Operationalization of the International Classification of Functioning, Disability and Health, ICF, in a Specialized Rehabilitation Center

Biz, Maria Cristina Pedro; Chun, Regina Yu Shon

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Original Article • CoDAS 32 (2) • 2020 • https://doi.org/10.1590/2317-1782/20192019046 copy

Operationalization of the International Classification of Functioning, Disability and Health, ICF, in a Specialized Rehabilitation Center

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

Describe the implementation process of the International Classification of Functioning, Disability and Health (ICF) in a Specialized Rehabilitation Center based on the biopsychosocial approach to health.

Methods

This is a descriptive, analytical, longitudinal study. The ICF implementation process in the healthcare center encompassed four stages: a) training on the use of the ICF; b) preparation of checklists by the team; c) collection of relevant data based on the checklist from the healthcare center users; and d) construction of a database.

Results

A checklist was constructed for each sector involved, and the database included user information and the ICF results during evaluation and reevaluation. The findings indicate higher problem-solving capacity in all sectors throughout the study period, and that training was crucial to operationalize the ICF. Preparation of the instruments based on the reality of the healthcare center was essential to meet local demands and those of each sector.

Conclusion

The ICF enabled greater practice of the biopsychosocial approach based on the engagement of the professionals in its operationalization, with evidence of healthcare problem-solving capacity and visibility and organization of the work process.

Keywords
International Classification of Functioning, Disability and Health; Health Indicators; Healthcare; Rehabilitation Center

xxx.0 – THERE IS NO problem (none, absent, insignificant) 0-4%
xxx.1- SLIGHT problem (light, small, ...) 5-24%
xxx.2 – MODERATE problem (medium, regular, ...) 25-49%
xxx.3 - SERIOUS problem (big, extreme, ...) 50-95%
xxx.4 – COMPLETE problem (total, ...) 96-100%
xxx.8 – Not specified
xxx.9 – No applicable

