International Classification Of Impairments Research Articles

Comparing Perspectives of People with Disabilities and Professionals on the ICIDH-2 Beta-1

The World Health Organization is revising the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). As part of the revision process, 51 individuals in the United States completed a survey. The respondents included people with and without disabilities and rehabilitation-related professionals. This article reports areas of agreement and disagreement on several changes proposed for the ICIDH-2. Results indicate agreement for the need to classify activities rather than disabilities, to replace "handicap" with "participation restriction," and to include environmental factors in the classification. Policy implications include tracking the influence of policy changes on the activities performed and on participation in major life activities by people classified as impaired in motor or mental capacity. Including the classification of environmental factors could encourage a confluence of the social and biological models of disability that would provide a richer understanding of the interactions between people with disabilities and their surroundings.

Measuring the outcome of occupational therapy: Tools and resources

Current pressures to document outcomes and demonstrate the efficacy of occupational therapy intervention arise from fiscal restraints as much as from the humanitarian desire to provide the best quality health care to consumers. However, measuring outcomes is important in facilitating mutual goal setting, increasing the focus of therapy on the client, monitoring client progress, as well as demonstrating that therapy is valuable. The aims of this article are to provide the reader with an overview of what outcomes research is and to provide resources to aid the selection of outcomes assessments in a variety of practice areas. This article adopts the latest version of the World Health Organisation’s health classification system (International Classification of Impairments, Activities and Participation), as an organizing framework, and promotes the use of this framework when undertaking outcomes research.

Clinical meaning of the Stroke-Adapted Sickness Impact Profile-30 and the Sickness Impact Profile-136.

Handicap or health-related quality of life (HRQL) measures are seldom used in stroke trials, although the importance of these measures has been stressed frequently. We studied the clinical meaning of the Stroke-Adapted Sickness Impact Profile-30 (SA-SIP30) and the original SIP136 for use in stroke research. We included 418 patients who had had a stroke 6 months earlier. We studied the associations between the SA-SIP30 and SIP136 scores versus other frequently used outcome measures from the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (Barthel Index, Rankin Scale) and the HRQL model (health perception items, Euroqol). To interpret the continuous SA-SIP30 and SIP136 scores, we used receiver operating characteristic curve analysis with the aforementioned measures as external criteria. The psychosocial dimension scores of both SIP versions remained largely unexplained. The physical dimension and total scores of both SIP versions were mainly associated with the disability measures derived from the ICIDH model, as well as with the physical HRQL domains. Most patients with an SA-SIP30 total score >33 or an SIP136 total score >22 had poor health profiles. There were no major differences between the SA-SIP30 and the SIP136, although the SA-SIP30 scores were less skewed toward the healthier outcomes than the SIP136. Our study showed that (1) both SIP total scores primarily represent aspects of physical functioning and not HRQL; (2) both SIP versions provide more clinical information than the frequently used disability measures; and (3) the SA-SIP30 should be preferred over the SIP136.

What is treatment evaluation research? What is its relationship to the goals of audiological rehabilitation? Who are the stakeholders of this type of research?

Three topics related to treatment evaluation research in audiological rehabilitation are discussed. First, the International Classification of Impairments, Activities and Participation (ICIDH-2) (World Health Organization, 1999) is described and proposed as a general conceptual framework for the design of intervention and research activities in audiological rehabilitation. Second, the three main domains of treatment evaluation research (efficacy, effectiveness, and efficiency) are briefly outlined. Third, the various consumers of treatment evaluation research in audiological rehabilitation are identified. Also, the domains of treatment evaluation research that are of interest to each of these consumer groups are presented. An analysis of the main interests of each group of stakeholders suggests that, at present, evaluative research in audiological rehabilitation does not adequately meet the needs of all stakeholders. Nevertheless, the future of evaluative research in audiological rehabilitation is promising, for several reasons: 1) research related to audiological rehabilitation is being actively pursued especially in the areas of treatment efficacy and treatment effectiveness; 2) the audiological rehabilitation community should be able to adapt its endeavors to the proposed conceptual framework of health conditions fairly easily (ICIDH-2; World Health Organization, 1999); 3) the research needs of the primary stakeholders of audiological rehabilitation are known; and 4) there is a keen interest within the professional community to develop this area of research. All of these conditions are propitious for setting the research agenda of treatment evaluation research in audiological rehabilitation for the next several years.

