Introduction to Disability and International

Classification of Functioning, Disability and

Health (ICF)

Prof Dr Mohd Raili Suhaili

MED47212
MBBS Programme
SEGi University

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 PART 1

DISABILITY
d

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 Definition of Disability
 “The question of definition of ‘person with
disability (PWD)’ and how PWDs perceive
themselves are knotty and complex” (Kaplan,
J.The definition of disability: Perspective of the disability
community. J.Health Care L. & Policy (352) 2000)

 “an inability to pursue an occupation

because of physical or mental impairment”
(Merriam-Webster-Online)

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 Impairment, Handicap & Disability
1. Impairment
• Any reduction in physical or mental capacities
• Generally disturbance at the organ level
• Need not be visible and can normally be
corrected eg impaired vision

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 Disability
3. Disability
• Restriction in a person’s ability to perform a
function in a manner considered normal for a
human being if impairment is not corrected.
4. Handicap
• Refers to social disadvantage as a result of
disability eg loss of earning.

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 Medical model
• According to International Classification of
Impairments, Disabilities and Handicap (ICIDH,
1980) ‘any restriction or lack of ability to perform
an activity in the manner or within the range
considered normal for human being’.
• Disability seen as outcome of impairment
• Impairment as the determining factor– any loss or
abnormality of psychological, physiological or
anatomical structure or function.
• Severely criticized
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 Social Model
• Social discrimination and and other barriers can have more negative
effect on PWDs than the impairment.
• According to this model disability is defined as “ the disadvantage or
restriction of activity caused by a contemporary social organization
which takes little or no account of people who have physical
impairment and thus excludes them from participation in the
mainstream of social activities”
• This definition focus on the relationship of the impairment to the
society, not to the individual.
• Disability is not seen as an individual problem but as social or civil
rights issue.
• Deals only with physical impairment
• According to the disabled rights movements “people are disabled by
society, not by their bodies”

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 Biopsychosocial model (ICF)
• WHO created the International Classification of
Functioning, Disability and Health (ICF) in 2002
• According to this model disability is defined as “the
outcome of the interaction between a person with an
impairment and the environmental and attitudinal
barriers he/she may face
• Shifts the focus from disability as an individual problem
• According to this model people are disabled by society
and by their bodies
• This model is a compromise between Medical and
Social model
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 Definition of Disability
• According to Persons With Disabilities Act
2008 (Laws of Malaysia) “disability is an
evolving concept and that disability results
from the interaction between persons with
disabilities (PWD) and attitudinal and
environmental barriers that hinders their
full and effective participation in society on
an equal basis with persons without
disabilities”

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 ICF model

  Intervention Prevention
Impairment  Medical treatment/care Prevention of the development of
 Medication further activity limitations
 Surgery
Activity limitation  Assistive devices  Preventive rehabilitation
 Personal assistance  Prevention of the development
 Rehabilitation therapy of participation restrictions
 
Participation  Accommodation  Environmental change
 Public education Anti-  Universal design
restriction discrimination laws  Lobbying for change
 Universal design  Environmental strategies

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 Type of impairments
• Blindness or partial sight
• Deafness or hard of hearing
• Heart condition
• Epilepsy
• Continence problem
• Insulin-dependent diabetes
• Learning difficulty
• Down’s syndrome
• Dyslexia
• Arthritis
• Mental health problem
• Wheelchair bound
• Restricted growth

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 Types of discrimination
1. Cultural
– Negative labeling ie descriptive words attached to people such as invalid,
handicapped, spastic, cripple , mongol, moron
2. Social
– Educational segregation
3. Economic
– Unemployment
• PWDs have more difficulty in finding job compared to non-disabled people
4. Physical
– Physical (built) environment
5. Behavioral
– PWDs are more likely to be the victims of violent crime compared to the non-
disabled people
– People often stared at them
– Loneliness and lack of intimacy

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 PART 2

ICD

ICD

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International Classification of Diseases-
ICD

• Defined as system of categories to

which morbid entities are assigned
according to established criteria.
• diseases and injuries can be grouped
by aspects such as anatomic site,
aetiology (cause), or treatment
approach.

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 International Classification of Diseases -
ICD
• The first international classification edition, known as the
International List of Causes of Death, was adopted by the
International Statistical Institute in 1893
• Current version is ICD 10
• international standard for defining and reporting diseases and
health conditions.
• It allows the world to compare and share health information using
a common language.
• defines the universe of diseases, disorders, injuries and other
related health conditions
• entities are listed in a comprehensive way so that everything is
covered.
• It organizes information into standard groupings of diseases

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 International Classification of Diseases -
ICD
• It allows for:
– easy storage, retrieval and analysis of health
information for evidenced-based decision-making;
– sharing and comparing health information between
hospitals, regions, settings and countries; and
– data comparisons in the same location across
different time periods.
• It is the diagnostic classification standard for
all clinical and research purposes

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 Purposes of ICD

1. For systematic recording analysis,

interpretation and comparison of mortality
and morbidity data collected in different
countries or areas at different time.
2. Used to translate diagnoses of diseases
and other health problems from words
into an alphanumeric code which permits
easy storage, retrieval and analysis of
data.
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 ICD
3. Allows the counting of diseases, injuries,
symptoms, reasons for encounter, factors that
influence health status, and external causes of
disease and death, such as accidents.
4. Such health information is used for epidemiology,
prevention, managing health care, allocation of
resources, outcomes monitoring, in research,
clinical context and primary care.
5. Information is reported, categorized, analyzed,
presented, and decisions are based on this
information at any level of a health system.
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 Before ICD
• Each disease was denoted by three or
four terms and each term has been
applied to as many different diseases
• vague, inconvenient names have been
employed
• complications have been registered
instead of primary diseases.

