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Use of The International Classification of Functioning, Disability and Health (ICF) as a conceptual framework and common language for disability statistics and health information systems
Open accessAbstract
A common framework for describing functional status information is needed in order to make this information comparable and of value. The World Health Organization's International Classification of Functioning, Disability and Health (ICF), which has been approved by all its member states, provides this common language and framework. The article provides an overview of ICF taxonomy, introduces the conceptual model which underpins ICF and elaborates on how ICF is used at population and clinical level. Furthermore, the article presents key features of the ICF tooling environment and outlines current and future developments of the classification.
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“This study followed the Preferred Reporting Items for Systematic Review and Meta-analyses: the PRISMA Statement19 guidelines and was registered at the International prospective register of systematic reviews, PROSPERO, under the identification number CRD42016039393.”
From Benchmarks of Significant Change After Aphasia Rehabilitation (2019) · cites this paper as [19]
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Ong, C., Lee, J. H., Leow, M. K., & Puthucheary, Z. (2016) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000000706 · Cited by 180
A Detailed Overview of Long-Term Outcomes in Severe Traumatic Brain Injury Eight Years Post-injury
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“The structured interview was developed for the study to assess impairments, activities, and participation according to the International Classification of Functioning, Disability, and Health framework (25).”
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Paradigm Shifts in Disability and Health: Toward More Ethical Public Health Research
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The ICF has made a difference to functioning and disability measurement and statistics
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“Kostanjsek [39], in a descriptive review of”
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“Although the ICD-10 is the most widely used classification within this family, there is a growing interest in the use of the ICF and ICF-CY in international health care, with regards to both physical disabilities [Cerniauskaite et al., 2011; Fayed, Cieza, & Bickenbach, 2011; Kostanjsek, 2011; Stucki & Cieza, 2008] and…”
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Feeding and Swallowing Disorders in Pediatric Neuromuscular Diseases: An Overview
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“In accordance with the International Classification of Functioning, Disability and Health (ICF), the assessment includes information on mealtime environment (participation), activities of the child during mealtimes (activities), and motor skills, neuromotor development, and neuromuscular conditions (body function and…”
MethodPatient-Reported Outcomes in Orthopaedics
MOTION Group (2018) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.17.00608 · Cited by 97
van Roekel, E. H., WINKLER, E. A. H., Bours, M. J. L., Lynch, B. M., Willems, P. J. B., Meijer, K., Kant, I., Beets, G. L., Sanduleanu, S., Healy, G. N., et al. (2016) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2016.06.022 · Cited by 92
“Compared to the traditional biomedical concept of health and disability as separate entities with a strong emphasis on physical health, the ICF adopts a broader bio-psychosocial definition of human functioning, as a multidimensional and universal concept which includes health and disability within a single spectrum (K…”
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“According to World Health Organization, the International Classification of Functioning, Disability, and Health (ICF) outlinesdisability as an umbrella term, confining impairment, activity, and participation limitations [1].”
MethodCarneiro, D. D. C., de Araújo, L. T., Santos, G. C., Damasceno, P. K. F., Vieira, J. L., dos Santos, R. R., Barbosa, J. D. V., & Soares, M. B. P. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24129939 · Cited by 90
“The ICF includes the influences of environmental factors, shifting the attention to impacts instead of causes, and has been increasingly implemented in many settings [62].”
BackgroundApplication of Smartphone Technologies in Disease Monitoring: A Systematic Review
Moses, J. C., Adibi, S., Islam, S. M. S., Wickramasinghe, N. S., & Nguyen, L. (2021) · Healthcare · doi:10.3390/healthcare9070889 · Cited by 91
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“Poor physical functioning is also linked to adverse health outcomes (15) and is addressed by the WHO’s International Classification of Functioning, Disability and Health (ICF) (16).”
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“allows medical, individual, social, and environmental influences on functioning and disability to be described and examined (33, 34).”
BackgroundInternational and European Disability Law and Policy
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Devoogdt, N., Groef, A. D., Hendrickx, A. A., Damstra, R. J., Christiaansen, A., Geraerts, I., Vervloesem, N., Vergote, I. B., & Kampen, M. V. D. (2014) · Physical Therapy · doi:10.2522/ptj.20130285 · Cited by 77
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Vaccination in people with disability: a review
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“impairments of body function, activity limitations and participation restrictions.(13) Data from WHO suggest that 15% of the world’s population has some impairment in function, with”
BackgroundBenchmarks of Significant Change After Aphasia Rehabilitation
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van der Veen, S., Evans, N., Huisman, M. A., Saleeby, P. W., & Widdershoven, G. A. M. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2089737 · Cited by 49
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“Human functioning is understood as a continuum of health states, and every human being exhibits one or another degree of functioning in each domain, at the body, person, and society levels.(2) The ICF does not itself develop instruments to describe and to measure functioning and disability related to health conditions…”
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“The ICF adopts a broad biopsychosocial definition of human functioning as a multidimensional concept, which does not only incorporate physical health components (body perspective), but also an individual’s ability to perform his/her daily activities and societal roles (individual and societal perspectives) [23].”