Current issues in rehabilitation outcome measurement: implications for audiological rehabilitation.

This paper will describe several key issues current in rehabilitation outcome measurement that should be considered in the establishment or choice of any new outcome measurement system or tools. The paper is a concept piece based on a review of literature rather than on experimental design. Social and political forces of the 1990s are affecting the need for outcome measurement and management: consumerism, or empowerment of the end user of services; the global Internet and information age; and the pervasiveness of the concept of quality improvement. In this context, several underlying concepts are important in effective outcome management approaches. Rehabilitation's focus on the person served provides a frame for measurement. Measurement in terms of the domains of the World Health Organization's International Classification of Impairments, Activities and Participation reflects meaningful dimensions of rehabilitation for people with hearing loss. Activities in the arena of rehabilitation performance indicator development are summarized and challenges in developing outcome management systems are discussed. The paper proposes that choice is a key outcome of interest in rehabilitation. Persons served in audiological rehabilitation and providers alike can benefit from systematic outcome measurement, but more can be learned about outcomes. Attention to consistent and uniform outcome measurement in audiological rehabilitation is consistent with the trends in the rehabilitation community at large.

A comprehensive model of the development of mental handicap in children treated for acute lymphoblastic leukaemia: A synthesis of the literature

Most clinical studies addressing sequelae in children with leukaemia are not theory-driven. Nonetheless, the role of different mediating biological (e.g. cranial irradiation, chemotherapy) and psychosocial variables (e.g. family functioning) has been empirically acknowledged. In these studies, a cause-effect relationship between biological variables and cognitive deficits, sometimes complex due to multiple agents, has been hypothesised. As for the psychosocial consequences, adaptation to the cancer-related stress has been the main focus, at both the individual and family levels. In this paper, we advocate the use of a global model for the development of handicap, derived from the International Classification of Impairments, Disabilities and Handicaps (ICIDH) by the World Health Organisation. This revised model proposes that handicap is the result of complex interactions between the characteristics of a person’s impairment, disabilities, and the characteristics of the environment. At each of these levels, risk/resilience factors are defined. This means that depending on the environmental obstacles they face, persons with an impairment or a disability may or may not experience a situation creating a handicap which is no longer seen as a stable status resulting from a disease to which the individual must adapt. By reviewing animal and clinical studies, current knowledge pertaining to leukaemia sequelae are integrated into the different levels defined by the model: organic impairment, disabilities, environmental obstacles, and handicap situation. Practical implications for research, policies, and individual treatments, and comparisons with existing models, are also outlined.

Early Childhood Intervention

Professor of Education University of North Carolina at Chapel Hill Chapel Hill, North Carolina Simeonsson has engaged in research and research training for 20 years at the Frank Porter Graham Child Development Center at the University of North Carolina at Chapel Hill. For the past five years, he has been involved in a project with the North American Collaborating Center to revise the World Health Organization's International Classification of Impairments, Disabilities, and Handicaps (WHO, ICIDH). He has publisbed extensively in the periodical literature on issues pertaining to childbood disability, intervention, and prevention.

