Olle Höök Lectureship 2015: The World Health Organization’s paradigm shift and implementation of the International Classification of Functioning, Disability and Health in rehabilitation

Abstract

The World Health Organization's (WHO) paradigm shift, implied by the launch of the International Classification of Functioning, Disability and Health (ICF), is inextricably entwined with the emergence of rehabilitation as a key health strategy of the 21 st century. To enable health systems to scale up rehabilitation we must spearhead the implementation of the ICF in rehabilitation towards its system-wide implementation in the healthcare system at large. In this essay, based on the Olle Höök lecture 2015 1 , it is argued that the launch of the ICF in 2001 represents a paradigm shift, as it has enabled the WHO to more comprehensively act on its mandate and has guided WHO policies to shape the health system in response to population functioning needs. It is shown that this paradigm shift has important implications for rehabilitation, including its conceptualization and scientific methods. A prerequisite for the system-wide implementation of the ICF in clinical practice, policy, and research, is the availability of practical tools that allow for the universal and standardized description of functioning. Finally, some reflections are presented on how we may foster the systemwide implementation of the ICF by applying approaches from the implementation sciences.

Being a person with disabilities or experiencing disability: Two perspectives on the social response to disability

“…Since no one could claim to possess a complete repertoire of capacities, suitable for all permutations of the physical and social environment, both epidemiologically and clinically people exhibit a spectrum of abilities, changeable over time. As Zola himself later stated, "having a disability was not a fixed status, but rather a continually changing, evolving and interactive process'' (37).…”

Rehabilitation: The health strategy of the 21st century

“…Only relatively recently have rehabilitation professionals themselves taken on the conceptual task of clarifying their rationale and role as providing a distinct, and equally important, health strategy (23). In no small part this conceptual task been made possible by the WHO's ICF, which has provided: (i) the framework for the most appropriate conceptual model of rehabilitation as a health strategy (43)(44)50); (ii) the conceptualization, development and organization of functioning and rehabilitation research (22); (iii) the classification of rehabilitation services (51, 52); and (iv) the basis for an information reference system for collecting functioning information relevant, not merely to rehabilitation service delivery and assessment, but across the healthcare system (53).…”

Recommended outcome measures for inpatient rehabilitation of multiple sclerosis are not appropriate for the patients with substantially impaired mobility

“…Generally, a comprehensive core set of OMs should include feasible, acceptable, valid, and responsive OMs. They should also cover all the relevant International Classification of Functioning, Disability and Health (ICF) domains (Stucki, 2016), namely activity and participation (Khan et al, 2007).…”