ICIDH Research Articles

Impairments and Disabilities in Hand Therapy: The Necessity of a Uniform Terminology for Communication and Research Purposes

Uniformity in the use of professional language is very important in the field of medicine. Impairments and disabilities are terms that are often used interchangeably. To health professionals analyzing a patient's health problem, formulating treatment goals, or writing questionnaires and protocols, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) offers a conceptual framework that has a great potential to remedy improper use of terms and that can enhance communication. The purpose of this article is twofold: (1) to familiarize the hand therapist with the ICIDH and (2) to present some proposals for a revision of the ICIDH that will make the classification structurally more practical and thereby will facilitate its use.

Psychiatric Disability Services and Ethnic Communities in Melbourne

Over the last few years there has been a greater interest in psychiatric disability and the provision of specialist psychiatric disability programs. This was partly due to the recognition that clinical treatment services alone were not sufficient to ensure recovery and a return to independent living for people with psychiatric disorder. based care. Research by the Victorian Tranxultural Psychiatry Unit has shown that arrcss to community based clinical services is problematic for many ethnic communities. This article explores the area of psychiatric disability services. which constitute a small but increasingly important part of the service system, and reports on a study which examined the use of these services by people of nonEnglish speaking background (NESB), and the implications of the findings for service providers. The concept of disability The International Classification of Impairments, Disabilities and Handicaps (ICIDH) developed by the World Health Organisation [ 11 provides the basis for differentiating between symptoms of illness and ongoing disabilities. The

An introduction to the concepts and classifications of the international classification of impairments, disabilities, and handicaps.

This paper aims to introduce the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) and to set the scene for the forthcoming revision process. The consequences of diseases and disorders at the level of the body (impairment), the person (disability), and the person as a social being (handicap) are defined and described. Bearing in mind some of the controversies and confusions which have become apparent in attempts to apply the ICIDH since its publication in 1980, the distinctions between the different concepts are explored: namely, impairment--disability; impairment--functional limitation--disability; and between disability--handicap. The nature of the classification schemes for these concepts is described, together with some implications for methods of assessment. Finally, the contribution the ICIDH has made, and its potential uses are briefly reviewed.

On the notions of disability and handicap

In 1980, the World Health Organization (WHO) published the International Classification of Impairments, Disabilities and Handicaps (ICIDH). In addition to a nomenclature and a classification, this publication contains a set of elaborate definitions of the central concepts in the area. This conceptual structure has been the focus of intensive critical discussion during the last decade. In 1989, a special society, the Canadian Society for the ICIDH, presented an alternative characterization of the concepts. This article attempts to continue this discussion by deepening the analysis concerning, in particular, two aspects of disability and handicap: first, the idea of normality contained in the WHO classification; second, the idea of context dependence, which is a special focus of the Canadian group. As a result of this discussion, the author presents an alternative set of definitions of the notions of disability and handicap.

Reliability of the diagnosis of impairments in survey research in the field of chiropody.

Chiropody is a rather unknown paramedical profession in The Netherlands. A chiropodist treats foot and nail problems or postural deviations which may be corrected by means of remedial foot therapy. There is no history of scientific research on chiropody. A necessary first step is a survey on professional practice, diagnosis and treatment. A requirement for a survey study is a reliable registration form. In this study a registration form that draws on the conceptual framework of the ICIDH (International Classification of Impairments, Disabilities and Handicaps) was tested on inter-observer reliability. A chiropodist and a trainee examined 49 patients. Reliability was determined using two measures: the percentage of agreement and Cohen's Kappa. Findings of this study indicate that the reliability of the registration form for the assessment of the chiropody diagnosis is satisfactory.

Clinical gait analysis: Problems and solutions?

Gait analysis aimed at clinical application in rehabilitation should be directed at objectification of consequences of impairments on the level of disabilities as conceptualized by the World Health Organization (WHO) in the International Classification of Impairments, Disabilities and Handicaps (ICIDH). Application of the current methods of analysis in neurology and rehabilitation is fraught with problems.

