ICF Educational and Clinical Resources

Original Editor - Ewa Jaraczewska based on the course by Patricia Saleeby

Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson  

Introduction[edit | edit source]

The development of the International Classification of Functioning, Disability and Health (ICF) framework helped to transform patient care into a more holistic, patient-centred approach.[1] However, the use of ICF in rehabilitation remains limited.[2] [3] [4] The World Health Organization (WHO) Family of International Classifications (FIC) webpage is a powerful resource and educational tool for all information related to the ICF and other classifications.[5]


WHO Home Page: Classifications and Terminologies[edit | edit source]

The Classifications and Terminologies home page includes:

  • Overview definition of various classifications
  • Terminology components of classifications
  • Definitions of the derived classifications
  • Definitions of related classifications

WHO listing of classifications:

  • International Classification of Functioning, Disability and Health (ICF) - a core member of the WHO family of classifications. The ICF was developed to describe functioning and disability, and how a person's functioning relates to a dynamic interaction between health conditions and environmental and personal factors.[6]
  • International Classification of Diseases (ICD)- currently in its eleventh revision. It serves as "the main basis for comparability of statistics on causes of mortality and morbidity between places and over time".[7] The ICD-11 replaced the ICD-10 and had the following innovations:
    • Ability for online coding tool
    • Remote access to ICD-11 content and services
    • Enhanced capability to capture and combine clinically relevant characteristics of cases
    • Integrated support for multiple languages[7]
  • International Classification of Health Interventions (ICHI) - belongs to the WHO family of classifications and was developed to standardise the collection and exchange of information on diagnosis, functioning and intervention for statistical and health care reimbursement purposes.[8][9] Procedures found in the ICHI include medical and surgical, rehabilitation, assistance with functioning, prevention and public health.[10] The ICHI was found to be adequate for the collection of international statistics.[11]
  • Other Classifications:
    • International Classification of Diseases for Oncology
    • International Classifications of Primary Care
    • Technical Aids for Persons with Disabilities
    • Others

Tab: International Classification of Functioning, Disability and Health (ICF)[edit | edit source]

ICF Home Page[edit | edit source]

From the home page, click on the ICF tab (see image).

ICF online.png

ICF Online[edit | edit source]

ICF Categories

  • Components include: Body functions, body structures, activities and participation, and environmental factors. Each component can be positive and negative.
    1. Each component is comprised of various domains. These are sets of related physiological functions, anatomical structures, actions, tasks, areas of life, and external influences.
    2. Categories (or units of classification) are included within each domain.
  • The following are examples of the components and their domains:
    • Component: Body Function / Domain: Sensory functions and pain
    • Component: Body Structure / Domain: Structures related to movement
    • Component: Activities and Participation / Domain: Community, social and civic life
    • Component: Environmental Factors / Domain: Support and relationships

ICF Qualifiers are numeric codes that are used to describe the extent of the functioning or disability in given category. They are coded as one or more numbers following a point (separator) after the code. The first number is a generic qualifier and the following numbers are the qualifiers for specific components.

  • Generic:
    • 0 - no problem
    • 1 - mild problem
    • 2 - moderate problem
    • 3 - severe problem
    • 4 - complete problem
    • 8 - not specified
    • 9 - not applicable
  • Specific:
    • Qualifier to measure the localisation of the impairment
    • Qualifier to measure the extent to which an environmental factor acts as a facilitator or barrier (environmental factor qualifier)[6]
  • Example: Facilitator
    • +0 - no facilitator
    • +1 - mild facilitator
    • +2 - moderate facilitator
    • +3 - substantial facilitator
    • +4 - complete facilitator
    • +8 - not specified (the environmental factor is a facilitator, but there is insufficient information to quantify the extent of the facilitative impact)
  • Example: Barrier
    • 0 - no barrier
    • 1 - mild barrier
    • 2 - moderate barrier
    • 3 - severe barrier
    • 4 - complete barrier
    • 8 - not specified (the environmental factor is a barrier, but there is insufficient information to quantify the extent of the problem)
    • 9 - not applicable

ICF coding example: d410.28 where d=component (Activities and Participation), 4=domain (Mobility), 10=second level category (changing body position), .2=qualifier (moderate difficulty), 8=capacity (not specified).[6]


Additional feature: Visualisation of the viewed items (see image on right). This feature helps users understand how everything is connected in the classification.

Tab: Home[edit | edit source]

WHO-FIC maintenance platform

  • A proposal platform that:
    • Offers free registration for new users to obtain initial access
    • Contains a search list

Online Resources[edit | edit source]

  • Online resources.png
    ICF checklist (ICF informed assessment)
    • ICF-based instrument to be used along with the ICF full or short version to obtain and record information from an interview, medical record, direct observation, or direct conversation with a patient on the functioning and disability of an individual[12]
    • Can be used as a Patient Reported Outcome (PRO) measure
    • Functioning assessed with the ICF checklist can enable a better understanding of self-reported disability on a region-specific outcome measure[13]
    • ICF checklist can help to detect clinical and social problems experienced by patients with a work-related injury during rehabilitation and the return-to-work process[14]
    • The main components of the ICF checklist include:
      • Information about patient's demographics
      • ICF categories and domains with qualifiers
      • Open area for general and clinical notes and contextual information, including personal factors which are not coded in the classification
  • Beginer guide.png
    ICF Beginner's Guide
    • The source of information to better understand the ICF includes:
      • An overview of the ICF
      • The need for the ICF
      • Who is the "user" and how the ICF can be used
  • ICF practical manual.png
    ICF Practical Manual
    • Offers clinical guidelines on how the ICF can be used
    • Available in a draft version only
  • E-learning.png
    e-Learning Tool
    • Available in several languages
    • Includes chapters containing information on the:
      • Need for ICF
      • Aims of the ICF
      • Uses of the ICF
      • ICF model
      • Structuring codes and qualifiers
      • General information on the WHO-FIC
    • Includes a Quiz
  • ICF Education Portal
    • Provides educational resources
    • Contains a list of ICF advisor educators in various countries
    • Includes information about community support, policy, etc
Core sets.png
ICF Core Sets[edit | edit source]