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“ICF, a well-established, universal and biopsychosocial model-based framework on health and disabilities, provides a common language for disability statistics and health information systems [27].”
Backgroundvan Roekel, E. H., Bours, M. J. L., Molder, M. E. M. T., Breedveld-Peters, J. J. L., Damink, S. W. M. O., Schouten, L. J., Sanduleanu, S., Beets, G. L., & Weijenberg, M. P. (2017) · Quality of Life Research · doi:10.1007/s11136-017-1539-z · Cited by 42
“The ICF adopts a broad biopsychosocial definition of human functioning, including physical health components (body perspective) and the ability to perform daily activities and societal roles (individual and societal perspectives) [43].”
BackgroundVisagie, S. J., Eide, A. H., Dyrstad, K., Mannan, H., Swartz, L. M., Schneider, M., Mji, G., Munthali, A., Khogali, M., Rooy, G. V., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0186342 · Cited by 42
Disability, violence, and mental health among Somali refugee women in a humanitarian setting
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“Certain groups may be particularly vulnerable to GBV, and among these are people with disabilities, who make up 15% of the global population (World Health Organization, 2002; Kostanjsek, 2011; World Health Organization (WHO) and The World Bank, 2011).”
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“This definition was used in early studies [9,17,18,41] and in studies defining targets for providing long-term care services in Japan [52] or Medicaid in the United States [17,21].”
BackgroundMethodIssues of Survivorship and Rehabilitation in Soft Tissue Sarcoma
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“The ICF supports data compilation, analysis, policy monitoring, service provision and communication between health professionals [53,54] and has been used to develop rehabilitation models [54,55].”
Work Participation Among Employees with Common Mental Disorders: A Meta-synthesis
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“ICF can be a valuable tool to strength internal communication, offering a basis for improved coordination [64, 91].”
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“Concepts that were linked to the ICF domain personal factors could not be linked to categories because personal factors are not yet classified in the ICF 13,15 .”
BackgroundMethodBölte, S., de Schipper, E. J., Holtmann, M. H., Karande, S., de Vries, P. J., Selb, M., & Tannock, R. (2013) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-013-0496-5 · Cited by 36
“participation change dramatically from dependent relationships in infancy to complex life situations in adolescence; (c) along with developmental changes in participation, the nature and number of environments change as well; and (d) lags in emergence of functions or acquisition of skills may reflect developmental del…”
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“Disability is also explained as difficulties in any or all three areas of functioning: impairment, activity limitation and participation restriction [1, 2].”
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“ICF has brought these concepts into a comprehensive whole of multiple dimensions of human functioning, such as biological, psychological, social and environmental [2].”
BackgroundThe Bidirectional Relationship Between Depressive Symptoms and Homebound Status Among Older Adults
Xiang, X., An, R., & Oh, H. (2017) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbx180 · Cited by 29
“Under the ICF model, the state of being homebound is a result of the interactions between body functions and structures, activities and participation, and environmental factors (Kostanjsek, 2011).”
BackgroundVrieze, T. D., Gebruers, N., Nevelsteen, I., Tjalma, W. A. A., Thomis, S., Groef, A. D., Dams, L., der Gucht, E. V., & Devoogdt, N. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05375-3 · Cited by 29
“These domains comprise body functions (includingmental functions) and structures, activities and participation, and environmental factors [13].”
BackgroundEnvironmental factors influencing participation of stroke survivors in a Western Cape setting
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“Environmental factors can compound or diminish the impact of impairments and activity limitations on life roles (Kostanjsek 2011; Schneidert et al. 2003; World Health Organisation 2001).”
BackgroundPrevalence of intellectual disability in Iran: Toward a new conceptual framework in data collection
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“[8,9] In 1998, in order to reach a universally accepted conceptual framework to define and classify disability, World Health Organization (WHO) has developed an instrument entitled the WHO Disability Assessment Schedule (WHODAS 2.”
Warnink‐Kavelaars, J., Beelen, A., Dekker, S., Nollet, F., Menke, L. A., & Engelbert, R. (2019) · BMC Pediatrics · doi:10.1186/s12887-019-1612-6 · Cited by 28
Hendriks, T. C. C., Botman, M., de Haas, L. E. M., Mtui, G. S., Nuwass, E. Q., Jaspers, M. E. H., Niemeijer, A. S., Nieuwenhuis, M. K., Winters, H. A. H., & van Zuijlen, P. P. M. (2021) · Burns · doi:10.1016/j.burns.2020.12.024 · Cited by 30
Maierhofer, S., Almazán‐Isla, J., Alcalde-Cabero, E., & de Pedro‐Cuesta, J. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-897 · Cited by 27
“The ICF is increasingly used in different sectors, including health, social affairs, labour and education [3,4].”
