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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.

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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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Differences between ICF as a model of functioning and as a coding system. a) Theoretical interaction of the components of the “process of functioning” model of ICF; b) actual relations among the different components in the ICF classification system (environmental factors are partially described, whilst personal factors are not coded by the ICF).
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Figure 2: Differences between ICF as a model of functioning and as a coding system. a) Theoretical interaction of the components of the “process of functioning” model of ICF; b) actual relations among the different components in the ICF classification system (environmental factors are partially described, whilst personal factors are not coded by the ICF).

Mentions: In this review we focus on the taxonomical aspects of the ICF/HrF and its boundaries with other related models in the health sector. It is important to note that the biopsychosocial approach which is mentioned in the ICF to capture the different perspectives on functioning (medical and social) is not formally defined, and it has been surpassed by the holistic/integrative model [21]. In any case, the “functioning” assessed by ICF is health-related functioning and this should be made clear to avoid misinterpretation, even though the ICF diagram of the process of functioning clearly states this hierarchical relation. However, it is also important to note that the ICF model of the “process of functioning” is only partially described in the ICF book, although its main components and the existing relations among them are clearly established (Figure 2a).


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

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

Differences between ICF as a model of functioning and as a coding system. a) Theoretical interaction of the components of the “process of functioning” model of ICF; b) actual relations among the different components in the ICF classification system (environmental factors are partially described, whilst personal factors are not coded by the ICF).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Differences between ICF as a model of functioning and as a coding system. a) Theoretical interaction of the components of the “process of functioning” model of ICF; b) actual relations among the different components in the ICF classification system (environmental factors are partially described, whilst personal factors are not coded by the ICF).
Mentions: In this review we focus on the taxonomical aspects of the ICF/HrF and its boundaries with other related models in the health sector. It is important to note that the biopsychosocial approach which is mentioned in the ICF to capture the different perspectives on functioning (medical and social) is not formally defined, and it has been surpassed by the holistic/integrative model [21]. In any case, the “functioning” assessed by ICF is health-related functioning and this should be made clear to avoid misinterpretation, even though the ICF diagram of the process of functioning clearly states this hierarchical relation. However, it is also important to note that the ICF model of the “process of functioning” is only partially described in the ICF book, although its main components and the existing relations among them are clearly established (Figure 2a).

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