Authors:

Gerold Stucki, MD, MS

Affiliations:
From the Department of Physical
Medicine and Rehabilitation and the
ICF Research Branch of the WHO CC
FIC (DIMDI), Institute for Health and 2005 DELISA LECTURESHIP
Rehabilitation Sciences, Ludwig-
Maximilians-University, Munich,
Germany.

Correspondence: International Classification of

All correspondence and requests for
reprints should be addressed to
Functioning, Disability, and Health
Gerold Stucki, MD, MS, Department
of Physical Medicine and
(ICF)
Rehabilitation, University Hospital A Promising Framework and Classification for
Munich, Marchioninistr. 15, 81377
Munich, Germany. Rehabilitation Medicine

Disclosures:
Presented as the “Joel A. DeLisa, MD, ABSTRACT
MS, Lectureship” at the 2005 Annual
Meeting of the Association of Stucki G: International Classification of Functioning, Disability, and Health (ICF):
Academic Physiatrists, Plenary A promising framework and classification for rehabilitation medicine. Am J Phys
Session, February 24, 2005, Tucson, Med Rehabil 2005;84:733–740.
Arizona.
Key Words: Disability, Classification, International Classification of Functioning, Dis-
0894-9115/05/8410-0733/0 ability, and Health, World Health Organization
American Journal of Physical
Medicine & Rehabilitation
Copyright © 2005 by Lippincott
Williams & Wilkins

DOI: 10.1097/01.phm.0000179521.70639.83
T he development and endorsement of the International Classification of
Functioning, Disability, and Health (ICF) by the 54th World Health Assembly in
May 2001 and the resolution on “disability, including prevention, management
and rehabilitation” (www.who.int) by the 58th World Health Assembly in May
2005 mirrors an important shift in the priorities by the World Health Organi-
zation (WHO). Although WHO has traditionally focused on infection control and
mortality reduction, WHO now increasingly recognizes the importance of re-
ducing the burden associated with health conditions throughout the world. The
importance of reducing the burden associated with health conditions is also
mirrored by WHO’s burden of disease reports such as the WHO technical report
on the “burden of musculoskeletal conditions at the start of the new millen-
nium” in the context of the Bone and Joint Decade.1
The new priority of WHO on reducing the burden associated with health
conditions is in line with the mission of rehabilitation medicine, which is
committed to reduce the burden or consequences associated with health con-
ditions by enabling people who experience or who are at risk of disability in their
immediate environment to achieve and maintain optimal functioning.
For WHO, the ICF complements indicators that have traditionally focused
on deaths and diseases.2 Although mortality or diagnostic data on morbidity and
diseases are important in their own right, they do not adequately capture health
outcomes of individuals and populations (e.g., diagnosis alone does not explain
what patients can do, what their prognosis is, what they need, and at what
treatment costs).2 The aim of the ICF is to provide a unified and standardized
language for describing and classifying health domains and health-related states
and hence to provide a common framework for health outcome measurement.
The ICF is a powerful framework and classification to strengthen the

October 2005 International Classification of Functioning 733

 rehabilitation perspective in medicine, medical and
multisectorial research, and service provision and
health, educational, social, and labor policy.
The objective of my lecture is to discuss the
ICF as a unifying framework and classification for
physical medicine and rehabilitation (PM&R). After
briefly introducing the ICF I will explore the ac-
ceptance and applicability of the ICF for medicine
and specifically rehabilitation medicine and intro-
duce practical tools and linkage methods. I will
then demonstrate the usefulness of the ICF as
unifying framework for the definition and concep-
tualization of our professional discipline. Finally I
will point out, how the ICF can importantly con-
tribute to research planning and reporting and to
rehabilitation practice.
ICF
The ICF is WHO’s framework for measuring
health and disability at both individual and popu-
lation levels. Whereas the International Classifica-
tion of Disease (ICD) classifies diseases as causes of
death, the ICF classifies health by accounting for
functioning.
As shown in Figure 1, the ICF consists of three
key components. In short, the first component,
body functions and structures, refers to physiologic
functions and anatomic parts, respectively; loss or
deviations from normal body functions and struc-
tures are referred to as impairments. The second
component, activity, refers to task execution by the
individual; “activity limitations” are difficulties the
individual may have in executing activities (“Are
you limited in using your telephone,”28 for exam-
ple, “when calling friends?”).28 The third compo-
nent, participation, refers to involvement in life
situations. “Participation restrictions” are prob-
lems the individual may experience with such in-
volvement (“Are you restricted in talking to your
friends?”). These three components are summa-
rized under the umbrella terms functioning and
disability. They are related to and may interact with
the health condition (e.g., disorder or disease) and
personal and environmental factors.
