ICIDH Research Articles

Visual function assessment of diagnostic radiography students

IntroductionDeterioration of visual acuity (VA) and visual impairment has been linked to age-related subtle changes, gender, and a correlation to socioeconomic status. This study aimed to assess first-year diagnostic radiography students’ visual functional abilities by applying the International Classification of Impairments, Disabilities and Handicaps (ICIDH) recommendations of functional VA screening and health-related quality of life questionnaire (HRQOL). MethodsThe design followed the World Health Organisation (WHO) electronic VA testing of monocular sight using LogMAR charts and binocular vision using Snellen charts, and an HRQOL questionnaire assessing for reduced ability of visual-based tasks in activities of daily living (ADL). The data was evaluated in correlation to the participant's visual correction, age, gender, and socioeconomic background. ResultsSeventy students were recruited, all meeting the WHO standard level for visual ability, with 100% (n = 70/70) met or achieved above normal binocular vision, correlating to expected normal population results from published studies for age. The monocular vision demonstrated 74% (n = 52/70) for the right eye, and 80% (n = 56/70) for the left eye for normal vision levels. The results did not differ significantly between each eye (p = 0.21), gender variations between the left eye (p = 0.27) and the right eye (p = 0.10) results were affected by sample ratio of females (80%; n = 56/70) to males (20%; n = 14/70), the visual correction did not impair binocular VA. The HRQOL assessment indicated no significant functional VA issues in the study sample. The study demonstrated no association between the participant's socioeconomic background that may influence their VA ability. ConclusionThe results provided normative binocular and monocular data on visual function in a sample of student radiographers and indicated that their thresholds align to normal (or near-normal) VA standards. Implications for practiceThe visual health data was reviewed for subgroup comparison and trend analysis, and did not identify risk factors within this sample group that their VA and visual functioning would impact upon radiography clinical placement tasks and activities. The sample is not generalisable to the wider population; further studies are recommended.

Мedical rehabilitation of children reconvalescent from infectious diseases according to the international classification of impairments, disabilities and handicaps

Infectious diseases are referred to as the most frequent and common diseases in our population, in children as well. Infectious pathology is often followed by the disorders in the organism structure and functions that requires medical rehabilitation measures. The purpose of this work is to prove the necessity of rehabilitation measures of certain level and form for those children who had different infectious diseases. The main research aim is to determine the organism disorders in its structure and functions in those children who recovered from infectious diseases according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH). Materials and methods: there was performed the health assessment of 103 children who had been discharged from the infectious departments of Scientific Research Institute of Children’s Infections (Departments of Respiratory Infections, Intestinal Infections, Neuroinfections, and Hepatitis) according to the health domains of ICIDH. Results: according to the stage of the organism disorders by ICIDH there were determined five groups. More than 36 % of children from the groups 3, 4, and 5 required the second stage of rehabilitation measures at the polyclinic and rehabilitation departments of Scientific Research Institute of Children’s Infections. Conclusion: International Classification of Impairments, Disabilities and Handicaps (ICIDH) can be used to develop the reasoning of level and form of rehabilitation measures in every child who had an infectious pathology.

Does different wording of a global oral health question provide different results?

Objective. Focusing on 70-year-old adults in Sweden and guided by the conceptual framework of International Classification of Impairments, Disabilities and Handicaps (ICIDH), the purpose of this study was to examine the extent to which socio-demographic characteristics, self-reported oral disease and social/psychological/physical oral health outcome variables are associated with two global measures of self-assessed satisfaction with oral health in Swedish 70-year-olds and if there is a degree of discordance between these global questions. Background. It has become an important task to create a simple way to measure self-perceived oral health. In these attempts to find practical ways to measure health, the ‘global oral health question' is a possible tool to measure self-rated oral health, but there is limited knowledge about how important the wording of this question is. Materials and methods. In 2012, a questionnaire was mailed to all persons born in 1942 in two Swedish counties, Örebro (T) and Östergötland (E). The total population of 70-year-olds amounted to 7889. Bivariate analyses were conducted by cross-tabulation and Chi-square statistics. Multivariate analyses were conducted using binary multiple logistic regression. Results. The two global oral health question of 70-year-olds in Sweden was mainly explained by the number of teeth (OR = 5.6 and 5.2), chewing capacity (OR = 6.9 and 4.2), satisfaction with dental appearance (OR = 19.8 and 17.3) and Oral Impact on Daily Performance (OIDP) (OR = 3.5 and 3.9). Conclusion. Regardless of the wording, it seems that the concept of a global oral health question has the same main determinants.

