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What You Need to Know About the New ICF Model for Low Back Pain Patients

There's a new kid on the block in research and health care delivery systems. Birthed by the World Health Organization (WHO), it's called the International Classification of Functioning, Disability, and Health or ICF. This article is designed to help health care providers understand what the ICF is and how it applied to patients with low back pain.

First, the ICF is a classification scheme with many categories used as a tool to describe the severity and course of a physical condition or disease that affects a person's function and ability. It's a model that can be adopted and used by health care workers around the world. Having a common tool of this type will make it possible to conduct and report on research in the same way worldwide.

Second, in the new classification scheme, the focus has shifted from assessing, measuring, and talking about impairments, disabilities, and handicaps to now focus on body functions and structures and activities and participation. Two other components within the ICF classifications include environmental and personal factors.

Each of these five components also have subsets or qualifiers to help define the level of functioning and health for the problem being described or evaluated. A scale from zero (no problem) to four (complete problem) is used to then quantify (put a number or percentage for) the subset.

Shifting to this new classification scheme will give everyone a common language to discuss health and ability (not disability) for patients with chronic and complex problems. Setting goals, planning treatment, and evaluating results will be framed in a positive light now. Communication within the health care team and with the patient will be improved by the use of language everyone can understand. Insurance companies will use it to manage cases and propose health care plans.

Now, within that framework, the authors of this article describe and discuss a subset of categories called the ICF Core Sets for Low Back Pain (LBP). This is one of 15 Core Sets for chronic problems such as stroke, multiple sclerosis, obesity, and diabetes mellitus.

The Core Sets for low back pain actually contain 78 ICF categories. They range from mobility and self care to sleep, energy and drive, and mental function. Other examples of categories include muscle tone and power, ability to maintain or change position, dressing, toileting, and mobility skills such as crawling, walking, or running. Once these categories have been assessed for a patient, there is a very comprehensive picture of the problems that person is having with function, health, and life situations.

Even though there are multiple ICF categories, the beauty of the model is that it allows for one instrument that can be used around the world. Results of research and clinical study can be combined and compared for better statistical significance. In this way, research results can be unified. The ICF provides a standard now for describing function in patients with chronic low back pain. That may not sound like much, but it's the first time any such standard has become available.

The ICF Core Sets provide the basis for what should be assessed as a measure of outcome. It tells us how to measure what we measure. And we don't have to throw out popular instruments already in use for assessing low back pain. Tools such as the commonly used North American Spine Society Lumbar Spine Outcome Assessment Instrument, Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire can be linked to the ICF.

Physicians treating patients with chronic low back pain can use the ICF Core Sets right from the start. At the first appointment, the patient's history, symptoms, and clinical presentation can all be documented in the medical record using the ICF Core Sets. Documentation can be done quickly and easily with a checklist on paper or electronically.

The data can be used to set goals, manage rehab, and assess the effectiveness of treatment. These elements are referred to as the Rehab-Cycle. The Core Set has a place to record how the patient feels about his or her situation. There's a separate section for the health professional to document all findings, including lab studies and X-rays or other more advanced imaging. In this way, a systematic approach makes it possible to identify and record all potential problems to be considered.

In order to better understand this new system, the authors present a case study of one patient (Mr. Smith) for whom the ICF Core Sets was used. In this way, they were able to show the reader how the new terminology is used in the evaluation and implementation of treatment. They also walk the reader through one Rehab-Cycle for Mr. Smith, including the development of a modified treatment plan and new goals.


Marita Stier-Jarmer, PhD, et al. How to Apply the ICF and ICF Core Sets for Low Back Pain. In The Clinical Journal of Pain. January 2009. Vol. 25. No. 1. Pp. 29-38.

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*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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