Elizabeth M. Badley

The ICIDH: Format, application in different settings, and distinction between disability and handicap: A critique of papers on the application of the International Classification of Impairments, Disabilities, and Handicaps

Recent papers on the ICIDH generally agree about the need for and the usefulness of the ICIDH, although inevitably some difficulties are reported in applying it. Some of these stem from the context and professional purpose of the assessments (on the whole the rehabilitation setting was found to be less problematic than community surveys), and others from the application to particular sub-groups, such as children, the elderly, the mentally ill, or those with milder or fluctuating disability. Most problems concerned the nature of the relationship between disability and handicap and the distinction between these concepts. This review suggests an alternative formulation of the disablement model which shows handicap as arising out of an interaction between impairment and disability and the environment in which the individual lives, the resources available, and the social and cultural setting. While on the whole optimistic, the papers reviewed indicate that there is still more work required both on a practical and conceptual level.

Impairment, disability, and the ICIDH model I: The relationship between impairment and disability

The conceptual scheme put forward in the International Classification of Impairments, Disabilities, and Handicaps suggests that impairment should be related to disability. This paper examines the proposition that disability should be related to impairment in terms of parts of the body involved, both in the physical requirements to carry out a given activity and as regards the site and types of functional limitation, by secondary analysis of data collected in a survey of disabled people in Great Britain. Factor analysis of data on functional limitations showed that these impairments could be considered in four groups representing manual dexterity, movements of the arm, strength, and lower limb function. These were found to be correlated with ability in self-care activities depending on the part of the body involved in the activity.

The assessment of physical independence handicap: experience in a community disablement survey

Two approaches to the ascertainment of physical independence handicap have been explored using data from a survey of disablement in the population. The survey used a two-stage methodology with an initial postal shift to ascertain those with selected disabilities, a stratified random sample of whom were followed-up with an in-depth interview. The first approach to handicap was direct ascertainment of the scale categories by means of a question in the interview schedule. The second approach was to synthesize the scale categories from the answers to interview questions about disabilities in activities of daily living and other relevant factors. The final synthesized algorithm gave a 75% match within one scale point with the direct question and 85% agreement with receipt of attendance allowance, a state benefit paid to those meeting certain criteria for dependence on others. The lessons learned from the work have been incorporated in a revised and expanded scale, which is suggested as a starting point for revision of physical independence dimension of handicap.

Impairment, disability, and the ICIDH model II: The nature of the underlying condition and patterns of impairment

This paper presents a further exploration of the conceptual scheme proposed in the International Classification of Impairments, Disabilities, and Handicaps which links underlying condition, impairment and disability. It examines the proposal that three general patterns of impairment profile might be expected depending on whether the underlying condition affects control (as in stroke or multiple sclerosis), mechanical performance (as in arthritis) or energy (as in cardiorespiratory conditions). Examination of patterns of functional limitation shows more resemblance between conditions in each of these groups than between the groups lending support to the proposal.

The relationship between impairment and disability in arthritis: an application of the theory of generalized linear models to the ICIDH

We investigated the relationship between impairment, as represented by limitation in range of movement and pain in the knee joint, and disability as measured by a series of activities of daily living in 123 patients with either rheumatoid arthritis or osteoarthrosis. A log-linear modelling technique found there was a positive association between functional limitation, as measured by reduction in angle of flexion, and disability. However, there was only a marginal relationship between pain in the knee joint and disability, and no association between pain and range of movement, which suggests that conventional beliefs that pain is a key factor in assessing health outcomes may need to be reassessed.

A survey of disablement in a British population using an action-orientated measure, physical independence handicap: Problems with activities of daily living and level of support

A population survey with the aim of obtaining information to facilitate the planning of services for younger physically disabled people provided the opportunity to explore the use of physical independence handicap in this context. A Phase 1 sift questionnaire was sent to one in three (25,167) occupied households in Calderdale, a district in Yorkshire, England, with a final 87% response rate. A Phase 2 in-depth interview was carried out on a stratified random sample of those identified as disabled in Phase 1. Interviews were obtained with 570 individuals aged 16-64 years, 93% of those available. The measure of physical independence handicap was derived from data obtained in the interview indicating need for help at infrequent or short intervals and immediate-needs dependence. The estimated prevalence of dependent people aged 16-64 in Calderdale is 26.6 per 1000 population (95% CI: 24.9-28.3). Rates were higher in females, and both prevalence and level of dependence increased with age. Disability in activities of daily living and locomotion was linked to the level of physical independence handicap. Problems with housework and collecting (including shopping) were most frequent for those who needed help on an infrequent basis, while self-care needs were substantial for the short and immediate-needs dependence groups. Only a small proportion reported receiving services in their home during the previous 12 months; 20% received services from a nurse and 10% the services of a local authority home help. Overall, 91% reported contact with the primary health care team within the previous 12 months and 68% with hospital and rehabilitation services.(ABSTRACT TRUNCATED AT 250 WORDS)