Categories	Qualifiers
b1144 Orientation in relation to the space	0		1		2		3		4
Evaluation	16	66.7%	1	4.2%	4	16.7%	2	8.3%	1	4.2%
Reevaluation	17	70.8%	2	8.3%	2	8.3%	2	8.3%	1	4.2%
Total	33	68.8%	3	6.3%	6	12.5%	4	8.3%	2	4.2%
b140 attention functions	0		1		2		3		4
Evaluation	9	37.5%	6	25.0%	5	20.8%	3	12.5%	1	4.2%
Reevaluation	10	41.7%	10	41.7%	2	8.3%	2	8.3%	0	0.0%
Total	19	39.6%	16	33.3%	7	14.6%	5	10.4%	1	2.1%
b152 Emotional functions	0		1		2		3
Evaluation	1	4.3%	10	43.5%	8	34.8%	4	17.4%
Reevaluation	4	17.4%	12	52.2%	6	26.1%	1	4.3%
Total	5	10.9%	22	47.8%	14	30.4%	5	10.9%
b235 Vestibular function	0		1		2		3		4
Evaluation	8	33.3%	2	8.3%	8	33.3%	3	12.5%	3	12.5%
Reevaluation	8	33.3%	11	45.8%	1	4.2%	1	4.2%	3	12.5%
Total	16	33.3%	13	27.1%	9	18.8%	4	8.3%	6	12.5%
b260 Proprioceptive function	0		1		2		3		4
Evaluation	6	25.0%	3	12.5%	10	41.7%	5	20.8%	0	0.0%
Reevaluation	6	25.0%	13	54.2%	2	8.3%	2	8.3%	1	4.2%
Total	12	25.0%	16	33.3%	12	25.0%	7	14.6%	1	2.1%
b265 Tactile function	0		1		2		3		4
Evaluation	7	29.2%	4	16.7%	7	29.2%	6	25.0%	0	0.0%
Reevaluation	10	41.7%	6	25.0%	5	20.8%	2	8.3%	1	4.2%
Total	17	35.4%	10	20.8%	12	25.0%	8	16.7%	1	2.1%
b280 Pain sensation	0		1		2		3		4
Evaluation	3	12.5%	7	29.2%	9	37.5%	3	12.5%	2	8.3%
Reevaluation	7	29.2%	10	41.7%	3	12.5%	3	12.5%	1	4.2%
Total	10	20.8%	17	35.4%	12	25.0%	6	12.5%	3	6.3%
b710 Functions related to the articulations stability	1		2		3		4
Evaluation	3	12.5%	5	20.8%	14	58.3%	2	8.3%
Reevaluation	11	45.8%	6	25.0%	4	16.7%	3	12.5%
Total	14	29.2%	11	22.9%	18	37.5%	5	10.4%
b730 Function of muscular strength	1		2		3		4
Evaluation	2	8.3%	8	33.3%	11	45.8%	3	12.5%
Reevaluation	10	41.7%	9	37.5%	1	4.2%	4	16.7%
Total	12	25.0%	17	35.4%	12	25.0%	7	14.6%
b735 Tonus	0		1		2		3		4
Evaluation	2	8.3%	2	8.3%	7	29.2%	11	45.8%	2	8.3%
Reevaluation	3	12.5%	7	29.2%	10	41.7%	3	12.5%	1	4.2%
Total	5	10.4%	9	18.8%	17	35.4%	14	29.2%	3	6.3%
b760 Functions related to voluntary movements	0		1		2		3
Evaluation	8	33.3%	1	4.2%	5	20.8%	10	41.7%
Reevaluation	8	33.3%	5	20.8%	8	33.3%	3	12.5%
Total	16	33.3%	6	12.5%	13	27.1%	13	27.1%
b765 Functions related to involuntary movements	0		1		2		3
Evaluation	14	58.3%	3	12.5%	5	20.8%	2	8.3%
Reevaluation	14	58.3%	7	29.2%	1	4.2%	2	8.3%
Total	28	58.3%	10	20.8%	6	12.5%	4	8.3%
b770 Functions related to gait pattern	0		1		2		3		4
Evaluation	1	4.2%	1	4.2%	1	4.2%	10	41.7%	11	45.8%
