Application of the International Classification of Functioning, Disability and Health (ICF) Model in Osteoporosis
Original Editor - Angeliki Chorti Top Contributors - Angeliki Chorti
Introduction[edit | edit source]
The International Classification of Functioning, Disability and Health (ICF) is a framework that describes in a more systematic way typical affected areas in health conditions in terms of body functioning and structure, activities and participation, personal and environmental circumstances. It uses a unified, globally agreed-upon language for the reporting of health and health-related states. The ICF has two components: a classification system for the coding of functioning and disability, and a conceptual framework that serves to define, describe, and organise information on health and disability aspects.
With regards to patients with osteoporosis (OP), in 2003, the World Health Organisation (WHO) produced a Technical Report on the burden of musculoskeletal conditions. Based on an iterative process that relied on the health domains covered by available evidence, expert and patient input, the most important health domains were proposed for patients with osteoporosis with the aim to develop internationally-accepted and evidence-based ICF Comprehensive and Brief Core Sets for osteoporosis.
ICF Core Set Categories for Osteoporosis[edit | edit source]
69 ICF categories have been included in the Comprehensive ICF Core Set; Fifteen relate to body functions, seven refer to body structures, twenty-one to activities and participation, and twenty-six to environmental factors. These categories can be considered when conducting a comprehensive, multidisciplinary assessment and are especially helpful for clinicians in multidisciplinary healthcare settings because they provide a thorough communication with the patient and a common language across healthcare disciplines. [1]
Out of the 69 categories, 22 ICF categories are included in the Brief ICF Core Set for osteoporosis. Two categories are related to body structures, four categories to body function, three categories related to activity and participation, and three categories refer to environmental factors.The Brief ICF Core Set can be used in assessing patients participating in a clinical study on osteoporosis. [2]
| ICF code | ICF category | Description | Included in the Brief version? |
|---|---|---|---|
| BODY FUNCTIONS | = physiological functions of body systems (including psychological functions) | ||
| b134 | Sleep functions | General mental functions of periodic, reversible and selective physical and mental disengagement from one's immediate environment accompanied by characteristic physiological changes. Inclusions: functions of amount of sleeping, and onset, maintenance and quality of sleep; functions involving the sleep cycle, such as in insomnia, hypersomnia and narcolepsy Exclusions: consciousness functions (b110); energy and drive functions (b130); attention functions (b140); psychomotor functions (b147) | No |
| b152 | Emotional functions | Specific mental functions related to the feeling and affective components of the processes of the mind. Inclusions: functions of appropriateness of emotion, regulation and range of emotion; affect; sadness, happiness, love, fear, anger, hate, tension, anxiety, joy, sorrow; lability of emotion; flattening of affect Exclusions: temperament and personality functions (b126); energy and drive functions (b130) | Yes |
| b1801 | Body Image | Specific mental functions related to the representation and awareness of one's body. Inclusion: impairments such as phantom limb and feeling too fat or too thin | No |
| b280 | Sensation of pain | Sensation of unpleasant feeling indicating potential or actual damage to some body structure. Inclusions: sensations of generalized or localized pain in one or more body part, pain in a dermatome, stabbing pain, burning pain, dull pain, aching pain; impairments such as myalgia, analgesia and hyperalgesia | Yes |
| b440 | Respiration functions | Functions of the muscles involved in breathing. Inclusions: functions of thoracic respiratory muscles; functions of the diaphragm; functions of accessory respiratory muscles Exclusions: respiration functions (b440); additional respiratory functions (b450); exercise tolerance functions (b455) | No |
| b455 | Exercise tolerance functions | Functions related to respiratory and cardiovascular capacity as required for enduring physical exertion. Inclusions: functions of physical endurance, aerobic capacity, stamina and fatiguability Exclusions: functions of the cardiovascular system (b410-b429); haematological system functions (b430); respiration functions (b440); respiratory muscle functions (b445); additional respiratory functions (b450) | No |