The concept of functioning is different from
the concept of quality of life. For this discussion,
quality of life refers to global or highly personalized
evaluations of functioning referring to satisfaction
or feelings (“How do you feel about your ability to
use your telephone?” “How satisfied are you talking
to your friends?”).
ACCEPTANCE AND APPLICABILITY OF
THE ICF FOR MEDICINE
There are a number of reasons why the ICF is
likely to gain acceptance world wide in medicine
and specifically rehabilitation medicine. They in-
clude the fact that the ICF was endorsed in May
734 Stucki
2001 by the World Health Assembly as a member of
the WHO Family of International Classifications.
This is different from its predecessor classification,
the International Classification of Impairment,
Disability, and Handicap (ICIDH),3 which has never
been approved by the World Health Assembly. In
contrast, the member states are now asked to im-
plement the ICF.
Indeed, many countries are now implementing
the ICF in different sectors, including health, social
affairs, labor, and education. Specific areas of ap-
plication include health statistics or disability eval-
uation and disability policy. Accordingly, the accep-
tance of the ICF will not only rely on medicine and
the health sector but on initiatives and the success-
ful implementation by these other sectors. With
respect to the health sector and, more specifically,
rehabilitation, it is important to recognize that the
ICF is relevant not only to PM&R, but also to a
large number of allied professional groups, includ-
ing physiotherapy, occupational therapy, psychol-
ogy, and social work. For example, in physiother-
apy and occupational therapy, many curricula are
now already based on or have integrated the ICF.
For the global acceptance of the ICF, it is also
important that the ICF has been developed in a
worldwide, comprehensive consensus process over
the last few years. Because of this approach, it does
not only address Western concepts but has world-
wide cultural applicability.
Its acceptance is further facilitated by the fact
that it addressed many of the criticisms of previous
conceptual frameworks4 and integrates principles
established in the context of the development of
the Nagi model of 1965 and 19765,6 and the Insti-
tute of Medicine model of 1991.7,8 The ICF at-
tempts to achieve a synthesis, thereby providing a
coherent view of different perspectives of health.9
The ICF follows the principle of a universal as
opposed to a minority model, and hence, it is
integrative and not merely medical or social. Ac-
cordingly, it also covers the whole lifespan and is
not only adult driven. Similarly it addresses human
functioning and not merely disability. As a truly
universal model, it is also inclusive and addresses
contextual aspects of the environment and the per-
son. It is interactive and not linearly progressive,
and it is etiologically neutral. The health condition
is seen in relation with functioning and not as the
unidirectional cause.
The bio-psycho-social and etiologically neutral
approach of the ICF parallels the perspective of
rehabilitation medicine and of many measures de-
veloped in PM&R.4 From the rehabilitation per-
spective, patients’ functioning and health are seen
as associated with, and not merely as a conse-
quence of, a condition or disease. Functioning and
health are also viewed in association with personal
Am. J. Phys. Med. Rehabil. ● Vol. 84, No. 10

FIGURE 1 Framework of International Classifica-
tion of Functioning, Disability, and
Health by the World Health Organization
in 2001.
and environmental factors. This is different from
the medical perspective in which functioning and
health are seen primarily as the unidirectional out-
come or consequence of a disease or condition.
Accordingly, most condition-specific measures and
even generic measures such as the Short Form-36
are based on a medical outcomes model that is not
etiologically neutral but sees functioning and its
components solely as a consequence of the condi-
tion. Therefore, these models do not address par-
ticipation as varying in relation to environmental
factors and generally do not address environmental
factors at all.10
With respect to the ICF classification, initial
scepticism regarding comprehensiveness has van-
ished. The ICF Core Set development can be seen
as “proof of concept.” To the surprise of many
clinicians and scientists involved, the ICF has been
shown to be a highly comprehensive classification
covering virtually all aspects of the patient experi-
ence.11 In the context of the ICF Core Set develop-
ment,11–13 it becomes clear that the ICF covers the
spectrum of problems encountered in people with a
wide number of chronic12 and acute13 health con-
ditions. Ongoing validation studies have shown
that the ICF covers target interventions and the
agreed on goals by the different health profession-
als involved in rehabilitation. The ultimate proof
awaits ongoing worldwide testing and validation
studies of the currently developed ICF Core Sets.
