International Classification of Functioning, Disability & Health (ICF) and Disablement Model Study Guide

Disablement Frameworks and Models of Health

  • Traditional Biomedical Model:

    • Defines health strictly as the absence or freedom from disease.
    • Limitations and Problems:
    • Provides no emphasis on how a disease impacts an individual's actual functional capabilities.
    • Fails to emphasize or evaluate the functional and societal consequences of disease.

  • Disablement Frameworks:

    • Established by Verbrugge and Jette (1994).
    • Purpose and Function:
    • Provide a standardized, common language for healthcare providers.
    • Serve as a foundational infrastructure for clinical care, research, and healthcare policy.
    • Define health in a multidimensional manner that extends beyond a singular medical diagnosis or condition.
    • Acknowledge and integrate the essential contributions of physical, psychological, and societal functioning to overall health status.
    • Verbrugge and Jette (1994) Definition of Disablement:
    • Disablement is defined as the consequences that acute and chronic conditions have on specific body system function and on an individual’s abilities to act in necessary, usual, expected, and personally desired ways in their society.

  • Biopsychosocial Model:

    • Integrates the medical model and the social model to form a holistic understanding of patient health.
    • Demonstrates the interaction between three primary domains centered around the individual Person:
    • Biology: Physiological and biological factors.
    • Psychology: Mental processes, emotional states, and cognitive functions.
    • Social Environment: Cultural, social, structural, and relational context.

Biopsychosocial Model of Health

International Classification of Functioning, Disability and Health (ICF)

  • Historical Background and Adoption:

    • Developed and published by the World Health Organization (WHO) in 2001.
    • Endorsed by the Fifty-Fourth World Health Assembly.
    • Adopted by the American Physical Therapy Association (APTA) in 2008 as a foundational framework.
    • Documented in Documentation Basics for the Physical Therapist Assistant, Third Edition and Guide to Physical Therapist Practice (2014).
    • Purpose: Establishes a uniform, standardized language and framework for describing health and health-related states, shifting clinical focus beyond a patient's primary diagnosis.

  • Overall Structure of the ICF Model:

    • The framework is partitioned into two major components: Part 1 (Functioning and Disability) and Part 2 (Contextual Factors).

Structure of the International Classification of Functioning, Disability and Health (ICF) Tree Model

  • Part 1: Functioning and Disability:

    • Functioning (Positive Aspects): Describes what the individual CAN do.
    • Body Functions and Structures: Intact anatomical structures and physiological functions.
    • Activities and Participation: Tasks performed and societal roles fulfilled.
    • Disability (Negative Aspects): Describes what the individual CANNOT do.
    • Impairments: Loss or deviation in body functions or structures.
    • Activity Limitations: Difficulties in executing daily tasks.
    • Participation Restrictions: Inability or barriers to fulfilling societal roles.

  • Specific Components and Definitions of ICF Part 1:

    • Body Functions: The physiological functions of body systems, which explicitly include psychological functions. Measured as normal status or change in body function.
    • Body Structures: Anatomical parts of the body such as organs, limbs, and their structural components. Measured as normal status or change in body structure.
    • Impairments: Problems in body function or structure, defined specifically as a significant deviation or loss from normative values. Clinically identified by evaluating structures and functions that deviate from normal.
    • Activities: The execution of specific tasks or actions by an individual. Evaluated through the domain of Capacity (what an individual can execute in a standardized environment).
    • Activity Limitations: Specific difficulties an individual may encounter or experience while executing activities. Defined as tasks the patient CANNOT do.
    • Participation: Involvement in a life situation or societal role. Evaluated through the domain of Performance (what an individual actually does in their current real-world environment).
    • Participation Restrictions: Problems or limitations an individual may experience in their extent of involvement in life situations and societal roles. Defined as roles the patient CANNOT carry out.

  • Part 2: Contextual Factors:

    • Represents the background factors that facilitate or impede an individual's functional abilities. Contextual factors act as either Facilitators or Barriers.
    • Environmental Factors: Physical, social, and attitudinal environments in which people live and conduct their lives. Includes:
    • Social attitudes.
    • Architectural characteristics.
    • Legal and social structures.
    • Climate and terrain.
    • Personal Factors: Individual internal traits and background characteristics not part of the health condition. Includes:
    • Age and gender.
    • Social background and education.
    • Profession.
    • Past and current life experiences.
    • Character, behavior patterns, and coping styles.