Application of the World Health Organization (WHO) ICF and ICF-CY to communication disability

The World Health Organization (WHO) has developed a framework and classification system that captures functional health status. The International Classification of Functioning, Disability, and Health (ICF) (2001) and the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY) (2007) represent a significant advancement in the understanding of functional health and disabilities compared to WHO's initial 1980 International Classification of Impairments, Disabilities, and Handicaps (ICIDH). The ICF and ICF-CY have been gaining acceptance across Europe in all health sectors and rehabilitation fields. This article describes the basics of the ICF and ICF-CY, and their possible clinical, educational, and research influences on the field of communication disorders. In addition, a discussion of European Union based initiatives using these classifications systems is presented, as well as recent ICF activities in Spain.

A Selective Critical but Constructive Desktop Appraisal of theAmerican Medical Association Guides to the Evaluation of Permanent Impairment (AMA 6)

AbstractThis desktop review has been conducted, from the reviewers' perspective, to evaluate the merits, advantages and disadvantages of adopting the 6th edition of theAmerican Medical Association (AMA6) Guides for the Evaluation of Permanent Impairment.The reviewers do not make any recommendation as to whetherAMA6should or should not be adopted by any particular jurisdiction, but rather provide comment from the perspective of a critical but constructive appraisal of published material. The observations reported represent the opinions of the reviewers, based on their appraisal of selected sections ofAMA4,AMA5andAMA6and the associated literature.AMA6has become surrounded by considerable controversy. At the time of review, at least two jurisdictions in the United States have voted against adoption ofAMA6. While the paradigm shift away from the World Health Organization (WHO) International Classification of Impairment, Disability and Handicap (ICIDH) framework to the WHO International Classification of Functioning, Disability and Health (ICF) framework has attempted to ‘move with the times’, andAMA6has attempted to reach higher levels of internal consistency and interrater and intrarater reliability, the methods used to achieve a radical change in theGuideshas come under criticism. It is quite difficult to distinguish between speculative and substantive criticism, because of paucity or obscurity in both source documents and subsequent commentary. A range of concerns have been identified.

Beyond Dueling Models: Commentary Responding to: Guralnik JM, Ferrucci L. The Challenge of Understanding the Disablement Process in Older Persons and Freedman V. Adopting the ICF Language for Studying Late-life Disability: A Field of Dreams?

Beyond Dueling Models: Commentary Responding to: Guralnik JM, Ferrucci L. The Challenge of Understanding the Disablement Process in Older Persons and Freedman V. Adopting the ICF Language for Studying Late-life Disability: A Field of Dreams?

CS11-05 The international classification of functioning, disability and health from the few point of social psychiatry

Social psychiatry has always suffered from an inappropriate diagnostic classification system. Social psychiatry is directed toward the integration of disabled persons into their family, profession and society in general. As such the exclusive assessment of symptoms is only of minor value for the objectives of social psychiatric approaches. It lies in the core of social psychiatry to assess patients’ problems with functioning. This has already been possible by using the International Classification of Impairment Disability and Handicap (ICIDH) which primarily focused on the deficits of affected persons. The International Classification of Functioning, Disability and Health now allows to classify not only deficits of affected persons but also their resources. Disability is always defined as an interaction of deficits in functioning on one side and the environment on the other side. This is a much more dynamic approach to rehabilitation than previously conceptualized.A good example for a modern view on the deficits and resources of affected persons is their occupational functioning. Only lately professionals almost without exception agreed on the fact that it is impossible to reintegrate or rehabilitate affected persons in the first labour market. For that reasons disabled persons were excluded from the labour market and trained and employed mainly in sheltered workshops. Today using a more interactive approach to occupational rehabilitation, professionals are much more optimistic to integrate disabled persons in the first labour market. This development in occupational rehabilitation will be described shortly and related to the International Classification of Functioning Disability and Health.

Patient-reported outcomes in stuttering treatment: conceptual framework

Evaluation of: Yaruss JS, Quesal RW. Overall Assessment of the Speaker’s Experience of Stuttering (OASES): documenting multiple outcomes in stuttering treatment. J. Fluency Disord. 31(2), 90–115 (2006). These authors presented the first complete instrument intended to measure the impact of stuttering in adults who stutter (Overall Assessment of the Speaker’s Experience of Stuttering; [OASES]). OASES is a 100-item self-report metric with four sections: general information, reactions to stuttering, communication in daily situations and quality of life. Its conceptual framework includes historic views of the influence of emotional and cognitive variables on stuttering; the WHO’s International Classification of Impairments, Disabilities and Handicaps (ICIDH); and the WHO’s International Classification of Functioning, Disability and Health (ICF). However, both this conceptual framework and the psychometric data presented to support the OASES are problematic in ways that clinicians and researchers in areas well-beyond stuttering may find informative as they consider their own applications.

