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Conceptual Foundations for Health Measurements

This article explores the conceptual foundations for health measurements and WHO classifications, including the International Classification of Diseases (ICD) and the International Classification of Impairments, Disabilities, and Handicaps (ICIDH). It examines the etiological framework, diagnosis of health conditions, disease process, signs and symptoms, and how people live and function. It also discusses disability and handicap conceptions, issues in defining disability, and the ICIDH classification of health domains.

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Conceptual Foundations for Health Measurements

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  1. Conceptual Foundations for Health Measurements

  2. WHO Classifications • International Classification of Diseases (ICD) • Etiological framework • Diagnosis of health condition • Disease process, signs & symptoms • International Classification of Impairments, Disabilities & Handicaps (ICIDH) • How people live; body functions • Activities & participation

  3. Disability and Handicap

  4. Conceptions of Disability “a disability is any restriction or lack of ability (resulting from an impairment) to perform an activity in the manner or within the range considered normal for a human being” (WHO ICIDH, 1980.)

  5. ICIDH - 1 Disability Handicap Impairment Body Society (N.b. dotted arrows indicate that one stage may, but need not, influence the next)

  6. ICIDH • Classification of health domains • Framework to study health and health-related outcomes • Covers non fatal outcomes

  7. Issues in the Definition • Defining disability in terms of activity limitations is neat, but what activities? • What level of limitation should be used? • Same expectations for everyone, or relative to age, sex, etc.? • Threshold: does not perform an activity, versus cannot perform it? Doesn’t but could??

  8. ICIDH - 2 • Appeared March, 2001 • Conceptual changes: • From consequences of disease (1980) to components of health (2000) • Uses more positive language (‘activity’ & ‘participation’ instead of ‘disability’ & ‘handicap’) • Broadens concept of disability • More on environmental factors in which the person lives

  9. ICIDH - 2 Health Condition (disorder / disease) Body Functions & structures Activities Participation PERSON Activities SOCIETY Participation BODY Structure & Function impairment limitation restriction

  10. Body Functions • Mental functions • Sensory • Voice & speech • CVD, hematological, etc. • Digestive, metabolic & endocrine • Genitourinary • Neuro-musculoskeletal • Skin

  11. Learning Communication Movement Self-care Domestic activities Interpersonal Major life activities Community Exchanging information Communicating Mobility Personal maintenance Home life Social relationships Work & employment Social & civic life Activities & Participation

  12. Health-Related Quality of Life

  13. Quality of Life • Quality of life is subjective & value-specific • Invented in the USA; ¿not universal? • Definition will at least vary across cultures (naïve enthusiasm for QoL) • Handicap reflects impairment + environment, so measures may perform differently in different environments

  14. Quality of life is… Having the important people in your life see your strengths and talents A good night’s sleep Validation of worth and affirmation of experience Having control of your own life Taking control of your condition Life free from stigma Having a ‘real’ job Having a purpose Being free to come and go Quality of Life (from a consumer’s perspective) Carne, B. A consumer perspective. Can J Community Mental Health 1998, Suppl 3: 21.

  15. The Deceptive Simplicity of HRQOL… Health-Related Quality of Life Or Quantity? (How would we we measure quality?) Definition? What model? (Caused by Associated with? or ?) Of life or Living?

  16. Mapping Physical Measures onto Quality of Life Clinical / Physical Markers Disease-Specific Dysfunction Health-Related Quality of Life Overall Quality of Life Source: SH Kaplan et al. Medical Care, 2000

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