Physical Therapy Diagnosis and the Relationship Between Impairments and Function

Physical therapy diagnosis refers to both a process and a particular label within a classification scheme. This article reviews the development of the concept of diagnosis in physical therapy and evaluates the clinical utility of using the World Health Organization's International Classification of Impairments, Disabilities, and Handicaps (ICIDH) as a taxonomy for physical therapy. In place of the ICIDH, a model developed by Nagi is suggested. If this model is applied to physical therapy, the relationship between impairments and functional limitations is identified as the primary diagnostic focus of physical therapy. Exploration and expansion of this model may best serve the development of a classification scheme for physical therapy diagnosis.

Clinical findings as outcome predictors in rehabilitation of patients with sciatica

In rehabilitation of patients with sciatica, factors prognostic of long-term outcome could prove beneficial in interventions and in evaluating progress toward fitness or capacity for work. In this study results of physical examinations, carried out one year after hospital treatment for suspected lumbar intervertebral disc herniation, were related to outcome after five-years, as assessed by the categorization of occupational handicap of the International Classification of Impairments, Disabilities and Handicaps (ICIDH). The sample consisted of 276 patients admitted to hospital in the years 1980-1982. Based on established clinical indications 179 patients underwent lumbar disc surgery and the remaining 97 received further conservative treatment. One year after hospitalization a physician and physiotherapist examined the patients at the Rehabilitation Research Centre (RRC) of the Social Insurance Institution in Finland. In 1986 the patients returned to the RRC for further evaluation of their occupational handicap at that time. Stepwise logistic regression analysis showed that sensory deficits of legs, tenderness in lumbar extension, decreased repetitive trunk flexion performance (sit-up test), decreased lumbar lordosis and tightness of hamstrings were indicative of a poor outcome in the operated group. For the non-operated patients no statistically acceptable regression analysis model could be established.

Impairment/function and disability/activity 3 years after cerebrovascular incident or brain trauma: A rehabilitation and occupational therapy view

A consecutive series of 195 individuals who had had a stroke or brain trauma in 1986 responded in 1989 to a questionnaire about the consequences of the incident for occupational performance. The questionnaire contained 86 questions organized to correspond to the WHO International Classification of Impairments, Disabilities and Handicaps (ICIDH). The questions were distributed over 11 areas of occupational performance: work, leisure activities/social role, life satisfaction, sensori-motor, perceptual, intellectual, emotional function, sleep, personal care, domestic/housework/gardening, and temporal adaptation. None of the individuals considered they had attained the same level of occupational performance in all 11 areas as before the incident. Eight patterns of occupational performance were identified: 35% considered that they performed personal care at the same level and had the same temporal adaptation as before the incident, and that they had minimal impairment/disability in the other areas of occupational performance; 27% thought that they had a considerable degree of disability in all areas of occupational performance except for temporal adaptation; 8% thought that they had imbalance in temporal adaptation and severe performance difficulties in all 11 areas of occupational performance; 4% were dissatisfied with their life situation, and had a changed family role, did not practise the leisure activities they wanted, and had severe sleep problems; and for 9% the levels of performance varied a great deal and depended on the particular area of performance. The consequences of stroke or brain trauma for function and activity 3 years afterwards are considerable.

Le Processus De Production Des Handicaps: Vers Un Cadre Conceptuel Renouvele

Since the mid-1970s the development of a specific conceptual framework for the consequences of disease and trauma has been occurring at the international level. A growing awareness among health professionals of the chronic physical, intellectual, and emotional problems which are reducing the abilities and social autonomy of a large percentage of the population have led the World Health Organization (WHO) to work on this matter. In this paper, the author explains the conceptual evolution of the field of disabilities. He defines the challenges and potential uses of an international classification of consequences of disease and trauma. This article proposes an interactive conceptual framework for the identification of handicaps and directions for the revision of the WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH). It is an invitation for the Canadian mental-health field to express points of view on the present process of the harmonization of terminology and concepts on the Canadian and international scenes. The English version of the proposal to revise the third level of the ICIDH (handicaps) can be obtained from the Canadian Society for the ICIDH, 1399, rue Thibodeau, Lac St-Charles, Québec GOA 2H0, Canada.