| b545 | Water, mineral and electrolyte balance functions | Functions of the regulation of water, minerals and electrolytes in the body. Inclusions: functions of water balance, balance of minerals such as calcium, zinc and iron, and balance of electrolytes such as sodium and potassium; impairments such as in water retention, dehydration, hypercalcaemia, hypocalcaemia, iron deficiency, hypernatraemia, hyponatraemia, hyperkalaemia and hypokalaemia Exclusions: haematological system functions (b430); general metabolic functions (b540); endocrine gland functions (b555) | No |
| b6202 | Urinary continence | Functions of control over urination. Inclusions:impairments such as in stress, urge, reflex, continuous and mixed incontinence | No |
| b710 | Mobility of joint functions | Functions of the range and ease of movement of a joint. Inclusions: functions of mobility of single or several joints, vertebral, shoulder, elbow, wrist, hip, knee, ankle, small joints of hands and feet; mobility of joints generalized; impairments such as in hypermobility of joints, frozen joints, frozen shoulder, arthritis Exclusions: stability of joint functions (b715); control of voluntary movement functions (b760) | Yes |
| b730 | Muscle power functions | Functions related to the force generated by the contraction of a muscle or muscle groups. Inclusions: functions associated with the power of specific muscles and muscle groups, muscles of one limb, one side of the body, the lower half of the body, all limbs, the trunk and the body as a whole; impairments such as weakness of small muscles in feet and hands, muscle paresis, muscle paralysis, monoplegia, hemiplegia, paraplegia, quadriplegia and akinetic mutism Exclusions: functions of structures adjoining the eye (b215); muscle tone functions (b735); muscle endurance functions (b740) | Yes |
| b740 | Muscle endurance functions | Functions related to sustaining muscle contraction for the required period of time. Inclusions: functions associated with sustaining muscle contraction for isolated muscles and muscle groups, and all muscles of the body; impairments such as in myasthenia gravis Exclusions: exercise tolerance functions (b455); muscle power functions (b730); muscle tone functions (b735) | No |
| b755 | Involuntary movement reaction functions | Functions of involuntary contractions of large muscles or the whole body induced by body position, balance and threatening stimuli. Inclusions: functions of postural reactions, righting reactions, body adjustment reactions, balance reactions, supporting reactions, defensive reactions Exclusion: motor reflex functions (b750) | No |
| b765 | Involuntary movement functions | Functions of unintentional, non- or semi-purposive involuntary contractions of a muscle or group of muscles. Inclusions: involuntary contractions of muscles; impairments such as tremors, tics, mannerisms, stereotypies, motor perseveration, chorea, athetosis, vocal tics, dystonic movements and dyskinesia Exclusions: control of voluntary movement functions (b760); gait pattern functions (b770) | No |
| b770 | Gait pattern functions | Functions of movement patterns associated with walking, running or other whole body movements. Inclusions: walking patterns and running patterns; impairments such as spastic gait, hemiplegic gait, paraplegic gait, asymmetric gait, limping and stiff gait pattern Exclusions: muscle power functions (b730); muscle tone functions (b735); control of voluntary movement functions (b760); involuntary movement functions (b765) | No |
| b780 | Sensations related to muscles and movement functions | Sensations associated with the muscles or muscle groups of the body and their movement. Inclusions: sensations of muscle stiffness and tightness of muscles, muscle spasm or constriction, and heaviness of muscles Exclusion: sensation of pain (b280) | No |
| BODY STUCTURES | = anatomical parts of the body such as organs, limbs and their components | ||
| s430 | Structure of respiratory system | No | |
| s720 | Structure of shoulder region | No | |
| s730 | Structure of upper extremity | No | |
| s740 | Structure of pelvic region | No | |
| s750 | Structure of lower extremity | Yes | |
| s760 | Structure of trunk | Yes | |
| s770 | Additional musculoskeletal structures related to movement | No | |
| ACTIVITIES AND PARTICIPATION | = execution of a task or action by an individual and involvement in a life situation | ||
| d410 | Changing basic body position | Getting into and out of a body position and moving from one location to another, such as getting up out of a chair to lie down on a bed, and getting into and out of positions of kneeling or squatting. Inclusion: changing body position from lying down, from squatting or kneeling, from sitting or standing, bending and shifting the body's centre of gravity Exclusion: transferring oneself (d420) | No |
| d415 | Maintaining a body position | Staying in the same body position as required, such as remaining seated or remaining standing for work or school. Inclusions: maintaining a lying, squatting, kneeling, sitting and standing position | No |
