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Disabil Rehabil. 2013 Jun;35(12):1015-25. doi: 10.3109/09638288.2012.717582. Epub 2012 Oct 17.

Enhancing the conceptual clarity and utility of the international classification of functioning, disability & health: the potential of a new graphic representation.

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The University of Western Ontario, London, ON, Canada.



To present a new graphic representation of the international classification of functioning, disability and health (ICF), entitled the ICF-conceptual revision (ICF-CR). The ICF-CR aims to be clearer and more usable tool than the ICF graphic currently used by starting to address criticisms of the ICF raised in the literature, with a focus on positioning quality of life (QoL) in relation to the ICF's other components.


This is a conceptual paper based on a review of criticisms of the ICF and related literature published on human functioning.


In addition to criticisms of the current graphic, four criticisms of the ICF are discussed in relation to the development of the ICF-CR, including: the lack of development of biopsychosocial theory, the lack of clarity between activities and participation, the language used, and the absence of QoL. General systems theory is used to help construct the new graphic in addressing these criticisms and to position QoL.


The ICF-CR is designed to be a more responsive graphic of human functioning; one which enhances the clarity of principles integral to the ICF, including biopsychosocial theory and universalism. It is hoped the ICF-CR will promote continued discussion toward the goal of enhancing the ICF, both visually and conceptually.

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