Applying Outcomes Research to Disability and Health
The ICIDH-2: Developments for a new era of outcomes research,☆☆,,★★

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Abstract

Gray DB, Hendershot GE. The ICIDH-2: developments for a new era of outcomes research. Arch Phys Med Rehabil 2000;81 Suppl 2:S10-S14. This article reviews the important concepts that led to the development of the International Classification of Impairments, Disabilities, and Handicaps (ICIDH), explicates the International Classification of Functioning and Disability (ICIDH-2), and discusses implications of the ICIDH-2 as a conceptual framework for outcome measures. The original ICIDH opened the door to include factors outside the traditional classification boundaries of disease, illness, and functional limitations that have framed the concept of disability. The new factors in the ICIDH-2 include a dimension for participation in social activities and a listing of environmental factors that are important for understanding the complexity of disability. The ICIDH-2 offers an opportunity for building a consensus on the terms used to describe disability and on the scope of factors to include in studying disability. © 2000 by the American Congress of Rehabilitation Medicine

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Background

The ICIDH is among the “family of classifications” developed, maintained, and disseminated by the World Health Organization (WHO).1 Another member of this family is the much older and more widely used International Classification of Diseases (ICD). It was first published in 1893 and is now in its 10th revision; the ICIDH was first published in 1980 and is now undergoing its first revision. In evaluating the progress of the ICIDH to date, it is well to keep in mind the long and difficult history

Purposes, organization, and activities of the revision process

The general revision of the ICIDH was undertaken by WHO collaborating centers for health classifications. Collaborating centers are organizations in WHO member nations that have entered into an agreement (“terms of reference”) with a WHO office to collaborate on specified activities. Collaborating centers usually are responsible for WHO activities in geographic areas defined by national boundaries and language. Thus, the WHO Collaborating Center for the Classification of Diseases in North

Discussion

The ICIDH-2 addresses several inadequacies of the original ICIDH by introducing the dimensions of Activity, Participation, and Contextual Factors. These dimensions provide a classification system that reaches beyond traditional body-centered descriptors of disability to include factors that social and empowerment models of disability advocate as being important to understanding disability.11, 12, 13 In addition to changes in the ICIDH-2 dimensions, new approaches to coding are being considered.

Conclusion

The original ICIDH broadened the concept of disability by including factors outside the traditional classification boundaries of disease, illness, and functional limitations. The ICIDH-2 is responsive to the evolution of disability models that now include environmental factors as important contributors to understanding the complexity of sources for disability. This inclusiveness offers an opportunity for a consensus on the terms used to describe disability and on the scope of factors to include

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Supported by the Office on Disability and Health at the Centers for Disease Control and Prevention (grant no. R04/CCR714134).

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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

Address correspondence to David B. Gray, PhD, Prog in Occupational Therapy, Washington University School of Medicine, 4444 Forest Park Ave, St. Louis, MO 63108; e-mail: [email protected].

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Reprints will not be available from the authors.

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