Auditory Disablements: An Update: Discapacidad auditiva: Una actualization

In 1999, the World Health Organization issued a document (Beta-2 ICIDH-2) that outlines proposed revisions to the original International Classification of Impairments, Disabilities, and Handicaps. The document, issued for trial purposes, is significant in that it redefines the theoretical context in which audiological research into hearing disability has operated since 1980 and will develop in the future. The purpose of this article is threefold. First, it provides an introductory descriptive overview of the primary disablement dimensions outlined in the Beta-2 version of the ICIDH-2 framework. Second, in discussing the implications of the revised framework for audiology, the article highlights particular classification issues that require clarification if the framework is to be applied effectively in audiological research and practice. Third, the article evaluates the revised framework in the context of recent conceptual developments in audiological research and raises a number of issues for further disc...

The Leeds assessment scale of handicap: its operationalisation, reliability, validity and responsiveness in in-patient rehabilitation

Purpose : This paper describes the application of the handicap dimension of the International Classification of Impairments, Disabilities and Handicaps. Method : A method of assessing four of the six roles (or areas of expected competency) was developed and applied to an inpatient population, aged 16 to 65 years, receiving specialist rehabilitation following neurological damage. Handicap assessment was a collaborative process by a multidisciplinary team. Difficulties were experienced in measuring inter-rate reliability in the busy, clinical setting. Results : We conclude that handicap assessment in an in-patient rehabilitation unit which uses a multidisciplinary approach to treating patients with complex physical, sensory and cognitive problems is both feasible and useful. Conclusion : The developed scale, The Leeds Assessment Scale of Handicap, provides a valid and valuable summary of human disadvantage, complementing the common disability assessments.

Towards a new ICIDH

In 1995 a special issue of Disability and Rehabilitation was published on the use of the International Classification of Impairments, Disabilities and Handicaps (ICIDH) which was issued by WHO in 1980. Since 1995 a lot of energy has been spent by WHO and other organizations aiming at the development of a new and improved ICIDH. In 1997, a draft ICIDH-2 (Beta-1 version) was circulated by WHO in order to be tested in the field. This paper informs the reader about the content of the draft ICIDH, the revision process planning and some Dutch comments relating to the actual draft.

Everything was done--patient still not satisfied: introduction to evidence-based surgery

Although the best knowledge in academic medicine has been used, some patients are still unsatisfied. By reason of these experiences there is a certain need to reflect our patterns of thinking. The surgical act is based on the laws of causality from Newton and Galilei and it is determined by the principle of cause and effect. Therefore the healing process must be interpreted as a turning back of pathogenesis or the linear chain of causalities. Scientific knowledge of this century demonstrate, that biologic healing processes are connected with the laws of cybernetics and the principles of semiotics. There are functional relations between the level of the organ (impairments) of the individual (disabilities) and of the society (handicaps). This International Classification of Impairments, Disabilities and Handicaps (ICIDH) serves as the key for the management of chronic diseases. An independent and a separate classification of the severity in each level is necessary to identify the consequences of the disease to the patient. Surgical interventions occur on the organ level, benefit and evidence are reflected especially on the individual level (gain of abilities). The assessment and the integration of the so called "sensory impairment", influenced by the biographical events of the patient, an the evaluation of the psychosocial resistance are important factors to recognize a unfavourable conformity between the degree of impairment and the degree of disability. With this classification a more patient-oriented discussion of the indications regarding operative procedures can be realised. The MARA model (mean age related ability) serves as a pragmatic basis for the description of the benefits of carried out and omitted interventions as changes of abilities by using the MARA curve as ethical guideline. This model, which is derived on ICIDH, the hierarchy of needs and the salutogenesis (semiotics, cybernetics), facilitate the introduction of evidence based surgery. It helps to estimate the several predictive values and correlation factors influencing the manifestation of the disease. On this way astonishing results in evidence can be expected. Finally many misunderstandings in health care discussions are explained by the fact that the differences between pathology and illness are not clearly interpreted.

The revision of the International Classification of Impairments, Disabilities and Handicaps and its application in MS.

The revision of the International Classification of Impairments, Disabilities and Handicaps and its application in MS.