Using the World Health Organization's International Classification of Impairments, Disabilities, and Handicaps in Occupational Therapy

Health status, although commonly defined in terms of the presence or absence of disease, can also be defined in terms of performance or functional status. Loss of performance results in disablement. The authors summarize the conceptual framework and categorization in the World Health Organization's International Classification of Impairments, Disabilities and Handicaps (ICIDH) (1980) and the Model of Occupational Performance in the Guidelines for the Client-Centred Practice of Occupational Therapy (Health and Welfare Canada and the Canadian Association of Occupational Therapists, 1983; 1986). Complementary elements of the ICIDH and the Model of Occupational Performance appear to be recognition that performance is an element of holistic health influenced by the social, physical and cultural environment. Also, the ICIDH categories of disablement appear to be conceptually mirrored in the model's categories of occupational performance. The authors use client and service data to illustrate three uses of the ICIDH in occupational therapy: communication with other health professionals; program planning and management; and, clinical evaluation and research.

Inter-rater and intra-rater reliability of disability ratings based on the modified D Code of the ICIDH

Since application of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) in its full form proved to be impractical, the use of selected parts, or of instruments based on the ICIDH, has been suggested. We have assessed the inter- and intra-rater reliability of disability ratings using a screening instrument, based on the D Code of the ICIDH. The level of functional abilities of all new patients (n = 39) seen by a resident at our outpatient clinic in an 11-week period was rated on a four-point scale for each of 28 items in five ability categories. Independent ratings were done by a resident and his supervisor (inter-rater reliability). Repeated rating by the resident was used to assess intra-rater reliability. Calculation of the inter- and intra-rater reliability was based both on the method of the relative agreement and on the measure kappa. The results showed relative agreements of greater than or equal to 82%, and kappa values of greater than or equal to 0.71 were found. This study shows that in a teaching hospital very satisfactory inter-rater and intra-rater reliabilities using a short instrument based on the D Code of the ICIDH can be achieved. It can therefore be recommended as a method for global disability rating.

Parents’reports of disability among 13 year olds: Preliminary experiences with WHO'S ICIDH

Disability, as defined by the International Classification of Impairments Disabilities and Handicaps (ICIDH), was studied in a sample of 13 year olds (n = 831) who are involved in a longitudinal study of health, development and behaviour. The disability categories of ICIDH were used to develop a self-administered questionnaire for completion by parents, and 831 parents completed the questionnaire. The most common reported disabilities were: writing/spelling (26%), coping with dust/pollens or chemicals (15%), and coping with school work (15%). Eighty-one parents reported that their teenager had some circumstantial dependency; 49 of these mentioned medication that was associated with asthma management. Despite problems in the application of the disability categories of ICIDH, they were considered to provide a useful means by which to study disability systematically among teenagers.

Chronic respiratory illness and disability: A critical review of the psychosocial literature

The paper attempts to offer a critical review of the current psychosocial literature on chronic obstructive airways disease (COAD: emphysema, chronic obstructive bronchitis and chronic asthma) from a (medical) sociological perspective. Following a brief exposition of the clinical nature of COAD and its epidemiology the paper reviews some of the main psychosocial literature in the field. It then focuses on some of the problems concerning issues of methodology and measurement within the existing research, particularly the inadequacy of many of the ‘quality of life’ instruments and disability measures used; the lack of research which combines both quantitative and qualitative data; and the predominant concern with the psychological aspects of the condition to the detriment of the social dimensions involved. Using the International Classification of Impairments, Disabilities and Handicaps (ICIDH) as its conceptual scaffold, the paper then goes on to argue that a sociological perspective is both a necessary and essential complement to existing research in this area in order to achieve a fuller understanding of chronic respiratory illness/disability and its sequelae. Finally, the paper attempts to offer some possible reasons why chronic respiratory and disability has received relatively little attention from within the social sciences and concludes with some reflections and suggestions on possible future developments in research into chronic respiratory illness and disability from within the social sciences.