| d430 | Lifting and carrying objects | Raising up an object or taking something from one place to another, such as when lifting a cup or carrying a child from one room to another. Inclusions: lifting, carrying in the hands or arms, or on shoulders, hip, back or head; putting down | Yes |
| d445 | Hand and arm use | Performing the coordinated actions required to move objects or to manipulate them by using hands and arms, such as when turning door handles or throwing or catching an object Inclusions: pulling or pushing objects; reaching; turning or twisting the hands or arms; throwing; catching Exclusion: fine hand use (d440) | No |
| d450 | Walking | Moving along a surface on foot, step by step, so that one foot is always on the ground, such as when strolling, sauntering, walking forwards, backwards, or sideways. Inclusions: walking short or long distances; walking on different surfaces; walking around obstacles Exclusions: transferring oneself (d420); moving around (d455) | Yes |
| d455 | Moving around | Moving the whole body from one place to another by means other than walking, such as climbing over a rock or running down a street, skipping, scampering, jumping, somersaulting or running around obstacles. Inclusions: crawling, climbing, running, jogging, jumping, and swimming Exclusions: transferring oneself (d420); walking (d450) | No |
| d465 | Moving around using equipment | Moving the whole body from place to place, on any surface or space, by using specific devices designed to facilitate moving or create other ways of moving around, such as with skates, skis, or scuba equipment, or moving down the street in a wheelchair or a walker. Exclusions: transferring oneself (d420); walking (d450); moving around (d455); using transportation (d470); driving (d475) | No |
| d470 | Using transportation | Using transportation to move around as a passenger, such as being driven in a car or on a bus, rickshaw, jit-ney, animal-powered vehicle, or private or public taxi, bus, train, tram, subway, boat or aircraft. Inclusions: using human-powered transportation; using private motorized or public transportation Exclusions: moving around using equipment (d465); driving (d475) | No |
| d475 | Driving | Being in control of and moving a vehicle or the animal that draws it, travelling under one's own direction or having at one's disposal any form of transportation, such as a car, bicycle, boat or animal-powered vehicle. Inclusions: driving human-powered transportation, motorized vehicles, animal-powered vehicles Exclusions: moving around using equipment (d465); using transportation (d470) | No |
| d510 | Washing oneself | Washing and drying one's whole body, or body parts, using water and appropriate cleaning and drying mate-rials or methods, such as bathing, showering, washing hands and feet, face and hair, and drying with a towel. Inclusions: washing body parts, the whole body; and drying oneself Exclusions: caring for body parts (d520); toileting (d530) | No |
| d540 | Dressing | Carrying out the coordinated actions and tasks of putting on and taking off clothes and footwear in sequence and in keeping with climatic and social conditions, such as by putting on, adjusting and removing shirts, skirts, blouses, pants, undergarments, saris, kimono, tights, hats, gloves, coats, shoes, boots, sandals and slippers. Inclusions: putting on or taking off clothes and footwear and choosing appropriate clothing | No |
| d620 | Acquisition of goods and services | Selecting, procuring and transporting all goods and services required for daily living, such as selecting, pro-curing, transporting and storing food, drink, clothing, cleaning materials, fuel, household items, utensils, cook-ing ware, domestic appliances and tools; procuring utilities and other household services. Inclusions: shopping and gathering daily necessities Exclusion: acquiring a place to live (d610) | No |
| d630 | Preparing meals | Planning, organizing, cooking and serving simple and complex meals for oneself and others, such as by mak-ing a menu, selecting edible food and drink, getting together ingredients for preparing meals, cooking with heat and preparing cold foods and drinks, and serving the food. Inclusions: preparing simple and complex meals Exclusions: eating (d550); drinking (d560); acquisition of goods and services (d620); doing housework (d640); caring for household objects (d650); caring for others (d660) | No |
| d640 | Doing housework | Managing a household by cleaning the house, washing clothes, using household appliances, storing food and disposing of garbage, such as by sweeping, mopping, washing counters, walls and other surfaces; collecting and disposing of household garbage; tidying rooms, closets and drawers; collecting, washing, drying, folding and ironing clothes; cleaning footwear; using brooms, brushes and vacuum cleaners; using washing ma-chines, driers and irons. Inclusions: washing and drying clothes and garments; cleaning cooking area and utensils; cleaning living area; using household appliances, storing daily necessities and disposing of garbage Exclusions: acquiring a place to live (d610); acquisition of goods and services (d620); preparing meals (d630); caring for household objects (d650); caring for others (d660) | No |