The Consequences of Brain Injury: Classification and Assessment of Outcome

A classification of the consequences and severity of any chronic condition is essential to its adequate service provision and to the study of its rehabilitation. The World Health Organisation (WHO) classification, International Classification of Impairments, Disabilities, and Handicaps (ICIDH), provided an initial framework in 1980. The recent revision of the ICIDH, ICIDH-2, goes some way towards normalising disablement. It also makes much clearer how disadvantage results from inability to engage and interact at a social level, a particular problem after brain injury. The benefits of an increase in activities of daily life after injury are often self-evident or justified by cost. Increases in social interaction also need to be qualified by validated measures of subjective well-being. These dimensions require exploration in the brain injured population.

Incidence and impact of childhood and adolescent injuries: a population-based study.

The study of disabilities, use of health services, and absenteeism of parents among 0- to 17-year-old residents of Jerusalem (n = 432) hospitalized for unintentional injuries. Telephone interviews with parents, 6 months after hospitalization. Disabilities among 4 to 17 year olds were measured by a 25-item scale derived from the International Classification of Impairments, Disabilities, and Handicaps and by limitations of activities. Six months after the injury, limitations ranged from 8.3% (daily activities) to 19.4% (sport activities). About one in three presented at least one disability in the 25-item scale. All disabilities were present in higher proportions among adolescents. The more severe injuries whether to the head or other parts of the body presented higher percentages of disabilities. Burns and traffic crashes were associated with higher proportions of disabilities than other causes and with more frequent work absenteeism by their parents. A relatively large proportion of children remain with long-term disabilities irrespective of cause and body part injured. Because the sequelae of injuries is multifaceted, rehabilitation should include coordination between health and other services.

Measuring outcomes in children's rehabilitation: A decision protocol

Objective: To develop and test the feasibility and clinical utility of a computerized self-directed software program designed to enable service providers in children's rehabilitation to make decisions about the most appropriate outcome measures to use in client and program evaluation. Design: A before-and-after design was used to test the feasibility and initial impact of the decision-making outcome software in improving knowledge and use of clinical outcome measures. Setting: A children's rehabilitation center in a city of 50,000. Participants: All service providers in the children's rehabilitation center. Disciplines represented included early childhood education, occupational therapy, physical therapy, speech and language pathology, audiology, social work, and psychology. Intervention: Using a conceptual framework based on the International Classification of Impairment, Disability, and Handicap (ICIDH), an outcome measurement decision-making protocol was developed. The decision-making protocol was computerized in an educational software program with an attached database of critically appraised measures. Participants learned about outcome measures through the program and selected outcome measures that met their specifications. The computer software was tested for feasibility in the children's rehabilitation center for 6 months. Outcome Measures: Knowledge and use of clinical outcome measures were determined before and after the feasibility testing using a survey of all service providers currently at the centre and audits of 30 randomly selected rehabilitation records (at pretest, posttest, and follow-up). Results: Service providers indicated that the outcomes software was easy to follow and believed that the use of the ICIDH framework helped them in making decisions about selecting outcome measures. Results of the survey indicated that there were significant changes in the service providers' level of comfort with selecting measures and knowing what measures were available. Use of outcome measures as identified through the audit did not change. Conclusions: The “All About Outcomes” software is clinically useful. Further research should evaluate whether using the software affects the use of outcome measures in clinical practice.

Arthrite chronique juvénile et spondylarthropathie à début juvénile. Étude des déficiences, incapacités et handicaps dans les formes polyarticulaires

Introduction The authors use the international classification of impairments, disabilities and handicaps for study the disablement in polyarticular juvenile arthritis or spondylarthopathies. Patients and method Thirty-two patients (18 women, 14 men) with a minimum of five years course (an average of 9.5 years) were assessed. The main deficiencies were pain, limited joint motion (hips, shoulders, ankles), and a decrease in the pinch strength. Results — Conclusion The functional independencescore (FIS) was slightly decreased in 39% of remission and stabilized patients and lowered in all exacerbation periods (average 115). The juvenile arthritis functional assessment report (Jafar) specific scales, assess disability in 50% of remission and stabilized patients. In exacerbation periods, the average value is 18.5. Nine percent of patients attended a specialized school. Social integration posed problems in 29%. This methodical analysis is imperative in the delivery of comprehensive physical treatments and appliances or modified physical and occupational environments.

