Denise G. Tate, Ph.D., ABPP
Els Nieuwenhuijsen, MPH, OTR
Department of Physical Medicine and Rehabilitation
University of Michigan
Changes in health care during the 20th Century called from a shift of treatment focus of acute illness to management of chronic illness and/or disability. In order to deal with this change in focus a new paradigm emerged. Instead of cure, functional management of the condition was the
goal and outcomes became the standard for measuring the performance of health care delivery and its effectiveness. The development of the lClDH-2 (International Classification of Impairment, Disability and Handicap) by the World Health Organization (WHO) was prompted by the need to measure the consequences of health conditions. The scheme of the ICD (International Classification of Disease) itself was considered insufficient to respond to this requirement since most people's health care needs can not be evaluated on the basis of diagnosis alone.
ICIDH is a classification of "disablements" which systematically groups consequences associated with health conditions (e.g. diseases, disorders or injuries). The term disablement covers three dimensions: (1) body structures or functions; (2) personal activities; and (3) participation in society. The original ICIDH was developed in 1980 and since then has been used for a number of purposes: as a statistical tool, in the collection and recording of
data; as a research tool, to measure outcomes, quality of life or environmental factors; as a clinical tool, in needs assessments, matching treatment with specific conditions, vocational assessments, rehabilitation and outcome evaluation, as a social policy tool, to aid in social security planning and compensation; and as an educational tool, to assist in curriculum design, identification of needs for awareness and social actions. This tool is therefore useful for healthcare practice, administration, research education, and policy. It contributes to improving the health and quality of life of the people worldwide by serving as a cross-cultural currency, since it provides uniformity in broad concepts and terminology and encourages
standardization of outcomes improving comparability of data.
The overall aim of the ICIDH-2 classification is to provide a unified and standard language to serve as a frame of reference for the "consequences of health conditions". To avoid the negative connotations of certain terms used previously by the original ICIDH to reflect the various dimensions of health-related experiences, the new ICIDH-2 uses a more positive terminology with two of these dimensions: the word "activities" is used instead of disability and "participation" instead of handicap. Impairments are described as "impairments of function and impairments of structure". In addition the ICIDH-2 addresses contextual factors (environmental and personal).
The ICIDH-2 is a multipurpose classification designed to serve various disciplines in rehabilitation, including rehabilitation psychology, and to provide a common framework for understanding and communicating the different dimensions of disablement and health.
The WHO initiated an elaborate process to revise the original ICIDH. Several ICIDH-2 Beta-1 Field trial test centers in Europe, Australia, and North America have been established to test the classification according to protocols. Four field test centers in the United States are currently involved in this endeavor: the Center for Independent Living in Ann Arbor, Michigan; Craig Hospital In.Colorado; the University of North Carolina in Chapel Hill; and Washington University in St. Louis, Missouri. During this testing process input from consumers, caregivers and health care providers is being received. The focus of the Beta-1 field test is to clarify certain items, refine definitions, enhance the concepts and the model, and to perform a
linguistic evaluation of the classification manual to ensure that the terms used are culturally sensitive and gender neutral. Future plans are to develop assessment tools, present case studies and applications. For more information about the ICIDH revision process please visit http://www.who.ch/icidh .
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