From disablement to enablement: Conceptual models of disability in the 20th century

Purpose. The aim of this work is to provide a general view of the conceptual elaborations on disablement in the 20th century and to discuss the role of these different contributions in developing the current concepts of disablement.Method. A review of the literature on conceptual models of disablement in the past century has been performed.Results. The 20th century has witnessed important theoretical considerations on health, diseases and their consequences. These considerations have generated various conceptual models, some of which share the same focus and point of arrival, the so-called ‘Disablement Process’. Among the models that were developed, two stand out, which were drafted and disseminated under the aegis of the World Health Organization, namely the International Classification of Impairments, Disabilities and Handicaps (ICIDH) and the International Classification of Functioning, Disability and Health (ICF), but these are just one part of the conceptual elaboration in the field. Further conceptualization was produced in health and social settings by specialists, self-advocacy associations and activist groups.Conclusions. The current ICF model of the World Health Organization has been translated and recognized in 191 countries; it also incorporates the contribution of self-advocacy associations and it is now recognized by most of them. This model has enjoyed higher visibility than other conceptual models, though its level of development was not higher or more original. To our opinion the ICF is not very clear on the essential choice of the model, i.e., to see disablement as a dynamic process that happens when personal limits collide with socio-environmental needs, rather than as a personal feature. This choice is instead clearer in other models, like Nagi's 1991, the Institute of Medicine (IOM) model by Brandt and Pope, where the identification of three dimensions (the individual, the environment and the individual-environment interaction) clarifies the role played by all three dimensions within the process of disablement and introduces major hints for further considerations on how to create virtuous processes of enablement.

The international classification for functioning, disability and health

The rheumatologic community is in a leading position for the development of International Classification of Functioning, Disability and Health (ICF) Core Sets and the research into the validity and application of the ICF. We can be proud of this achievement, but not all of us are aware of this new development. What is the ICF? Rheumatologic conditions have major impact on patients. Apart from symptoms such as pain, stiffness, and fatigue, patients are limited in activities and restricted in participation in society [2]. When unable to continue paid work, for example, there are important consequences for the patients, their families, but also for society. A major goal of the management of rheumatic diseases is to maintain or restore functioning. This contributes to the well-being of the patients, their families, and other caregivers. It is clear that maintaining function requires more than control of disease activity. By using the ICF, which was developed by the World Health Organization (WHO), we can obtain information on all three areas that are important for global functioning: body functions and structures, activities (actions by an individual), and participation (involvement in life situations) [3]. The ICF is one of the three reference classification systems that were proposed and developed by the WHO and belong to the Family of International Classifications. The main aim of the classification systems is to improve integration of health information. The International Classification of Diagnosis (ICD) is well known and widely applied [4]. The ICF was developed from the older International Classification of Impairments, Disabilities, and Handicaps (ICIDH) and accepted in 2001 [3]. It is increasingly recognized as an important classification in clinical medicine, outcome research, and healthcare organization. The International Classification of Health Interventions (ICHI) is proposed as the newest member of the family, and its development has just started [1]. The WHO aims to implement effectively the ICF worldwide and formulated strategic directions in which the three following are the most relevant: (1) The ICF has to become the framework to classify function, (2) easy-to-use ICF linked instruments should be developed to assess functional outcome as well as effectiveness of interventions, and (3) the level and quality of implementation of the ICF should be improved to increase quality and comparability Clin Rheumatol (2007) 26:1803–1808 DOI 10.1007/s10067-007-0623-0

‘My sight is poor, but I'm getting on now’: The health and social care needs of older people with vision problems

A health needs assessment project, based in four districts of the North Western Region, has recently investigated the health and social care needs of older people with vision problems. The research project had two stages. In the first, different perspectives on service needs for this client group were gathered through a process of triangulation, involving a literature review, a local survey, a clinical assessment linked to the local survey, secondary analysis of routinely collected health service data, interviews with service providers and focus groups with actual or potential service users. This provided information on‘need’, clinically defined, subjectively defined (both qualitatively and quantitatively) and defined in terms of demand for services. It also provided a picture, albeit partial, of the present pattern of service provision for older people with vision problems. The second stage explored the implications of the information collected for the commissioning of services for this group. The study findings are presented here. We have used the International Classification of Impairments, Disabilities and Handicaps (ICIDH) (WHO 1980) as a framework both to consider the nature and scale of need and to discuss appropriate interventions in relation to these needs.

