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Consequences of disease: testing the WHO International Classification of Impairments, Disabilities and Handicaps
1University of St. Andrews, School of Psychology, Fife, UK. mj1@st-and.ac.uk
Insights
The International Classification of Impairments, Disabilities and Handicaps (ICIDH) model
Area of Science:
- Rehabilitation Medicine
- Health Services Research
- Disability Studies
Background:
- The International Classification of Impairments, Disabilities and Handicaps (ICIDH) model posits a sequential relationship between disease consequences: impairment (I), disability (D), and handicap (H).
- Understanding these relationships is crucial for effective rehabilitation and disability management.
Purpose of the Study:
- To investigate the independent measurability of impairment, disability, and handicap.
- To assess the validity of the sequential or causal relationship between impairment, disability, and handicap as proposed by the ICIDH model.
Main Methods:
- Utilized cross-sectional data from 101 disabled adults and longitudinal data from 108 myocardial infarction (MI) and 68 Stroke patients.
- Employed standard impairment measures, the Sickness Impact Profile (SIP) for disability and handicap, and judges' classifications based on ICIDH definitions.
- Applied correlation, Confirmatory Factor Analyses, and Path Analyses to test the hypotheses.
Main Results:
- Valid measures for disability and handicap were developed, with evidence of construct separation for Stroke patients but not other groups.
- Impairment was not found to be predictive of disability or handicap in either Stroke or MI patients.
- For Stroke patients, disability significantly predicted handicap, supporting a portion of the ICIDH model, but no relationship was found between impairment and disability or handicap.
Conclusions:
- The study partially supports the ICIDH model, specifically the progression from disability to handicap in Stroke patients.
- Challenges in independently measuring impairment, disability, and handicap were identified, suggesting potential limitations in the ICIDH model's testability.
- Further research is needed to refine measures and validate the ICIDH model across diverse clinical populations.
Abstract:
The International Classification of Impairments, Disabilities and Handicaps (ICIDH) model proposes that there are three consequences of disease, impairment (I), disability (D) and handicap (H) and that they are sequentially related. This paper examines first, whether I, D and H can be measured independently and second, whether there is support for the sequential or causal relationship between the three constructs. Cross-sectional data from a representative sample of 101 disabled adults and longitudinal data from 108 myocardial infarction (MI) and 68 Stroke patients were used. Standard measures of I were used for each clinical condition. Measures of D and H were derived from the British version of the Sickness Impact Profile (SIP) and additional measures of D were available for the Stroke group. Judges classified SIP items according to ICIDH definitions of D and H. Correlation, Confirmatory Factor Analyses and Path Analyses were used to examine the main hypotheses. Valid measures of D and H were derived and there was evidence of separation of the three constructs for the Stroke patients but not for the other groups. For both Stroke and MI, I was not predictive of D and H. For Stroke, the best path model included a path from D to H, but not from H to D and this was found for self-report and performance measures of D. Using these measures, the ICIDH model was supported in that D predicted H for stroke, but there was no support for a path between I and D or between I and H. Further it was not always possible to distinguish the three constructs. Possible limitations in the measures and in the ICIDH model as a testable scientific model are discussed.
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