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 Other ICD Adaptations
• International Classification of Diseases for
Oncology, 3rd Edition (ICD-O-3)
• International Classification of External
Causes of Injury (ICECI)
• International Classification of Primary
Care, Second edition (ICPC-2)

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 WHO Family of International Classifications
(WHO-FIC)
Related Classifications Reference Derived Classifications
Classifications
International Classification of International Classification of Diseases
Primary Care (ICPC) International for Oncology, Third Edition (ICD-O-3)
International Classification of Classification of
External Causes of Injury (ICECI) Diseases (ICD) The ICD-10 Classification of Mental and
Behavioural Disorders
The Anatomical, Therapeutic, International
Chemical (ATC) classification Classification of Application of the International
system with Defined Daily Doses Functioning, Classification of Diseases to Dentistry
(DDD Disability and and Stomatology, Third Edition
ISO 9999 Technical aids for persons Health (ICF (ICD-DA)
with disabilities – Classification and
Terminology International Application of the International
Classification of Classification of Diseases to Neurology
International Classification for
Patient Safety (ICPS) Health
Interventions (ICD-10-NA
International Classification of International Classification of
Nursing Practice (ICNP) (ICHI) Functioning, Disability and Health,
under Children & Youth Version (ICF-CY)
development
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 ICD-10

• information about diseases and

conditions and their causes is grouped
as follows:
– Communicable diseases
– General diseases that affect the whole body
– Local diseases arranged by site
– Developmental diseases
– Injuries
– External causes
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 ICD-101

Volume 1 Volume 2 Volume 3

1. ICD Version 10 is the current version used in most countries including

Malaysia. The latest version is ICD-11

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 PART 3

ICF

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 Disability
• “limitations and participation restrictions.”
(ICF,WHO)
• It denotes the negative aspects of the
interaction between an individual(with a
health condition) and that individual’s
contextual factors (environmental and
personal factors).
• ’’ Functioning ‘‘is an umbrella term for
body functions, body structures, activity
and participation. It denotes the positive
aspects of the interaction between’’ the
individuals and their contextual factors
(WHO, 2001)

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Separate Classification of Disease and
Disability

+ = case

Diagnosis Disability

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ICD-10 B24 HIV disease B24 HIV disease
activity limitations
ICF performance restriction in:
Almost fully functional
moderate participation restriction in
Moving around (d455.44) Higher education (d830.03)
Washing (d510.33)
Education (d830.44)
…
Extracted from :Dr T. Bedirhan Üstün ,Classifications, Terminologies and Standards ,World
Health Organization
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 “Diagnosis” alone fails to predict:
• service needs (National Advisory Mental Health Council 1993)
• length of hospitalisation (McCrone and Phelan, 1994)
• level of care (Burns, 1991)
• outcome of hospitalization (Rabinowitz et al, 1994)
• receipt of disability benefits (Massel et al, 1990; Segal and
Choi, 1991;Basset and
Regier)

• work performance (Gatchel et al, 1994; Massel et al, 1990)

• social integration (Ormel et al, 1993

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“Diagnosis” and “Disability” can predict
• health service utilization (Hoeper et al 1979;Regier et
al,1985;Basset and Folstein, 1991; Von Korff et al, 1992; Ormel et
al, 1993)
• Length of Hospitalization (Horn, 1990)
• Outcome after hospitalization (Rabinowitz et al,1994)
• return to work (Hlatky et al, 1986)
• work performance (Massel et al, 1990)
• recovery of social integration (Tate, 1989)

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 What is ICF?
• It is a framework for describing and organizing
information on functioning and disability.
• Approved for use by WHO in 2001
• Coding for the complete range of functional
state; cover body structures and functions,
impairment, activities and participation in society
• Incorporates major models of disability
– Medical model
– Psychosocial model

www.who.int/classification/icf
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 ICF model
• Disability is multi-dimensional and
interactive
• Include contextual factors in which the
persons live including physical
environmental and cultural norms relevant
to the diseases
• Language used is “positive” (disability and
handicap removed)

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 Need for ICF
• Medical classification of diagnoses
alone not sufficient for planning and
management purposes
• For basic public health purposes
reliable and comparable data are
needed
• A way of classifying domains of areas of
life is needed
- Towards a Common Language for Functioning, Disability and
Health ICF World Health OrganizationGeneva2002

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 Aims of ICF:

• To understand and study health

- health-related states
- outcomes and determinants
• To establish a common language
• To permit comparison of data
• To provide a systematic coding scheme

- International classification of functioning, disability and health :

ICF. World Health Organization 2001; page no- 3-5

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 Application of ICF
1. At the individual level :
- Personal’s level of functioning
- Treatment and outcome measures
- Communication
- Self evaluation

- Towards a Common Language for Functioning, Disability and

Health ICF World Health OrganizationGeneva2002

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 Application of ICF
2. At the institutional level:
- Educational and training purpose
- Resource planning and development
- Quality improvement
- Management and outcome evaluation
- Research purpose

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 Application of ICF
3. At the social level:
- Security purpose and insurance
benefit
- Social policy and legislative purpose
- For universal designing
- Environmental modification

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 Coding guidelines for ICF

Parts of the Classification

1. Part 1
• Body Functions and Body Structures
• Activities and Participation. 
2. Part 2
• Environmental Factors
• Personal Factors (currently not classified in the ICF)

International classification of functioning, disability and health : ICF. World Health Organization 2001;
page no-219-234

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•ICF has identified the following generic qualifier scale:
– NO problem (none, absent, negligible) 0-4%
– MILD problem (slight, low…) 2-24%
– MODERATE (medium, fair) 25-49%
– SEVERE (high, extreme, …) 50-95%
– COMPLETE (total…) 96-100%

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 Coding guidelines for ICF
• b for Body Functions and
• s for Body Structures
• d for Activities and Participation
• e for Environmental Factors
• 34 – chapters
• 362- second level
• 1424 - codes, third and fourth level

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 Body Functions
• Chapter 1- Mental functions
• Chapter 2- Sensory functions and pain
• Chapter 3- Voice and speech functions
• Chapter 4- Functions of cardiovascular, hematological,
immunological and respiratory system
• Chapter 5- Functions of digestive, metabolic and
endocrine systems
• Chapter 6- Genitourinary and reproductive functions
• Chapter 7- Neuromusculoskeletal and movement related
functions
• Chapter 8- Functions of the skin and related structures

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 Body structures
• Chapter 1- Structures of the nervous system
• Chapter 2- The eye, ear and related structures
• Chapter 3- Structures involved in voice and speech
• Chapter 4- Structures of cardiovascular, hematological,
immunological and respiratory systems
• Chapter 5- Structures related to the digestive, metabolic and
endocrine systems
• Chapter 6- Structures related to genitourinary and
reproductive functions
• Chapter 7- Structures related to movement related
functions
• Chapter 8- Skin and related structures

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 Activities and Participation
• Chapter 1- Learning and applying knowledge
• Chapter 2- General tasks and demands
• Chapter 3- Communication
• Chapter 4- Mobility
• Chapter 5- Self-care
• Chapter 6- Domestic life
• Chapter 7- Interpersonal interactions and
relationships
• Chapter 8- Major life areas
• Chapter 9- Community, social and civic life

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 Environmental Factors
• Chapter 1- Products and technology
• Chapter 2- Natural environment and
human-made changes to
environment
• Chapter 3- Support and relationships
• Chapter 4- Attitudes
• Chapter 5- Services, systems and
policies
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 Personal factors
• Not coded in ICF because of wide
international variability and thus could not
agree upon codes
• Still is included in the framework because of
its importance to understanding functioning
and disability
• Personal factors such as:
• Age, Gender, Individual psychological assets,
lifestyles, upbringing, race, food preferences,
fitness, habits and coping styles.

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 Coding-muscle function
• Once an impairment is present, it can be
scaled in severity using the generic
qualifier
For example:
• b7302.1 (5–24 %)
• b7302.2 (25–49 %)
• b7302.3 (50–95 %)
• b7302.4 (96–100 %)

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 Coding-muscle function
• The absence of an impairment (according to a
predefined threshold level) is indicated by the value “0”
for the generic qualifier.
* For example:
• b7302.0

• If there is insufficient information to specify the severity

of the impairment, the value “8” should be used.
• b7302.8

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 Coding body structures

• The impairment of a person with

hemiparesis mainly in ankle foot
region of lower limb

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 Coding body structures
• Scaling of qualifiers for body structures

s75022.

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 Coding the Activities and Participation
component
• For example, the performance of a person who
is having less power in his left leg due to
hemiparesis and since then has used a cane but
faces moderate difficulties in walking around
because the sidewalks in the neighbourhood are
very steep and have a very slippery surface

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i.e. d4500.3 _ moderate restriction in
performance of walking short distances
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Coding environmental factors

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 Coding environmental factors
• for example:
- e430: individual attitudes of people in
positions of authority
• General or specific opinions and beliefs of
people in positions of authority about the
person or about other matters (e.g. social,
political and economic issues), that influence
individual behaviour and actions. 
• e 430.2

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 References
• www.who.int/classifications/icf/
• http://www.handicapincifre.it/documenti/ICF
• www.icf-research-branch.org
• http://apps.who.int/classifications/icfbrowser

–.

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THANK YOU

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