ICF Australian User Guide V1.0

Contents

2.    Overview of the ICF

2.2    Classifications and codes

The ICF contains a hierarchy of classifications and codes for each of the components-Body Functions and Structures, Activities and Participation, and Environmental Factors. Measures can be recorded against each of the neutral codes, to indicate the extent of 'problem' with any of these aspects of functioning. Environmental factors can be recorded as being either barriers to, or facilitators of, a person's functioning.

Figure 2.2 outlines the hierarchy of classification in the ICF. Domains are at chapter level (e.g. mental functions) and consist of facets or blocks (e.g. specific mental functions) within which are nested groups of second-level, third-level, and sometimes fourth-level categories. These categories are the units of classification. Each successive level can be used to further refine the code, or level of detail recorded; the user chooses the level appropriate to the classification.

Figure 2.2 outlines the hierarchy of classification in the ICF

  Figure 2.2: Hierarchy of classification in the ICF

Qualifiers

Qualifiers are numeric measures coded after the relevant category code. Qualifiers are recognised as essential to the meaningful use of the classification because the domains and codes are expressed in neutral language. Without qualifiers, the codes have no inherent meaning (WHO 2001:222).

A uniform or 'generic' qualifier is provided to record the extent of the 'problem' in relation to impairment, activity limitation, participation restriction and environmental barrier. The extent of the problem is denoted using the following scale:

0    No problem

1    Mild problem

2    Moderate problem

3    Severe problem

4    Complete problem

8    Not specified

9    Not applicable

The Environmental factors qualifier uses both a positive and a negative scale, to indicate the extent to which an environmental factor acts as either a facilitator or barrier.

.0 No barrier +0 No facilitator

.1 Mild barrier +1 Mild facilitator

.2 Moderate barrier +2 Moderate facilitator

.3 Severe barrier +3 Substantial facilitator

.4 Complete barrier +4 Complete facilitator

.8 Barrier, not specified +8 Facilitator, not specified

.9 Not applicable +9 Not applicable

It is recognised that these qualifiers need calibration to relate them to existing measurement and assessment instruments in the field.

In addition to the generic qualifier, qualifiers for specific components are included:

• a 2nd qualifier for Body structure, which measures the change in body structure
• a suggested 3rd qualifier for Body structure to record the localisation of the impairment.

Two constructs-'performance' and 'capacity'-can also be used with the generic qualifiers for the Activities and Participation domains. These constructs indicate the environment in which measurement is taking place.

According to the ICF (WHO 2001:15):

performance.describes what an individual does in his or her current environment;

capacity.describes an individual's ability to execute a task or an action.(and) aims to indicate the highest probable level of functioning that a person may reach in a given domain at a given moment. To assess the full ability of the individual, one needs a 'standardised' environment to neutralise the varying impact of different environments on the ability of the individual. This 'standardised' environment may be (a) an actual environment commonly used for capacity assessment in test settings; or (b) in cases where this is not possible, an assumed environment which can be thought to have a uniform impact.

The ICF also states:

The gap between capacity and performance reflects the difference between the impacts of current and uniform environments, and thus provides a useful guide as to what can be done to the environment of the individual to improve performance (WHO 2001: 15).

Thus the notion of 'capacity' also relates to the identification of what is needed to enhance a person's opportunities to 'perform' to their 'highest probable level of functioning'. In this sense, the 'assumed' environment may be thought of as, in some sense, optimum. This aspect of the concept of 'capacity' appears to accord with Australian policy goals, focusing on people's abilities. In comparison, the notion of a 'standardised environment' may be more difficult to operationalise widely, except within particular disciplines e.g. clinically based physiotherapy.

The ICF is intended to be grounded in a human rights philosophy, and its relationship to the UN Standard Rules on Equalization of Opportunities for Persons with Disabilities is acknowledged. Operationalising these rules appears to relate primarily to performance, i.e. the actual participation experience of people with disabilities.

The general format of an ICF code is as follows.

In this example, the code s250.28 is recorded for a person experiencing a moderate problem with the structure of the middle ear, where:

• s denotes the component, in this case Body structures

• the first digit (2) denotes the chapter or domain, i.e. The eye, ear and related structures

• the second and third digits (50) denote the second-level category, i.e. structure of middle ear

• the first digit after the decimal point (2) denotes the generic qualifier, indicating, in this case, a moderate impairment with the middle ear

• the second digit after the decimal point (8) indicates, in this case, that the nature of the impairment is not specified.

Box 2.1 gives more detailed examples of codes.

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