The World Health Organization's international classification of functioning, disability and health: implications for clinical and research practice in the field of augmentative and alternative communication

In 2001, the World Health Organization (WHO) ratified and published a new classification system, the International Classification of Functioning, Disability and Health (ICF). There has been a varying amount of discussion and debate across the health and disability fields about what the ICF means and what it has to offer. However, there has been little discussion of its use and value in the field of augmentative and alternative communication (AAC). This article describes the earlier International Classification of Impairments, Disabilities, and Handicaps (ICIDH), upon which the current ICF was based; and outlines the ICF and the preliminary, derived Child and Youth version of the ICF (ICF-CY). The article also proposes what the ICF has to offer the AAC field, from both a clinical and research perspective; and concludes with a discussion of the advantages and challenges of using the ICF.

Role of Inequality and Inequity in Chronic Arsenicosis and Its Consequences

TM5-O-10 Introduction: Millions of people living in the eastern part of India are exposed to arsenic by consuming arsenic-contaminated groundwater. The existing literature has revealed the adverse health impact of chronic arsenic poisoning. However, there is little information regarding the role of inequality and inequity on occurrence of chronic arsenicosis and its consequences, which are thought to be very important in policy formulation and its effective implementation. The present study explores the role of social-cultural factors and present development paradigm on the occurrence of the disease and its physical and social consequences in the form of disability and handicap. Methods: A cross-sectional survey was conducted in 5 arsenic-affected villages, and the population exhibiting arsenical dermatologic manifestation was taken as cases. In addition to researching effects at the individual level, in-depth analysis regarding the role of social security, governance, and development policy (water agriculture, health care) on arsenic exposure and people's suffering was also conducted. The World Health Organization's International Classification of Impairment, Disability and Handicap (ICIDH) was also used, as the guiding tool to define the consequences of disease. Results: Our data showed that modern agriculture practice and drinking water policy has made people more dependent on groundwater and hence more exposure to arsenic. Occurrence and severity of manifestation was significantly associated (P < 0.05) with arsenic exposure level, gender, occupation, socioeconomic status, nutrition, and access to health care. The poor population suffered more due to malnutrition, occupation, access to healthcare services as well as social services, and economic constraint, thereby impacting their ability to seek safer and alternative sources of water. The impairments due to chronic arsenicosis caused 4 major disabilities: personal care (75.8%), locomotor (62.9%), gripping (62.9%), and growing intolerance to heat and cold (30%). Three varieties of handicaps were found: physical independence (29.5%), occupational (38%), and social integration (42.8%). The magnitude of disabilities depended on the severity of impairment and socio-cultural and physical environmental factors. The severity of handicaps was found to be dependent on the magnitude of disability, socioeconomic status, social and family support, occupation, and gender relation. Discussion and Conclusions: The present study established the role of social, economic, and cultural disparities, governance, policy, and their complex relationships on the incidence and magnitude of chronic arsenicosis and its consequences. The study shows that it is imperative to address the existing disparities and people's perception in mitigation strategy to make it more effective and sustainable.

Towards an international framework for communication disorders: Use of the ICF

There has been an interest in the World Health Organization's framework of functioning and disability by those in communication disorders since the original 1980 International Classification of Impairments, Disabilities, and Handicaps (ICIDH). In 2001, WHO published the substantially revised International Classification of Functioning, Disability, and Health (ICF). This framework is gaining in acceptance as a system that would be beneficial for the field and for our clients. This article describes the basics of the ICF and how it differs from the ICIDH; the possible applications of the ICF to communication disorders; some of the work done with the ICF in communication disorders internationally; and the benefits to the field from increased interdisciplinary and international collaboration using the ICF as a common framework. Learning outcomes: As a result of this activity the reader will be able to: (1) describe the basics of the ICF, (2) describe the applications of the ICF to communication disorders, and (3) describe the possible impact upon the field internationally.