Reevaluation	1	4.2%	7	29.2%	8	33.3%	0	0.0%	8	33.3%
Total	2	4.2%	8	16.7%	9	18.8%	10	20.8%	19	39.6%
d410 Change the basic body position	0		1		2		3		4
Evaluation	2	8.3%	4	16.7%	9	37.5%	7	29.2%	2	8.3%
Reevaluation	5	20.8%	11	45.8%	5	20.8%	1	4.2%	2	8.3%
Total	7	14.6%	15	31.3%	14	29.2%	8	16.7%	4	8.3%
d415 Keep the body position	0		1		2		3		4
Evaluation	2	8.7%	5	21.7%	10	43.5%	4	17.4%	2	8.7%
Reevaluation	5	21.7%	10	43.5%	4	17.4%	2	8.7%	2	8.7%
Total	7	15.2%	15	32.6%	14	30.4%	6	13.0%	4	8.7%
d445 Use of hand and arm	0		1		2		3		4
Evaluation	6	25.0%	3	12.5%	7	29.2%	3	12.5%	5	20.8%
Reevaluation	7	29.2%	6	25.0%	4	16.7%	3	12.5%	4	16.7%
Total	13	27.1%	9	18.8%	11	22.9%	6	12.5%	9	18.8%
d450 Gait	1		2		3		4
Evaluation	0	0.0%	4	16.7%	10	41.7%	10	41.7%
Reevaluation	6	25.0%	10	41.7%	0	0.0%	8	33.3%
Total	6	12.5%	14	29.2%	10	20.8%	18	37.5%
d460 Moving through different places	0		1		2		3		4
Evaluation	0	0.0%	1	4.2%	5	20.8%	8	33.3%	10	41.7%
Reevaluation	2	8.3%	6	25.0%	9	37.5%	0	0.0%	7	29.2%
Total	2	4.2%	7	14.6%	14	29.2%	8	16.7%	17	35.4%
d465 Moving using an equipment	0		1		2		3		4		9
Evaluation	2	8.3%	3	12.5%	7	29.2%	6	25.0%	5	20.8%	1	4.2%
Reevaluation	7	29.2%	9	37.5%	1	4.2%	2	8.3%	4	16.7%	1	4.2%
Total	9	18.8%	12	25.0%	8	16.7%	8	16.7%	9	18.8%	2	4.2%
e1101 Medicines.	0		1
Evaluation	10	41.7%	14	58.3%
Reevaluation	10	41.7%	14	58.3%
Total	20	41.7%	28	58.3%
e1201 Health care products and technology for personal mobility and transportation	0		1		2
Evaluation	4	16.7%	5	20.8%	15	62.5%
Reevaluation	4	16.7%	10	41.7%	10	41.7%
Total	8	16.7%	15	31.3%	25	52.1%
e210 Physical geography	0		1		2
Evaluation	13	56.5%	4	17.4%	6	26.1%
Reevaluation	13	54.2%	5	20.8%	6	25.0%
Total	26	55.3%	9	19.1%	12	25.5%
e355 Health care professionals	0		1		2
Evaluation	4	16.7%	17	70.8%	3	12.5%
Reevaluation	4	16.7%	18	75.0%	2	8.3%
Total	8	16.7%	35	72.9%	5	10.4%
e398 Support and relationship, others specified	0		1		2
Evaluation	9	37.5%	12	50.0%	3	12.5%
Reevaluation	9	37.5%	12	50.0%	3	12.5%
Total	18	37.5%	24	50.0%	6	12.5%
e498 Attitudes, others specified	0		1		2
Evaluation	9	37.5%	10	41.7%	5	20.8%
Reevaluation	9	37.5%	10	41.7%	5	20.8%
Total	18	37.5%	20	41.7%	10	20.8%
e570 Social security related services, systems and policies	0		1		2
Evaluation	11	45.8%	9	37.5%	4	16.7%
Reevaluation	12	50.0%	9	37.5%	3	12.5%
Total	23	47.9%	18	37.5%	7	14.6%