Development of the ICF core sets helped to decrease barriers to the use of the ICF framework in clinical practice and provide "a practical information platform for routinely collected data".[15] It contains a selection of ICF categories (set of codes) for specific health conditions, groups and/or settings.[16] These codes can be brief or comprehensive, and they help to produce a very specific ICF-based documentation form, as each user can choose what is relevant to his or her clinical practice.[5] ICF core sets are valid and relevant for patients and clinicians in specific rehabilitation settings.[17] The list of the code sets are as follows:

  • Generic
  • Rehabilitation
  • Environmental factors
  • Conditions:
    • Musculoskeletal
    • Cardiopulmonary
    • Neurological
    • Neurodevelopmental
    • Psychiatric
    • Other
ICF research.png

ICF Research Branch[edit | edit source]

The ICF research branch is the entity that works with the WHO. Their mission is to "seek a better understanding of disability through multidisciplinary research".[18] The following items are housed on this website:

  • ICF core sets
  • e-Learning
  • Case studies
  • ICF-based documentation form
  • Training tool

Resources[edit | edit source]

References[edit | edit source]

  1. van der Veen S, Evans N, Huisman M, Welch Saleeby P, Widdershoven G. Toward a paradigm shift in healthcare: using the International Classification of Functioning, Disability and Health (ICF) and the capability approach (CA) jointly in theory and practice. Disability and Rehabilitation. 2022 Jun 21:1-8.
  2. Almutairi NA, Almarwani MM. Knowledge and use of the International Classification of Functioning, disability and health (ICF) and ICF Core Sets for musculoskeletal conditions among saudi physical therapists. Musculoskelet Sci Pract. 2022 Aug;60:102573.
  3. Pernambuco AP, de Carvalho L, Polese JC. Knowledge and use of the ICF in clinical practice by physiotherapists and occupational therapists of Minas Gerais. Fisioter. Pesqui. 2018; 25(2)
  4. Khuman R, Patel R. Knowledge and use of International Classification of Function (ICF) Core Sets in Clinical Practice by Indian Physiotherapist. Conference paper, 2019
  5. 5.0 5.1 Saleeby P. ICF Educational and Clinical Resources Course. Physiopedia 2022
  6. 6.0 6.1 6.2 The International Classification of Functioning, Disability and Health (ICF). Available from https://www.aihw.gov.au/reports/disability/icf-disability-health/formats [last access 30.07.2022]
  7. 7.0 7.1 Harrison JE, Weber S, Jakob R, Chute CG. ICD-11: an international classification of diseases for the twenty-first century. BMC Med Inform Decis Mak 2021; 21(206)
  8. Manchaiah V, Swanepoel DW, Fortune N. The International Classification of Health Interventions (ICHI) – a new tool for describing and reporting interventions in audiology. International Journal of Audiology, 2020; 59(6): 403-405
  9. Donada M, Della Mea V, Cumerlato M, Rankin N, Madden R. A System for Supporting Development and Update of the International Classification of Health Interventions (ICHI). Stud Health Technol Inform. 2018;247:895-899
  10. Zaiss A, Dauben HP. ICHI – International Classification of Health Interventions : Prozedurenklassifikation im Spagat zwischen Statistik und Abrechnung [ICHI-International Classification of Health Interventions : A balancing act between the demands of statistics and reimbursement]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018 Jul;61(7):778-786. German.
  11. Fung KW, Xu J, Ameye F, Burelle L, MacNeil J. Evaluation of the International Classification of Health Interventions (ICHI) in the coding of common surgical procedures. Journal of the American Medical Informatics Association, 2022, 29 (1):43–51.
  12. International Classification of Functioning, Disability and Health Checklist (ICF-Checklist). Available from https://eprovide.mapi-trust.org/instruments/international-classification-of-functioning-disability-and-health-checklist [last access 26.07.2022]
  13. Soberg HL, Engebretsen KB, Juel NG, Roe Y, Brox JI. Associations between shoulder pain and functioning on the ICF checklist and the disabilities of the arm, shoulder, and hand scale–a cross-sectional study. Disability and Rehabilitation. 2020 Oct 8;42(21):3084-91.
  14. Magalhães FB, de Lima MAG, Neves RDF, Costa-Black K, de Araújo TM, Porto LA. Disability and functioning assessment of women with RSI/WRMSDs: the use of the ICF checklist. Rev Bras Med Trab. 2019 Dec 1;17(4):545-556.
  15. Cieza A, Kostansjek N. The International Classification of Functioning, Disability and Health: the first 20 years. Dev Med Child Neurol. 2021 Apr;63(4):363.
  16. Selb M, Escorpizo R, Kostanjsek N, Stucki G, Üstün B, Cieza A. A guide on how to develop an International Classification of Functioning, Disability and Health Core Set. Eur J Phys Rehabil Med. 2015 Feb;51(1):105-17.
  17. Karlsson E, Gustafsson J. Validation of the international classification of functioning, disability and health (ICF) core sets from 2001 to 2019–a scoping review. Disability and Rehabilitation. 2021 Jan 22:1-3.
  18. ICF Research Branch. Mission. Available from https://www.icf-research-branch.org/about-us/our-mission [last access 26.07.2022]