| d710 | Basic interpersonal interactions | Interacting with people in a contextually and socially appropriate manner, such as by showing consideration and esteem when appropriate, or responding to the feelings of others. Inclusions: showing respect, warmth, appreciation, and tolerance in relationships; responding to criticism and social cues in relationships; and using appropriate physical contact in relationships | No |
| d770 | Intimate relationships | Creating and maintaining close or romantic relationships between individuals, such as husband and wife, lov-ers or sexual partners. Inclusions: romantic, spousal and sexual relationships | No |
| d850 | Remunerative employment | Engaging in all aspects of work, as an occupation, trade, profession or other form of employment, for payment, as an employee, full or part time, or self-employed, such as seeking employment and getting a job, doing the required tasks of the job, attending work on time as required, supervising other workers or being supervised, and performing required tasks alone or in groups. Inclusions: self-employment, part-time and full-time employment | No |
| d855 | Non-remunerative employment | Engaging in all aspects of work in which pay is not provided, full-time or part-time, including organized work activities, doing the required tasks of the job, attending work on time as required, supervising other workers or being supervised, and performing required tasks alone or in groups, such as volunteer work, charity work, working for a community or religious group without remuneration, working around the home without remunera-tion. Exclusion: Chapter 6 Domestic Life | No |
| d859 | Work and employment, other specified and unspecified | No | |
| d910 | Community life | Engaging in all aspects of community social life, such as engaging in charitable organizations, service clubs or professional social organizations. Inclusions: informal and formal associations; ceremonies Exclusions: non-remunerative employment (d855); recreation and leisure (d920); religion and spirituality (d930); political life and citizenship (d950) | No |
| d920 | Recreation and leisure | Engaging in any form of play, recreational or leisure activity, such as informal or organized play and sports, programmes of physical fitness, relaxation, amusement or diversion, going to art galleries, museums, cinemas or theatres; engaging in crafts or hobbies, reading for enjoyment, playing musical instruments; sightseeing, tourism and travelling for pleasure. Inclusions: play, sports, arts and culture, crafts, hobbies and socializing Exclusions: riding animals for transportation (d480); remunerative and non-remunerative work (d850 and d855); religion and spirituality (d930); political life and citizenship (d950) | Yes |
| ENVIRONMENTAL FACTORS | = make up the physical, social and attitudinal environment in which people live and conduct their lives | ||
| e110 | Products or substances for personal consumption | Any natural or human-made object or substance gathered, processed or manufactured for ingestion. Inclusions: food, drink and drugs | Yes |
| e115 | Products and technology for personal use in daily living | Equipment, products and technologies used by people in daily activities, including those adapted or specially designed, located in, on or near the person using them. Inclusions: general and assistive products and technology for personal use | No |
| e120 | Products and technology for personal indoor and outdoor mobility and transportation | Equipment, products and technologies used by people in activities of moving inside and outside buildings, in-cluding those adapted or specially designed, located in, on or near the person using them. Inclusions: general and assistive products and technology for personal indoor and outdoor mobility and transportation | No |
| e135 | Products and technology for employment | Equipment, products and technology used for employment to facilitate work activities. Inclusion: general and assistive products and technology for employment | No |
| e150 | Design, construction and building products and technology of buildings for public use | Products and technology that constitute an individual's indoor and outdoor human-made environment that is planned, designed and constructed for public use, including those adapted or specially designed. Inclusions: design, construction and building products and technology of entrances and exits, facilities and routing | No |