The Environment in the International Classification of Functioning, Disability and Health

Background The World Health Organization has adopted two classifications relating to disability, one was published in 1980 and the more recent one in 2001. Although the international classification of functioning, disability and health (ICF) was drafted as a revision of the international classification of impairments, disabilities and handicaps (ICIDH), the ICF is based on major changes when compared with the ICIDH. One of them has to do with the environment.Method Quotations from the classification manuals and related articles are presented in order to make clear the scope of the environment in the ICF.Results The ICF has a universal application. The gap between capacity and performance reflects the barriers created by the environment.Conclusions In the ICF, universalism and barriers have specific meanings, reflecting specific policy choices.

The implementation of the International Classification of Functioning, Disability and Health in Germany: experiences and problems

The bio-psycho-social model of the International Classification of Functioning, Disability and Health (ICF) has already found wide acceptance in Germany. In particular, the introduction of contextual factors (environmental factors and personal factors) is welcomed. Several rehabilitation facilities have used the model and the chapters of the revision version (Beta-2) as guidelines for documenting their interviews with rehabilitation patients. Their experiences are encouraging. However, it has already been recognized that coding with the ICF will be difficult and time consuming. Thus, the practicability of the ICF should be improved. Training in the use of the ICF is absolutely essential. It is welcomed that the ICF provides a common vocabulary for both people with disability and for professionals in the fields of rehabilitation and disability. This is particularly important in Germany because we have a rather complicated social system. In contrast to the International Classification of Impairments, Disabilities and Handicaps (ICIDH), the ICF, in general, contains neutral terms only. Many of our physicians in rehabilitation complain about that. Obviously they also need to be able to express the signs and symptoms of restrictions of functioning in negative terms and in this respect they feel that the ICIDH was more helpful. While both the concept of activities and the concept of participation are clearly understood from the point of view of content some of us have severe problems with the operationalization of both concepts via qualifiers. From a theoretical perspective we regret that the concept of activity is not theory driven and that the concept of participation is not operationalized independently from the concept of activity. A proposal for solving these problems is given. In Germany, the ICIDH, or the ICF latterly, has been taken into account in the following areas. The new German Social Code Number IX (SGB IX) from 2001, Rehabilitation and participation of people with disabilities, is based on the ICF. All guidelines and general recommendations within the context of rehabilitation have been adjusted to the ICF. The ICF plays an important role in the training for the medical field of physical medicine and rehabilitation and is also included in the training curricula of the medical specializations of social medicine and rehabilitation. The German research programme "Rehabilitation sciences" includes some projects dealing with the ICF. The model of consequences of diseases (ICIDH) has been part of the rehabilitation quality insurance programme of the German Pension Insurance since 1994. Since 1 April 2004, the institutes of the German Health Insurance have applied the ICF to their rehabilitation application form.

Sobre el concepto de discapacidad. Una revisión de las propuestas de la OMS

El concepto de discapacidad ha sido recientemente revisado por la Organización Mundial de la Salud (OMS), como consecuencia de la necesidad de ajustar los procedimientos de diagnóstico a las nuevas realidades, aquí se expone una breve revisión de la evolución que este concepto ha tenido desde la primera clasificación internacional de deficiencias, discapacidades y minusvalías (CIDDM).

Socio-demographical examinations on disability prevalence and rehabilitation status in southwest of Turkey

Purpose: Disability is one of the most important social issues in the community. In contrast to the developed countries, Turkey has, unfortunately, no goods records on the current issues of disability such as the number of disabled and handicapped, and their socio-demographic properties due to the lack of sufficient studies in the specified area. The present study was, therefore, aimed to determine the status of disabled in the entire region of Isparta and to establish relationships between the distinctive disability properties in order for a better understanding of its important aspects.Materials and Method: Data were collected in 2002 from 3500 people residing throughout the region by the gradual sampling method according to the evaluation criteria of International Classification of Impairments, Disabilities and Handicaps (ICIDH) by WHO.Results: The disability prevalence in the studied group was found to be 5.3%, and 4.8% of the disabled were previously rehabilitated. Forty one percent of the disabled were found to have two types of disability. In the study, it was shown that the disability prevalence significantly increased by the age. The disabled were shown to be under-educated and not benefit from the rehabilitation services in one hand, and there were insufficient activities of rehabilitation established in the region in other hand.Conclusion: We concluded that the medical and social rehabilitation services must be initiated and freely provided to these local people, particularly to those young disables whose life will greatly change to a better living standard.

Book Review

Book Review

Connecting impairment, disability, and handicap in immune mediated polyneuropathies

Background: In the World Health Organisation (WHO) International Classification of Impairments, Disabilities, and Handicaps (ICIDH), it is suggested that various levels of outcome are associated with one another. However, the...