The ICIDH-2 – using the classification for statistics and research

The World Heath Organisation is in the process of revising the International Classification of Impairments, Disabilities and Handicaps (ICIDH). This paper describes the background to the ICIDH and the new features of the revised classification in relation to its aims and applications. The ICIDH has been extensively used in prevalence studies of disability and to measure the effectiveness of rehabilitation and examples of some of these studies are cited. The paper concludes with the plans for the future development of the ICIDH and the particular problems in translating the underlying concepts into assessment instruments that can provide valid and reliable data for research and statistical purposes including comparative studies.

Activities and functional assessment 1 year after spinal fusion for paralytic scoliosis.

The results of spinal fusion in patients with paralytic deformities are usually presented as the correction of the deformity. When evaluating the surgical results in such patients, it is advantageous to classify the patients into subgroups because of the varying dysfunction and disabilities. The aim of this study was to evaluate the effect of spinal fusion in patients with paralytic scoliosis in relation to function in terms of Impairments, activities in terms of Disabilities, and dependence in terms of Handicaps 1 year postoperatively, with emphasis on subgroups. A total of 94 patients with paralytic scoliosis and 18 different diagnoses were evaluated 1 year after surgery. The patients were classified according to whether or not they could understand verbal instructions. The patients were also grouped according to the Scoliosis Research Society classification of diagnoses. A set of instruments was used with the variables classified according to WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH). This consists of the patient's/relative's motives for surgery, persistent skin discoloration, ambulating or use of wheelchair, use of a brace, sitting balance, weight distribution on a sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Klein and Bell, care given, time spent resting, and seating supports. The set of instrument also included a follow-up questionnaire comprising 12 different areas, where the patients/relatives assessed the results of surgery. The study showed that spinal fusion in paralytic scoliosis led to showed improvements in the whole group of patients at the Impairment level in the angle of scoliosis, sitting balance, weight distribution, and reduced number of patients with persistent skin discoloration, and at the Handicap level in reduced time for resting during the day, reduced number of seating supports in the wheelchair, and in the use of a brace. Most of the parameters were unchanged. The results in the subgroups were almost the same as in the whole group, although pain and reaching at the Impairment level, and ADL at the Disability level, could not be measured in the patients who were unable to understand verbal instructions. The subjectively assessed results showed that seating posture was ranked positively irrespective of the motive for surgery. The study showed that the patients with paralytic scoliosis maintained or improved their function and level of independence in terms of Impairment and Handicap 1 year postoperatively. The subjective results assessed by the patients/relatives also showed a positive outcome of surgery. Weight distribution on a seating surface was improved, but still uneven, and with respect to better sitting balance and increasing time sitting in a wheelchair, this can involve a risk for pressure sores and needs further investigation. When introducing outcomes including the Disability level, one must take the importance of homogeneity in the groups into consideration.

The revision of the international classification of impairments, disabilities and handicaps and its application in MS

The revision of the international classification of impairments, disabilities and handicaps and its application in MS

Models of disablement, universalism and the international classification of impairments, disabilities and handicaps

A review and critique of models of disability is presented, tracing the development of frameworks and classificatory instruments (International Classification of Impairments, Disabilities and Handicaps) over the past 20 years. While the ‘social’ model is now universally accepted, it is argued that universalism as a model for theory development, research and advocacy serves disabled persons more effectively than a civil rights or ‘minority group’ approach. The development of the revised International Classification (ICIDH-2) is discussed in this light.