BackgroundZia, N., Loeb, M. E., Kajungu, D., Galiwango, E., Diener‐West, M., Wegener, S., Pariyo, G. W., Hyder, A. A., & Bachani, A. M. (2020) · BMC Public Health · doi:10.1186/s12889-020-09455-1 · Cited by 27
Stallinga, H. A., Roodbol, P. F., Annema, C., Jansen, G. J., & Wynia, K. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12266 · Cited by 27
Tofani, M., Mustari, M., Tiozzo, E., Dall’Oglio, I., Morelli, D., Gawronski, O., Salata, M., Cantonetti, L., Castelli, E., Lallo, D. D., et al. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2136269 · Cited by 26
Huyck, J. J., Anbuhl, K. L., Buran, B. N., Adler, H. J., Atcherson, S. R., Cakmak, O., Dwyer, R. T., Eddolls, M. S., May, F. E., Fraenzer, J.-T., et al. (2021) · Frontiers in Education · doi:10.3389/feduc.2021.755457 · Cited by 25
Boakye, M., Ball, T., Dietz, N. E., Sharma, M., Angeli, C., Rejc, E., Kirshblum, S., Forrest, G. F., Arnold, F. W., & Harkema, S. J. (2023) · Surgical Neurology International · doi:10.25259/sni_1074_2022 · Cited by 25
Fear of Falling and Environmental Factors: A Scoping Review
Rico, C. L. V., & Curcio, C. (2022) · Annals of Geriatric Medicine and Research · doi:10.4235/agmr.22.0016 · Cited by 26
Honado, A. S., Atigossou, O. L. G., Roy, J., Daneault, J., & Batcho, C. S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032286 · Cited by 24
“Activity limitations are the difficulties a person might have in executing daily activities [6,12].”
BackgroundWenzel, T.-R., & Morfeld, M. (2016) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-016-2401-0 · Cited by 24
Bettecken, K., Bernhard, F. P., Sartor‐Pfeiffer, J., Hobert, M. A., Hofmann, M., Gladow, T., van Uem, J. M. T., Liepelt‐Scarfone, I., & Maetzler, W. (2017) · PLoS ONE · doi:10.1371/journal.pone.0176816 · Cited by 24
Gelsomini, M., Spitale, M., & Garzotto, F. (2021) · Multimedia Tools and Applications · doi:10.1007/s11042-021-11164-9 · Cited by 23
“These are conceptualized by the International Classification of Functioning a “functioning levels” which stand for persons level of functioning as a dynamic interaction between their health conditions, environmental factors, and personal factors, as proposed by the biopsychosocial model of disability [33].”
BackgroundHao, J., Yao, Z., Harp, K. A., Gwon, Y., Chen, Z., & Siu, K. (2022) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2022.2094302 · Cited by 22
“Extracted VR outcomes were organized based on the three levels of ICF framework (Kostanjsek, 2011), including Body Functions and Structure, Activity and Participation; and meta-analysis was performed where the same outcome measure was used.”
MethodKibret, A. K., Yilma, T. M., Davies, T. C., Genetu, Z. A., Mekonone, S. T., Alene, B. M., Addis, B. M., Nigussie, K., Getachew, R., & Araya, B. M. (2024) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2024.2362248 · Cited by 30
Determinants of disability at 6 months after stroke: The GRECogVASC Study
Tasseel‐Ponche, S., Barbay, M., Roussel, M., Lamrani, A., Sader, T., Arnoux, A., Canaple, S., Lamy, C., Leclercq, C., Aarabi, A., et al. (2022) · European Journal of Neurology · doi:10.1111/ene.15319 · Cited by 21
Richardson, J. A., Beauchamp, M. K., Bean, J. F., Brach, J. S., Chaves, P. H. M., Guralnik, J. M., Jette, A. M., Leveille, S. G., Hoenig, H., Manini, T. M., et al. (2023) · The Journals of Gerontology Series A · doi:10.1093/gerona/glad143 · Cited by 21
Definition and Validation of the ICF – Usability Scale
Martins, A. I., Rosa, A. F., Queirós, A., Silva, A. G., & Rocha, N. P. (2015) · Procedia Computer Science · doi:10.1016/j.procs.2015.09.257 · Cited by 21
Dorjbal, D., Cieza, A., Gmünder, H. P., Scheel‐Sailer, A., Stucki, G., Üstün, T. B., & Prodinger, B. (2016) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzw078 · Cited by 21
The New Role of Biomedical Informatics in the Age of Digital Medicine
López–Campos, G., & Martin-Sanchez, F. J. (2016) · Methods of Information in Medicine · doi:10.3414/me15-02-0005 · Cited by 21
“…a classification for self-quan-tification systems (devices and software) and a classification for activities, such as sleep or physical exercise, that can be measured with self monitoring devices, based on the WHO International Classi - fication of Functioning, Disability and Health (ICF) [39].”