The main challenge to the acceptance of the
ICF is the size of the classification system, with
⬎1400 categories. Dr. Üstün from WHO has
pointed out that “a clinician cannot easily take the
main volume of the ICF and consistently apply it to
his or her patients. In daily practice, clinicians will
only need a fraction of the categories found in the
ICF.”2 It is important to recall that the ICF is a
reference classification and is not intended to be a
practical tool. Therefore, “to be useful, practical
ICF-based tools need to be tailored to the need of
the prospective users without forgoing the infor-
October 2005
mation needed for health statistics and health re-
porting.”2
PRACTICAL TOOLS FOR THE
APPLICATION OF THE ICF IN MEDICINE
Currently, WHO has developed two generic
tools, the ICF Checklist14 and the self-administered
questionnaire WHO Disability Assessment Sched-
ule Version II (WHODAS II),15 covering the com-
ponents activity and participation. There are also a
number of national16,17 and international initia-
tives to operationalize ICF16,17 and to apply tools
such as the ICF Core Sets2,11,18 to chronic condi-
tions12 and to acute hospital and early postacute
rehabilitation care.13,19 Such applications may fa-
cilitate use of the ICF in other research, clinical
practice, and teaching settings.
WHODAS II
The WHODAS II is a generic health status
measure with two versions of 36 or 12 questions,
respectively, based on the ICF. It includes six do-
mains: understanding and communicating, getting
around, self care, getting along with others, house-
hold and work activities, and participation in soci-
ety (http://www.who.int/icidh/whodas/index.html).
It can be used in adults ⬎18 yrs of age. It has
been developed cross-culturally and is applicable
across the spectrum of cultural and educational
backgrounds. Interviewer and self-report forms
and proxy versions are available. The administra-
tion time for the 12-item version is approximately
5 mins and for the 36-item version is 20 mins.
ICF Checklist
The ICF Checklist is a 12-page, “short” version of
the ICF, with 125 second-level categories. All infor-
mation from written records, primary respondent,
other informants, and direct observation can be used
(http://www3.who.int/icf/checklist/icf-checklist.pdf).
It takes around 1 hr to complete but may take much
longer in patients with multiple impairments, activity
limitations, and participation restrictions.
ICF Core Sets
Although both tools have their applications,
the “generic character of the ICF Checklist and the
WHODAS does not address the needs of clinicians
and researchers concerned with people with spe-
cific conditions or in care after an acute episode.”2
The ICF Checklist is hardly practical for rehabili-
tation research or practice.4
Meeting this requirement has been a primary
motivation for WHO to develop ICF Core Sets in
collaboration with the Department of PM&R and
the newly established ICF Research Branch of the
WHO CC FIC (DIMDI) at the Ludwig Maximilian
International Classification of Functioning 735
 University Munich (http://www.ICF-Research-
Branch.org).2,11–13,18,19
Currently, ICF Core Sets have been developed
for 12 most burdensome chronic conditions2,11,12
and for acute hospitals and early postacute reha-
bilitation facilities.13,18,19 The process leading to
the current first versions involved a formal deci-
sion-making and consensus process integrating ev-
idence gathered from preliminary studies. The ICF
Core Sets are now being tested and validated inter-
nationally and from the patient20 and health pro-
fessional perspective using a number of ap-
proaches, including observational studies, focus
groups, Delphi methods, and explanatory analyses.
For each health condition, both a Brief ICF
Core Set and a Comprehensive ICF Core Set have
been established. The Brief ICF Core Set is in-
tended to be rated in all patients included in a
clinical study or epidemiologic study. The Brief ICF
Core Set for a specific condition includes as few
categories as possible to be practical but as many as
necessary to be sufficiently comprehensive to de-
scribe in clinical studies and possibly clinical en-
counters the typical spectrum of problems in func-
tioning of patients with a specific condition.
Because it is intended that the categories of the
Brief ICF Core Set for a condition serve as a min-
imum data set that will be reported in every clinical
study to describe the burden of disease in a com-
parable way across studies, the list needs to be as
short as possible.
The Comprehensive ICF Core Set is intended
to guide multidisciplinary assessments in pa-
tients with that condition. It is a list of ICF
categories that includes as few categories as pos-
sible to be practical, but as many as necessary to
be sufficiently comprehensive to describe in a
comprehensive, multidisciplinary assessment
the typical spectrum of problems in functioning
of patients with a specific condition. Obviously,
this list will be considerably longer than the
Brief ICF Core Set.
