning”. We recently made a comprehensive review of this construct and a series of related concepts in ICF and other WHO documents [4] . D&F may be initially regarded as a unidimensional bipolar construct with a positive pole (good functioning) and a negative pole (disability) in ICF. However, there is a clear asymmetry between the two poles, as positive functioning involves many more alternatives than negative functioning. On the other hand, the analysis of the hierarchical structure and the conceptual relationship between the terms ‘functioning’ and ‘disability’ in the WHO family of classifications and related documents may indicate that ‘disability’ is actually a subcategory of ‘functioning’, as ‘disease’ is a subcategory of ‘health condition’ (Figure 1). The current definition of ‘functioning’ in ICF should incorporate the wording ‘positive functioning’ and “health-related” functioning as the global term, as health-related quality of life is regarded as a subcategory of well-being.

Bottom Line: The curtailed taxonomy of ICF and its unclear distinction from other approaches have had significant implications for research, policy and legislation, as illustrated by the case of the legislation and services for functional dependency in Spain and other examples.The ICF model of functioning is more comprehensive and usable than previous alternatives, but a full taxonomy of the HrF construct is needed to avoid further confusions in this field.This should also comprise harmonization with other classifications of the WHO Family of International Classifications and other models of health functioning.

View Article: PubMed Central - HTML - PubMed

Affiliation: Research Unit, Fundació Villablanca, Grup pere Mata, Reus, Spain. luis.salvador@telefonica.net

ABSTRACT

Background: The International Classification of Functioning (ICF) has acquired a central role in the WHO Family of International Classifications and it has been extensively adopted as the reference framework for health-related functioning (HrF). This review aims to provide a description of the ICF/HrF to contextualise ICF/HrF in relation to other approaches to health functioning and to describe its application in policy and legislation with a special focus on Spain.

Methods: Narrative review based on the scientific literature and prior expert knowledge.

Results: ICF is both a coding system and a conceptual framework of HrF, which is framed as a unidimensional, bipolar and asymmetric construct with a negative pole (disability) and a positive pole (good functioning) with higher complexity. Other models of HrF include health promotion, quality of life and activities of daily living (ADL). The curtailed taxonomy of ICF and its unclear distinction from other approaches have had significant implications for research, policy and legislation, as illustrated by the case of the legislation and services for functional dependency in Spain and other examples.

Conclusions: The ICF model of functioning is more comprehensive and usable than previous alternatives, but a full taxonomy of the HrF construct is needed to avoid further confusions in this field. This should also comprise harmonization with other classifications of the WHO Family of International Classifications and other models of health functioning.

Show MeSH
Related in: MedlinePlus