| e155 | Design, construction and building products and technology of buildings for private use | Products and technology that constitute an individual's indoor and outdoor human-made environment that is planned, designed and constructed for private use, including those adapted or specially designed. Inclusions: design, construction and building products and technology of entrances and exits, facilities and routing | No |
| e225 | Climate | Meteorological features and events, such as the weather. Inclusions: temperature, humidity, atmospheric pressure, precipitation, wind and seasonal variations | No |
| e240 | Light | Electromagnetic radiation by which things are made visible by either sunlight or artificial lighting (e.g. candles, oil or paraffin lamps, fires and electricity), and which may provide useful or distracting information about the world. Inclusions: light intensity; light quality; colour contrasts | No |
| e310 | Immediate family | Individuals related by birth, marriage or other relationship recognized by the culture as immediate family, such as spouses, partners, parents, siblings, children, foster parents, adoptive parents and grandparents. Exclusions: extended family (e315); personal care providers and personal assistants (e340) | No |
| e320 | Friends | Individuals who are close and ongoing participants in relationships characterized by trust and mutual support. | No |
| e325 | Acquaintances, peers, colleagues, neighbours and community members | Individuals who are familiar to each other as acquaintances, peers, colleagues, neighbours, and community members, in situations of work, school, recreation, or other aspects of life, and who share demographic features such as age, gender, religious creed or ethnicity or pursue common interests. Exclusions: associations and organizational services (e5550) | No |
| e340 | Personal care providers and personal assistants | Individuals who provide services as required to support individuals in their daily activities and maintenance of performance at work, education or other life situation, provided either through public or private funds, or else on a voluntary basis, such as providers of support for home-making and maintenance, personal assistants, trans-port assistants, paid help, nannies and others who function as primary caregivers. Exclusions: immediate family (e310); extended family (e315); friends (e320); general social support services (e5750); health professionals (e355) | No |
| e355 | Health professionals | All service providers working within the context of the health system, such as doctors, nurses, physiotherapists, occupational therapists, speech therapists, audiologists, orthotist-prosthetists, medical social workers. Exclusion: other professionals (e360) | Yes |
| e360 | Other professionals | All service providers working outside the health system, including lawyers, social workers, teachers, architects and designers. Exclusion: health professionals (e355) | No |
| e410 | Individual attitudes of immediate family members | General or specific opinions and beliefs of immediate family members about the person or about other matters (e.g. social, political and economic issues), that influence individual behaviour and actions. | No |
| e420 | Individual attitudes of friends | General or specific opinions and beliefs of friends about the person or about other matters (e.g. social, political and economic issues), that influence individual behaviour and actions. | No |
| 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 mat-ters (e.g. social, political and economic issues), that influence individual behaviour and actions. | No |
| e440 | Individual attitudes of personal care providers and personal assistants | General or specific opinions and beliefs of personal care providers and personal assistants about the person or about other matters (e.g. social, political and economic issues), that influence individual behaviour and actions. | No |
| e450 | Individual attitudes of health professionals | General or specific opinions and beliefs of health professionals about the person or about other matters (e.g. social, political and economic issues), that influence individual behaviour and actions. | No |
| e455 | Individual attitude of health-related professionals | General or specific opinions and beliefs of health-related professionals about the person or about other matters (e.g. social, political and economic issues), that influence individual behaviour and actions. | No |
| e460 | Societal attitudes | General or specific opinions and beliefs generally held by people of a culture, society, subcultural or other social group about other individuals or about other social, political and economic issues, that influence group or indi-vidual behaviour and actions. | No |
| e535 | Communication services, systems and policies | Services, systems and policies for the transmission and exchange of information. | No |