The Groningen Social Disabilities Schedule

Most of the existing instruments for the assessment of social dysfunctioning of psychiatric patients are merely lists of precoded items, leaving little or no room for posing supplementary questions. In this article a new, semi-structured questionnaire--the Groningen Social Disabilities Schedule (GSDS)--is described, in which this shortcoming is met. The development of the GSDS is based on social role theory and on the existence of a hierarchy in social disabilities, demonstrated in an earlier World Health Organization study. Compatibility was sought with the International Classification of Impairments, Disabilities and Handicaps (ICIDH), a trial-classification of the World Health Organization, to be used in research on the consequences of illness. It is concluded that the inter-rater reliability of the GSDS is good. To a large extent the hierarchy proved to hold true for this instrument. Some implications for future research and for the ICIDH are discussed.

The International Classification of Impairments, Disabilities and Handicaps: Its Usefulness in Classifying and Understanding Biopsychosocial Phenomena

The International Classification of Impairments, Disabilities and Handicaps (ICIDH) was developed because of the growing awareness that ICD-9 failed to reflect many of the problems that people bring to health care systems. The ICIDH was designed to classify the consequences of disease such as the disruption of daily activity and the social disadvantage that accompany illness. However, since its introduction, the ICIDH has largely been ignored by psychiatry, despite its conceptual strength. In particular, it provides a framework for applying the biopsychosocial model and studying the phenomena of mental illness. The latter is an important issue because of clinical psychiatry's inherent weakness in distinguishing between symptoms of disease and the psychosocial consequences, a particular inadequacy of the DSM-III diagnostic criteria. The utility of the ICIDH is shown in the study of the phenomena of panic disorder and agoraphobia, where I conclude that agoraphobia should be classified as a disability/handicap and not a disorder.

Beurteilerübereinstimmung einer deutschen Version der International Classification of Impairments, Disabilities, and Handicaps (ICIDH) der Weltgesundheitsbehorde

A German version of the "International Classification of Impairments, Disabilities, and Handicaps (ICIDH)" edited by the World Health Organization (1980) has tested in respect to the interrater reliability. The investigation was carried out with 36 staff members from three rehabilitation institutions for the blind or partially sighted, who rated in pairs a visually impaired child or adult with the classification system. The calculation of the interrater reliability was based both on the method of the relative agreement between the raters and on the measure "kappa". Altogether, the KAPPA-calculation yielded unsatisfactory interrater agreements. The reasons for the low reliability figures can be seen on one hand in the classification system itself, on the other hand in motivational barriers within the group of raters. The investigation however also indicates, that by modifying the classification system and by intensively training the raters, improvement concerning the reliability figures can be expected.

Using the ICIDH in household surveys: problems and possibilities

The ICIDH presents a scheme for recording detailed data relating to the consequences of disease in patients treated by the health-care system. At first sight, it seems to have little relevance to recording, much less collecting, data obtained during a household survey of disablement. However, the scheme is based on definitions which represent a logical development from those successfully used in disablement surveys conducted in Canterbury. The experience gained in these surveys suggests that the conceptualization of disablement in future surveys could, with advantage to clarity and comparability, be based on the definitions presented in the ICIDH. Further, the ICIDH indicates the range of disablement components and indicators from which a selection might be made in any particular survey. Also, it sometimes presupposes methods of collecting the data relating to these components and indicators which might be adapted to survey use. 1. The International Classification of Impairments, Disabilities and Handicaps (ICIDH)