ICF and the disability universe: specificity in a complex world

Abstract

Background and aims: The International Classification of Functioning, Disability and Health (ICF) defines functioning and disability in terms of Body Functions and Structures, Activities and Participation, influenced by Environmental Factors. I investigated how ICF applications align with ICF aims, contents and principles and how the ICF is used to improve functioning measurement and statistics. I evaluated research since ICF publication for: a change in thinking; applications aligned with ICF specifications and philosophy; and emergence of new knowledge. These themes also frame my six publications included. Results: The ICF is used in diverse applications, settings and countries, in processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys and information systems; international efforts to improve disability data; new ICF-based instruments. Knowledge is growing about ICF components and interactions, the effects of environment on functioning, the meaning and measurement of participation. My publications contribute to the ICF aims and literature. I advocated greater use of the ICF to inform health and disability policies. To improve ICF applications, I outlined a path to meaningful measurement of functioning and disability, and identified the need for an Integrative Measure of Functioning for use in national programs for diverse populations. To build new knowledge, I demonstrated the relevance of the ICF to monitoring community-based rehabilitation and led development of a monitoring tool for use by low resource communities. Conclusion: The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating improvements in measurement and statistics. The field nevertheless needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin improved policies, services and outcomes for people with diverse challenges in functioning.