LINKAGE OF MEASUREMENT
INSTRUMENTS TO THE ICF
ICF Core Sets define what to measure and not
how to measure. There are many options and con-
stantly new emerging measures that can serve as
indicators to specifically measure ICF categories.
Options include ICF Core Set– based recordings
using the ICF qualifiers of functional limitations
(e.g., no, some, full limitation) applied based on the
history, clinical examination, and functional obser-
vations, drawing on appropriate clinical test batter-
ies, standardized self-report patient questionnaires,
and measures of functional independence, occupa-
tion, or “handicap.”
Because the ICF is the universal and standard-
736 Stucki
ized language to describe functioning and health,
the concepts contained in existing measurement
instruments can potentially be translated into ICF-
compatible language, after which content compar-
isons among these instruments can be per-
formed.10,21–23 This may facilitate the selection of
specific measures that are most applicable to the
core set comparisons mentioned. To link the mea-
sures to the ICF, linkage rules have been devel-
oped24 and have recently been refined.25
ICF AS THE UNIFYING FRAMEWORK
FOR THE DEFINITION OF
REHABILITATION MEDICINE
A unifying framework of concepts and termi-
nology is of utmost importance for any profes-
sional, academic, and scientific field to facilitate
and ensure communication and exchange among
scientists and practitioners. Such a common
framework seems to have particular importance for
a professional discipline like PM&R, which is not
defined by a disease or an organ system and which
is typically interdisciplinary both in research and
practice. Thus, disciplines like PM&R have had
many definitions and difficulties to come up with
one generally accepted definition and conceptual-
ization.
Also, current definitions of rehabilitation, in-
cluding those from WHO,26 have focused on en-
abling the individual only. Consequently, they have
neglected the social perspective recognizing that
people with health conditions not only experience
disability in relation to impairments but also in
relation to physical, social, and economic barriers
of their particular environment. Accordingly, cur-
rent definitions generally fail to address the imme-
diate environment in the context of the rehabilita-
tion of individuals. Neither do they explicitly
address social policy or political actions necessary
to favorably change the environment for the dis-
abled.
If one had to chose one common denominator
for the definition of the science and practice of
rehabilitation, it is “human functioning,” ranging
from body functions and structures to activities
and participations and the interaction with the
person and the environment.
The ICF provides a globally accepted frame-
work and classification of functioning, encompass-
ing both the individual perspective, referring to the
concept of enabling the person, and the societal
perspective, referring to the concept of changing
the immediate and general environment. As such,
it has the potential to become the unifying concep-
tual and terminological framework for PM&R.4,27
Based on the ICF, the author is currently
working in cooperation with Professor John
Melvin, MD, from the Department of Rehabilitation
Am. J. Phys. Med. Rehabil. ● Vol. 84, No. 10
Medicine, Jefferson Medical College at the Thomas
Jefferson University in Philadelphia and in cooper-
ation with the European Union of Medical Special-
ists on tentative ICF-based definitions. It is our
goal to stimulate an open worldwide discussion,
and we envision the adoption of generally agreed
on definitions by the International Society of Phys-
ical and Rehabilitation Medicine, regional, and na-
tional societies in the next years. The tentative
definitions will also be valuable for the definition of
rehabilitation in the introductory chapter of the
envisioned world report on disability and rehabili-
tation that has been requested by the World Health
Assembly in the context of their endorsement of a
resolution on disability, including prevention,
management, and rehabilitation.28
The tentative brief definition of PM&R (hence-
forth referred to by the global acronym of PRM)
under discussion reads as follows: PRM is the med-
ical specialty that coordinates and performs inter-
ventions to optimize functioning of people with/or
at risk of disability including the diagnosis and
treatment of their health conditions.
Alternatively, a more detailed and comprehen-
sive, modular definition that may be tailored to
specific audiences and purposes reads as follows:
PRM is the medical specialty that, based on the
diagnosis of health conditions and the assessment
of functioning and its determinants, manages and
performs interventions and services using physical
medicine and pharmacological, engineering, be-
havioral, educational, vocational, and other strate-
gies, with the goal of enabling people experiencing
or at risk of disability, and their immediate envi-
ronment, to achieve and maintain optimal func-
tioning, autonomy, and self-determination in the
interaction with the environment in all situations
from the acute hospital to the community.
Similar definitions are in preparation for PRM,
as defined from the societal perspective, for reha-
bilitation as a multisectorial approach and for re-
habilitation science.