  • Component Interactions and Direct Physical Agent Application:

    • Dynamic interactions occur bi-directionally between Health Conditions (disorders or diseases), Body Functions and Structures, Activities, Participation, and Contextual Factors (Personal and Environmental).
    • In physical therapy interventions, the level at which physical agents have direct effects is specifically targeted at Body Functions and Structure.

Model for the International Classification of Functioning, Disability and Health showing direct effect of physical agents

Clinical Case Applications of the ICF Model

Examples of Conditions, Impairments, Activity Limitations, and Participation Restrictions

  • Case 1: Spinal Injury

    • Condition: Spinal Injury.
    • Impairment: Paralysis.
    • Activity Limitation: Ambulation, climbing stairs, and related physical mobility tasks.
    • Participation Restriction: Lack of accommodations in public transportation leads to inability to participate in religious activities.

  • Case 2: Panic Disorder

    • Condition: Panic Disorder.
    • Impairment: Anxiety.
    • Activity Limitation: Not capable of going out alone.
    • Participation Restriction: Other people's negative reactions lead to a lack of social relationships.

  • Case 3: Juvenile DM (Diabetes Mellitus)

    • Condition: Juvenile DM.
    • Impairment: Pancreatic dysfunction.
    • Activity Limitation: None (when condition is fully controlled via medication).
    • Participation Restriction: Prevented from going to school because of societal stereotypes.

  • Case 4: R TKR (Right Total Knee Replacement)

    • Condition: R TKR.
    • Impairment: Pain, limited range of motion (ROM), and difficulty walking.
    • Activity Limitation: Impaired ambulation, difficulty transferring, and stair navigation.
    • Participation Restriction: Unable to go to the grocery store, perform self-care tasks (dressing and showering self), or go out to dinner or work.

Physical Therapy Documentation and Disablement

  • Essential Functions of Disablement Frameworks in Documentation:
    • Clinical documentation must directly reflect principles of disablement.
    • Establishes uniform consistency in clinical terminology across interprofessional settings.
    • Explicitly measures and documents impairments, activity limitations, and participation restrictions.
    • Articulates how underlying pathology and impairments contribute directly to activity limitations and participation restrictions.
    • Demonstrates how therapeutic interventions produce targeted changes in identified impairments, activity limitations, and participation restrictions.

PTA Role in Recognizing and Reporting Red Flags

  • Core Responsibilities of the Physical Therapist Assistant (PTA):

    • Conduct ongoing patient assessments during every intervention session.
    • Promptly gather and provide critical information to the Physical Therapist (PT) regarding emerging red flags.
    • Standardize terminology: Clinicians should consistently utilize the word "symptoms" rather than simply "pain" to capture a broader range of pathological signs and patient experiences.
    • Utilize open-ended questioning strategies to uncover unstated clinical issues:
    • "Is there anything else you want to share?"
    • "Are you having any other symptoms?"
    • "Are you better, worse or the same?"
    • Consistently communicate changes to the PT and actively seek clinical guidance.

  • Red Flag Findings Requiring Immediate Communication with the PT:

    • Reference Text: Recognizing & Reporting Red Flags for the PTA by Goodman & Marshall.
    • Diabetes Mellitus (DM): Presence of red, swollen nail beds.
    • Cancer: Presence of a new red rash, nodules, or dips/indentations in the skin.
    • Respiratory Dysfunction: Productive cough with yellow, green, or rust-colored sputum.
    • Neurological/Cognitive Changes: Abrupt changes in mental status, acute confusion, or new onset of delirium.
    • Dermatological / Infectious Conditions: Presence of a vesicular rash associated with herpes zoster.
    • Cardiopulmonary Changes: New onset of shortness of breath (SOB).

Questions & Discussion

  • Review and inquiry period reserved for addressing clinical scenarios, ICF framework categorizations, and red flag communication protocols.