Categories	Qualifiers
b140 Attention functions	0		1		2
Evaluation	4	40.0%	4	40.0%	2	20.0%
Reevaluation	6	60.0%	4	40.0%	0	0.0%
Total	10	50.0%	8	40.0%	2	10.0%
b144 Memory functions	0		1		2
Evaluation	5	50.0%	3	30.0%	2	20.0%
Reevaluation	8	80.0%	2	20.0%	0	0.0%
Total	13	65.0%	5	25.0%	2	10.0%
b147 Psychomotor functions	0		1		2
Evaluation	6	60.0%	3	30.0%	1	10.0%
Reevaluation	8	80.0%	2	20.0%	0	0.0%
Total	14	70.0%	5	25.0%	1	5.0%
b152 Emotional functions	0		1		2
Evaluation	4	40.0%	1	10.0%	5	50.0%
Reevaluation	7	70.0%	3	30.0%	0	0.0%
Total	11	55.0%	4	20.0%	5	25.0%
b1560 Hearing perception	0		1		2		3
Evaluation	3	30.0%	2	20.0%	4	40.0%	1	10.0%
Reevaluation	7	70.0%	3	30.0%	0	0.0%	0	0.0%
Total	10	50.0%	5	25.0%	4	20.0%	1	5.0%
b1561 Visual perception	0		1
Evaluation	5	50.0%	5	50.0%
Reevaluation	10	100.0%	0	0.0%
Total	15	75.0%	5	25.0%
b1670 Language recognition	0		1
Evaluation	8	80.0%	2	20.0%
Reevaluation	10	100.0%	0	0.0%
Total	18	90.0%	2	10.0%
b1671 Language expression	0		1		2		3		4
Evaluation	0	0.0%	1	10.0%	5	50.0%	1	10.0%	3	30.0%
Reevaluation	2	20.0%	7	70.0%	1	10.0%	0	0.0%	0	0.0%
Total	2	10.0%	8	40.0%	6	30.0%	1	5.0%	3	15.0%
b310 Voice function	0		1		2
Evaluation	9	90.0%	0	0.0%	1	10.0%
Reevaluation	9	90.0%	1	10.0%	0	0.0%
Total	18	90.0%	1	5.0%	1	5.0%
b320 Articulation functions	0		1		2		3		4
Evaluation	0	0.0%	1	10.0%	3	30.0%	3	30.0%	3	30.0%
Reevaluation	2	20.0%	7	70.0%	1	10.0%	0	0.0%	0	0.0%
Total	2	10.0%	8	40.0%	4	20.0%	3	15.0%	3	15.0%
b330 Functions of speech fluency and rhythm	0		1
Evaluation	9	90.0%	1	10.0%
Reevaluation	10	100.0%	0	0.0%
Total	19	95.0%	1	5.0%
d132 Language acquisition	0		1		2
Evaluation	7	70.0%	2	20.0%	1	10.0%
Reevaluation	9	90.0%	1	10.0%	0	0.0%
Total	16	80.0%	3	15.0%	1	5.0%
d137 Concepts acquisition	0		1		2
Evaluation	3	30.0%	5	50.0%	2	20.0%
Reevaluation	8	80.0%	2	20.0%	0	0.0%
Total	11	55.0%	7	35.0%	2	10.0%
d160 Focusing the attention	0		1		2
Evaluation	3	30.0%	5	50.0%	2	20.0%
Reevaluation	8	80.0%	2	20.0%	0	0.0%
Total	11	55.0%	7	35.0%	2	10.0%
d166 Reading	0		2		3		9
Evaluation	1	10.0%	3	30.0%	1	10.0%	5	50.0%
Reevaluation	5	50.0%	0	0.0%	0	0.0%	5	50.0%
Total	6	30.0%	3	15.0%	1	5.0%	10	50.0%
d170 Writing	0		1		2		3		9
Evaluation	1	10.0%	1	10.0%	1	10.0%	2	20.0%	5	50.0%
Reevaluation	4	40.0%	1	10.0%	0	0.0%	0	0.0%	5	50.0%
Total	5	25.0%	2	10.0%	1	5.0%	2	10.0%	10	50.0%
d310 Communication-reception of oral messages	0		1
Evaluation	8	80.0%	2	20.0%
Reevaluation	10	100.0%	0	0.0%
Total	18	90.0%	2	10.0%
d325 Communication-reception of written messages	0		1		2		3		9
Evaluation	2	20.0%	1	10.0%	1	10.0%	1	10.0%	5	50.0%
Reevaluation	4	40.0%	1	10.0%	0	0.0%	0	0.0%	5	50.0%
Total	6	30.0%	2	10.0%	1	5.0%	1	5.0%	10	50.0%
d330 Speech	0		1		2		3		4
Evaluation	0	0.0%	2	22.2%	4	44.4%	2	22.2%	1	11.1%
Reevaluation	4	44.4%	4	44.4%	1	11.1%	0	0.0%	0	0.0%
Total	4	22.2%	6	33.3%	5	27.8%	2	11.1%	1	5.6%
d710 Basic interpersonal interactions	0		1		2
Evaluation	6	60.0%	1	10.0%	3	30.0%
Reevaluation	7	70.0%	3	30.0%	0	0.0%
Total	13	65.0%	4	20.0%	3	15.0%
d760 Family Relations	0		1		2
Evaluation	6	60.0%	1	10.0%	3	30.0%
Reevaluation	7	70.0%	3	30.0%	0	0.0%
Total	13	65.0%	4	20.0%	3	15.0%
d820 School Education	0		1		2
Evaluation	6	60.0%	2	20.0%	2	20.0%
Reevaluation	7	70.0%	2	20.0%	1	10.0%
Total	13	65.0%	4	20.0%	3	15.0%
d920 Recreation and Leisure	0		1		2
Evaluation	8	80.0%	1	10.0%	1	10.0%
Reevaluation	8	80.0%	2	20.0%	0	0.0%
Total	16	80.0%	3	15.0%	1	5.0%
e330 Persons in position of authority			1
Evaluation			10	100.0%
Reevaluation			10	100.0%
Total			20	100.0%
e410 Individual attitudes of the core family	0		1		2
Evaluation	0	0.0%	7	70.0%	3	30.0%
Reevaluation	1	10.0%	6	60.0%	3	30.0%
Total	1	5.0%	13	65.0%	6	30.0%
e415 Individual attitudes of the expanded family	0		1		2
Evaluation	3	30.0%	3	30.0%	4	40.0%
Reevaluation	4	40.0%	3	30.0%	3	30.0%
Total	7	35.0%	6	30.0%	7	35.0%
e420 Individual attitudes of friends	0		1		2
Evaluation	2	20.0%	6	60.0%	2	20.0%
Reevaluation	3	30.0%	6	60.0%	1	10.0%
Total	5	25.0%	12	60.0%	3	15.0%
e355 Health care professionals	0		1		2
Evaluation	0	0.0%	9	90.0%	1	10.0%
Reevaluation	1	10.0%	9	90.0%	0	0.0%
Total	1	5.0%	18	90.0%	1	5.0%

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[1] Conflict of interests: nothing to declare.