ICF-BASED STANDARDS FOR THE
PLANNING AND REPORTING OF
STUDIES
Currently, rehabilitation studies are often dif-
ficult to interpret for the reader. A main reason is
the widely varying taxonomy due to a lack of a
generally accepted framework and taxonomy for
functioning, disability, and health. Authors who all
have the same construct in mind may refer to
“function,” “physical function,” “physical func-
tional disability,” “physical disability,” “disability,”
“functional limitation,” or “quality of life.” The
reader is thus often left wondering what the study
is all about.
Readers may also find that primary and sec-
October 2005
ondary study endpoints are not explicitly denoted.
The endpoint may be defined in terms of a mea-
surement instrument totally unknown to the
reader when there is a wide variety of them in use,
and because measurement instruments typically
contain a wide variety of constructs, the reader may
wonder which constructs are actually measured.
Similarly, the exact targets of rehabilitation
interventions, especially in the case of complex and
multidisciplinary interventions, are hardly men-
tioned. Often, only the therapeutic modality (e.g.,
exercise) or the involved therapeutic professions
(physiotherapy, nurse practitioner) are denoted.
The authors thus leave it to the readers’ creativity
to imagine which impaired body functions, limited
activities, or restricted participation were targeted
by the interventions provided.
Statistical analyses often provide more insight
into statistical methods than information about the
exact handling of the study variables (e.g., about
which variables were included or left out in a
multivariate analysis).
Also, most current rehabilitation studies do
not analyze the mechanism of action, especially in
the case of multidisciplinary interventions. Only
rarely are the changes in the intervention targets
(e.g., improvement in strength and mobility) ex-
plicitly denoted and specifically examined to show
that they indeed contribute to the explanation of
the change in the study endpoint (e.g., physical
function). As recent studies have shown, what ex-
plains improvements in the study endpoint may
often be surprisingly different from what was ini-
tially expected and may relate to confounders (e.g.,
to changes in anxiety and depression) rather than
changes in the targeted body function parame-
ters.29
It seems, therefore, that the systematic use of
the ICF taxonomy and ICF-based standards in the
description of the study population, the interven-
tion targets, and the analyses may contribute im-
portantly to the quality, readability, and compara-
bility of rehabilitation studies.30 Consequently, the
author is thus currently preparing ICF-based
guidelines for the design and reporting of rehabil-
itation studies in a cooperative project with the
editor of the Journal of Rehabilitation Medicine,
Professor Gunnar Grimby, MD.
At the core of the guidelines is the suggestion
to report a categorical profile of functioning of the
population under study using the appropriate Brief
ICF Core Sets. To do this, one may use either the
ICF qualifier scale or an indicator measure of the
respective ICF category mapped to this category
using established linking rules.24,25
For the planning of studies, this requires that
at least all categories of the appropriate Brief ICF
Core Set or Sets are addressed by the measure-
International Classification of Functioning 737
 ments intended for use in the study. As pointed out
earlier, the ICF and the ICF Core Sets may indeed
serve as a most useful reference when selecting
among candidate measures. Content validity is ar-
guably the single most important consideration
when selecting a measure. Obviously, the selected
measures also need to fulfil the requested metric
requirements, including the ability to cover the
range of severity encountered in the population
and sensitivity to change.
It is then suggested to report all intervention
targets using the ICF taxonomy. With respect to
the analysis section, it is suggested to report the
variables used in multivariate analyses using again
the respective ICF code.
ICF IN CLINICAL PRACTICE
Similar to the planning and reporting of reha-
bilitation studies, the ICF has the potential to sig-
nificantly increase the quality of rehabilitation care
delivery. Currently, there have been some descrip-
tive attempts to explore the application of the ICF
to structure clinical assessment31 and how to apply
the ICF in the context of specific areas, for exam-
ple, in the rehabilitation management of people
with rheumatoid arthritis.32,33
The basis for the implementation of the ICF in
rehabilitation medicine is a common understand-
ing and uses of the taxonomy of the rehabilitation
process. A practical taxonomy of the rehabilitation
process based on a problem solving approach is the
rehabilitation cycle.4 It involves the four steps—
assessment, assignment, intervention, and evalua-
tion— or in a more proactive taxonomy—assess,
assign, intervene, and evaluate.4
In the context of a case management situation,
the assessment step includes the identification of
patients’ problems and the definition of long-term
and, if appropriate, the program goals of an envi-
sioned rehabilitation program that is specified in
the assignment step. The evaluation step refers to
the evaluation of program goal achievement.
