Rehabilitation Process and Outcome

Current criticisms of the International Classification of Function, Disability and Health (ICF) are focused on its activity/participation component and on its conceptual basis. I propose structural and conceptual changes. (1) The components would be body structure, body function, intent, actual environment, and participation. (2) Intent would be linked to the concept of self-agency, and its codes would have two qualifiers associating it with capability and strength of willed activity. (3) All activity/participation codes of the original ICF would be moved to the modified ICF’s participation component. This component is based on interaction between intent and environment, and it is linked to the concept of joint agency. (4) A new entity, scene setting, represents the sum total of all components’ codes involved in a given act of participation. (5) Additional constructs are suggested to elucidate the relations between intent and environment that allow enactment of a given act of participation. The modified ICF is consistent with current concepts of disability and unambiguous in distinctions between body function, activity, and participation. There are no significant alterations in the original ICF codes.