Conceptual Description of Prevention within the International Classification of Functioning, Disability and Health (ICF) - A first Proposal
Background:
The increasing prevalence of disability (
WHO, World Bank, 2011) have led to thinking about concepts and strategies for the prevention of disabilities. Consequently, the German Federal Government included the main providers of rehabilitation into the new law on prevention (BMG, 2015), which refers to the classical model of prevention with the categories of primary, secondary and tertiary prevention. However, it seems that it is not compatible with the model of the International Classification of Functioning, Disability and Health (
ICF) of the
WHO (2001).
The traditional description or definitions of prevention are exclusively disease oriented whereas the
ICF provides a comprehensive model of functioning and health including multiple interactions between health conditions, body functions and structures, activities and participation and taking into account contextual (personal and environmental) factors. As rehabilitation aims at improving functioning, preventive measures, within this context a new concept of prevention on the basis of the
ICF model seems to be of major relevance and importance.
Purpose:
To develop a Conceptual Description of Prevention within the
ICFMethods:
Based on the Conceptual Description of Rehabilitation as a Health Strategy (Meyer
et al., 2011) a "Conceptual Description of Prevention in Rehabilitation" was developed. Its characteristics should be compatible with the
ICF and facilitate the design of prevention measures aiming at the reduction of prevalence of disabilities in light of health conditions.
Results:
The first proposal reads as follows: "Prevention in rehabilitation is the strategy within rehabilitation which based on WHO´s integrative model of functioning, disability and health applies and integrates
- approaches to assess risks of the development impairments in light of health conditions
- approaches to optimize a person’s capacity - approaches that build on and strengthen the resources of the person
- approaches that provide a facilitative environment - approaches that develop a person´s performance
- approaches that stabilize a person’s quality of life in light of health conditions along and across the continuum of care,
- including hospitals, rehabilitation facilities and the community; and across sectors
- including health, education, labor and social affairs with the goal
- to empower persons with health conditions at risk of developing disability to maintain optimal functioning in interaction with the environment".
Discussion:
The draft of a Conceptual Description of Prevention in Rehabilitation shows that rehabilitation and prevention of disability conceptually are very close. Both aim at optimal functioning. However, prevention in rehabilitation must begin not only as disability already has occurred, but also it must start already if a risk of disability development is occurring. Clinical allocation of this concepts should be developed e. g. in the early management of joint replacement surgery (including presurgery interventions, strategies to prevent pain chronification, and work-oriented rehabilitation measures for patients with less severe limitations of work ability).
