Exploring Use of the International Classification of Functioning,Disability and Health in Pediatric Occupational Therapy

PURPOSE: The World Health Organization (2002) developed the International Classification of Functioning, Disability and Health (ICF) to reconceptualize disability and to facilitate interdisciplinary collaboration. Although the ICF is a powerful framework for structuring health care processes, little is known about ICF use by pediatric occupational therapists. Therefore, this study measured ICF use in pediatric occupational therapy in the United States and determined the linkage of the ICF to currently used frames of reference (FORs) and intervention foci. This study aimed to answer the following research questions: What is the extent of ICF use among pediatric occupational therapists in the United States? What FORs and intervention foci are currently used in pediatric occupational therapy practice in the United States? What ICF components are reflected in the FORs and intervention foci used in pediatric occupational therapy?

METHOD: This study, Part 2 of an ICF study, used a cross-sectional descriptive survey design. Participants were recruited via social media and professional and personal contacts. Participants were pediatric occupational therapists in the United States working with children at least 50% of their workday. Data were collected using a 25-question online survey. Questions examined participant demographics, knowledge and use of the ICF in pediatric practice, choice of assessment tools and outcome measures, choice of FORs and intervention foci, and ICF use in decision making related to FORs and intervention foci. Researchers analyzed data using a linking process developed by Cieza et al. (2016) to extract concepts of the FORs and intervention foci used in practice and to link the concepts to specific ICF categories. To ensure rigor, the first and second authors independently performed the linking then convened for consensus. Frequency distribution, central tendencies, and percentages were used to analyze demographic, FOR, and ICF use data.

RESULTS: Of the 113 occupational therapists who accessed the survey, 78 completed it. Among the 45 respondents who identified the FORs they used, 37 (82%) reported most regularly using the developmental FOR. Improving a child’s self-regulation was the most frequently and regularly used intervention focus (n = 47). Of the 48 respondents to the ICF use question, 39 (81%) were not using the ICF in their decision making related to FOR and intervention focus choice. The linking process revealed that three of the four FORs and 10 of the 14 frequently and regularly used intervention foci were linked to the ICF body function component.

CONCLUSION: A considerable number of surveyed pediatric occupational therapists reported not using the ICF in their clinical decision making. The majority of the FORs and intervention foci participants reported using were not occupation focused. The result of the linking process in the study demonstrated how pediatric occupational therapists could use the ICF language and framework in articulating clinical decisions related to frames of reference and intervention foci.

IMPACT STATEMENT: Considering the profession’s distinct occupation-centered philosophy, pediatric occupational therapists may reflect on the leanings of their practice using the ICF to examine the extent to which interventions relate to ICF body functions and structures and activities and participation.

References

Cieza, A., Fayed, N., Bickenbach, J., & Prodinger, B. (2016). Refinements of the ICF linking rules to strengthen their potential for establishing comparability of health information. Disability and Rehabilitation. Advance online publication. https://doi.org/10.3109/09638288.2016.1145258

World Health Organization. (2002). Towards a common language for functioning, disability and health: ICF. Geneva: Author. Retrieved from http://www.who.int/classifications/icf/icfbeginnersguide.pdf