MethodThe United Nations Convention on the Rights of Persons with Disabilities
Broderick, A., & Ferri, D. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108289450.009 · Cited by 21
Measuring patient outcomes: A primer
Bryant, D., & Fernandes, N. (2011) · Injury · doi:10.1016/j.injury.2010.11.049 · Cited by 21
Paramasivam, A., Jaiswal, A., Minhas, R., Holzhey, P., Keyes, K., LOPEZ, R., & Wittich, W. (2021) · PLoS ONE · doi:10.1371/journal.pone.0261413 · Cited by 20
Meeting the needs of people with neuro-developmental disorder through a phygital approach
Spitale, M., Gelsomini, M., Beccaluva, E. A., Viola, L., & Garzotto, F. (2019) · Biannual Conference of the Italian SIGCHI Chapter (CHItaly) · doi:10.1145/3351995.3352055 · Cited by 20
“Predictable rules may be also well matched to the systematic processing styles of NDD individuals [24].”
BackgroundMethodHaas, B. M., Playford, E. D., Ahmad, A., Yildiran, T., Gibbon, A. J., & Freeman, J. A. (2015) · Spinal Cord · doi:10.1038/sc.2015.155 · Cited by 20
Kostanoğlu, A., Hoşbay, Z., & Tarakçı, E. (2016) · Journal of Physical Therapy Science · doi:10.1589/jpts.28.1728 · Cited by 19
Rozevink, S. G., van der Sluis, C. K., & Hijmans, J. M. (2021) · Journal of NeuroEngineering and Rehabilitation · doi:10.1186/s12984-021-00934-z · Cited by 20
Pisa, M., Ruiz, J. A., DeLuca, G. C., Crespo, M. D. A., DelMastro, H. M., Olson, K. M., Triche, E. W., & Lo, A. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.103917 · Cited by 19
Levy, M., Burns, R. J., Deschênes, S. S., & Schmitz, N. (2017) · Psychosomatics · doi:10.1016/j.psym.2017.03.004 · Cited by 19
Nkansah‐Dwamena, E. (2022) · Journal of International Development · doi:10.1002/jid.3663 · Cited by 20
Evaluation of Individuals with Non-Syndromic Global Developmental Delay and Intellectual Disability
AlMutiri, R., Malta, M., Shevell, M. I., & Srour, M. (2023) · Children · doi:10.3390/children10030414 · Cited by 20
Beaudrap, P. D., Pasquier, E., Tchoumkeu, A., Touko, A., Essomba, F., Brus, A., du Loû, A. D., Aderemi, T. J., Hanass‐Hancock, J., Eide, A. H., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2015-008934 · Cited by 18
Zhang, X., Qiu, H., Liu, S., Li, J., & Zhou, M. (2020) · Medical Science Monitor · doi:10.12659/msm.918811 · Cited by 18
“Therefore, the ability to perform routine daily activities or the ability to participate in activities was more likely to affect the LOS in stroke patients when compared with other categories, emphasizing the clinical significance of participation in the ICF framework [43].”
Backgroundde Castro, S. S., Filho, P. S. B. A., Bonates, M. F., da Silva, M. C., & Castaneda, L. (2019) · Acta Fisiátrica · doi:10.11606/issn.2317-0190.v26i4a169816 · Cited by 17
Metadata
- Authors
- Kostanjsek, N.
- Affiliations
- World Health Organization (CH)
- Corresponding author
- Kostanjsek, Nenad
- ORCID
- Kostanjsek, Nenad
- Venue
- BMC Public Health
- Published
- 2011
- Volume
- 11
- Issue
- Suppl 4
- Pages
- S3
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC3104216
- OpenAlex
- W2027013776
- Cited by
- 434
- References
- 18
- Citations by year
- 2026: 34 · 2025: 38 · 2024: 40 · 2023: 44 · 2022: 41 · 2021: 27 · 2020: 36 · 2019: 51 · 2018: 24 · 2017: 18 · 2016: 29 · 2015: 17 · 2014: 10 · 2013: 14 · 2012: 7
- Type
- conference abstract
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- International Classification of Functioning, Disability and Health, disability statistics, health information systems, functional status, conceptual framework, disability classification
- MeSH terms
- Disability Evaluation, Persons with Disabilities, Humans, Information Systems, Vocabulary, Controlled, International Classification of Diseases
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