In the context of a rehabilitation program, the
assessment step includes the identification of pa-
tients’ problems, the review and potential modifi-
cation of the assigned program goal, and the defi-
nition and modeling of the first cycle goals and
intervention targets. The assignment step refers to
the assignment to health professionals and inter-
vention principles. The intervention step refers to
the specification of the intervention techniques,
indicator measures, and target values to be
achieved in a predefined time period. The evalua-
tion step refers to the evaluation of goal achieve-
ment with respect to the specified cycle goals and
intervention targets.
Especially in the assessment step, the ICF and
the ICF Core Sets are most useful. The ICF frame-
738 Stucki
work can be used as an “ICF sheet,” with an upper
section for the patient perspective and a lower
section for the professional perspective.31 This is a
practical way to structure and document patients’
problems and clinical and technical examinations.
Also, important personal and environmental fac-
tors can be denoted.
The patients’ problems based on the history
and the clinical examination and technical investi-
gations can be gathered in a nonsystematic or in a
systematic way using the applicable ICF Core Sets.
To use a systematic approach either alone or in
addition to the nonsystematic approach is most
useful and advisable to ensure that all potentially
relevant problems have been summarized in ICF
Core Sets. This is most beneficial in the training
situation of team members. The structured ap-
proach also has the advantage that different team
members can take primary responsibility for de-
fined categories. A structured approach also has
the advantage of a systematic information struc-
ture, for example, in the context of clinical quality
management, bench-marking, or research.
Using the described linkage methods10 and
computer algorithms, systematically gathered in-
formation from self-administered questionnaires
or test batteries can be linked to the most appro-
priate ICF category and can be linked and inte-
grated in an electronic ICF sheet. Depending on
the context of either a case management situation
or a rehabilitation program, the long-term goal,
the program goal or the first cycle goal(s), and
intervention targets can be defined in ICF terms.
Whereas long-term goals or service goals are typi-
cally defined on the level of participation, cycle
goals are most typically selected from the activity
component or, in the case of the acute hospital,
from the body function component. Once the cycle
goals have been defined, the team will identify the
intervention targets that are related to the cycle
goal and, once improved, are expected to lead to
the improvement of the cycle goal.
The use of the ICF may enhance a structured
approach to rehabilitation management and ease
the communication of the team with respect to
problems, goals, intervention categories, and inter-
ventions. Most importantly, it may improve the
communication between settings, with insurers or
case managers. An ICF-based rehabilitation man-
agement approach is also most useful in the con-
text of clinical quality management and assurance,
teaching, evidence-based rehabilitation, and best
practice and in the formulation, implementation,
and evaluation of guidelines.
In the context of disability evaluation, the ICF
provides a comprehensive framework for assess-
ment and modeling of the determinants of work
incapacity.
Am. J. Phys. Med. Rehabil. ● Vol. 84, No. 10
CONCLUSION
There is no doubt that the ICF is on its way to
becoming the generally accepted framework and
classification in medicine and, specifically, rehabil-
itation medicine. The implementation of the ICF
will strengthen the patient and the rehabilitation
perspective in medicine, the health care system,
and across sectors. The ICF is a most useful unify-
ing framework for common, worldwide accepted
definitions of rehabilitation medicine and rehabil-
itation sciences and may thus strengthen the iden-
tity, coherence, and prospects of these disciplines.
The ICF also provides an important foundation for
human functioning science, an emerging scientific
field of study. Together with neurobiology, behav-
ioral science, and engineering, human functioning
science is a most important basic science for the
applied field of rehabilitation science and rehabili-
tation medicine. The quality, interpretability, and
comparability of rehabilitation research will benefit
from the implementation of ICF-based standards
such as the Brief ICF Core Sets for the planning
and reporting of studies. Similarly, communica-
tion, documentation, and best practice approaches
will benefit from a shift toward a more structured
ICF-based rehabilitation management. The suc-
cessful implementation of the ICF relies on scien-
tifically sound and inclusive initiatives for the de-
velopment of practical tools and concepts in the
public domain. This can only be achieved through
global cooperation and in close collaboration with
WHO. In this respect, the International Society of
Physical and Rehabilitation Medicine, its regional
networks, and many associated national societies
have demonstrated leadership and have spear-
headed new developments. In this spirit, the Asso-
ciation of Academic Physiatrists has decided to
provide me with the opportunity to speak to its
distinguished membership and to have a focus on
the application of the ICF in rehabilitation medi-
cine at this year’s meeting. I am most thankful and
I am looking forward toward an active cooperation
with our American colleagues.
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