| e540 | Transportation services, systems and policies | Services, systems and policies for enabling people or goods to move or be moved from one location to another | No |
| e570 | Social security services, systems and policies | Services, systems and policies aimed at providing income support to people who, because of age, poverty, un-employment, health condition or disability, require public assistance that is funded either by general tax reve-nues or contributory schemes. Exclusion: economic services, systems and policies (e565) | No |
| e575 | General social support services, systems and policies | Services, systems and policies aimed at providing support to those requiring assistance in areas such as shop-ping, housework, transport, self-care and care of others, in order to function more fully in society. Exclusions: personal care providers and personal assistants (e340); social security services, systems and policies (e570); health services, systems and policies (e580) | No |
| e580 | Health services, systems and policies | Services, systems and policies for preventing and treating health problems, providing medical rehabilitation and promoting a healthy lifestyle. Exclusion: general social support services, systems and policies (e575) | Yes |
Applications[edit | edit source]
The ICF core-sets for OP have been used in applications within the literature related to: defining, universally and systematically, typical domains of the functioning of patients with OP; [3] comparing the OP- ICF codes to commonly used OP-specific patient-reported HRQL instruments in order to evaluate the quality of the disease-specific questionnaires; [4] assessing common areas between OP and osteoarthritis; [5][1] and using the OP-ICF codes in clinical practice and clinical vignettes to demonstrate how the ICF can apply across diverse clinical presentations of osteoporosis. [6]
There are also suggestions that the ICF framework can be used to map research questions and guide clinical practice specific to OP by providing insight into relevant treatment and rehabilitation; as a guide for clinicians working with OP patients; as a tool to ensure thorough patient intake, and to track progress during an intervention.[6]
Strengths[edit | edit source]
The OP ICF Core Sets main strength is that it can conceptualise a person’s level of functioning as a dynamic interaction between health condition, environmental factors, and personal factors. [6] The bi-directional feature of the conceptual framework allows for demonstrating how the components of disability interact in a multidimensional way to shape the experience and consequences of disability. Another key strength of the conceptual framework is that it is universal, i.e. it can be applied across different health disciplines. And most importantly, it focuses on the importance of personal factors, which can mediate how a disability or a health condition is really experienced.
Limitations[edit | edit source]
The use of ICF core sets is not a simple task; it requires training and expertise. Although a thorough understanding of the disease or its dimensions may not be entirely possible,[6] the ICF core sets still reflect a more comprehensive framework for the understanding of the dimensions of health that affect people with OP when compared OP-specific questionnaires.
Resources[edit | edit source]
ICF Core Set for Osteoporosis including the Comprehansive and Brief ICF Core Sets for Osteoporosis
World Health Organisation (WHO) International Classification of Functioning, Disability and Health (ICF)
References[edit | edit source]
- ↑ 1.0 1.1 Lorbergs AL, MacIntyre NJ. The International Classification of Functioning, Disability and Health (ICF) Core Sets: application to a postmenopausal woman with rheumatoid arthritis and osteoporosis of the spine. Physiother Theory Pract. 2013 Oct;29(7):547-61.
- ↑ ICF Research Branch. ICF Core Set for Osteoporosis. Available from: https://www.icf-research-branch.org/icf-core-sets-projects2/musculoskeletal-conditions/icf-core-set-for-osteoporosis [accessed 11/11/2023]
- ↑ Cieza A, Schwarzkopf S, Sigl T, Stucki G, Melvin J, Stoll T, Woolf A, Kostanjsek N, Walsh N. ICF Core Sets for osteoporosis. J Rehabil Med. 2004 Jul;(44 Suppl):81-6.
- ↑ Borchers M, Cieza A, Sigl T, Kollerits B, Kostanjsek N, Stucki G. Content comparison of osteoporosis-targeted health status measures in relation to the International Classification of Functioning, Disability and Health (ICF). Clin Rheumatol. 2005 Apr;24(2):139-44.
- ↑ Schwarzkopf SR, Ewert T, Dreinhöfer KE, Cieza A, Stucki G. Towards an ICF Core Set for chronic musculoskeletal conditions: commonalities across ICF Core Sets for osteoarthritis, rheumatoid arthritis, osteoporosis, low back pain and chronic widespread pain. Clin Rheumatol. 2008 Nov;27(11):1355-61.
- ↑ 6.0 6.1 6.2 6.3 Ziebart C, Page AD, MacDermid JC. Application of ICF conceptual framework in Osteoporosis. Physiother Theory Pract. 2020 Oct;36(10):1077-1087.
