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Table A Some implications of the extended WHO ICF model of illness


Comment or example


Time frames will differ in different systems

Hospitals focus on pathology, which has a short time frame, and cannot cope with patients with activity limitations, when a longer time frame applies

Healthcare systems should have separate systems focused on pathology and activities (acute hospitals, and rehabilitation units)

Relations between different systems will be very variable

Not all disease causes impairment or activity limitation, and two people with apparently similar pathology may have very different changes in activity or participation

Healthcare systems should not base financial or other management solely on pathological diagnosis

Relations between systems will occur in both directions

Changing behaviour may reduce impairment and even reduce (risk of) pathology

Some common disorders, such as back pain, may best be reduced through changing social context (such as.sickness benefit rules or employment setting)

Illness may arise without pathology

All the functional illnesses

Treatments should focus on altering beliefs and expectations and the behaviour of healthcare professions.

Normal will have different comparators in different systems

Normal performance at the level of activities varies greatly—for example, many men do not iron clothes. Normal appearance and function of cells varies little

The past performance and current wishes of patients should be used to set outcome goals

Context will have a major effect on illness

Ability to work may be determined by the ability of a person to access their workplace

Organisations, such as employers, social services and housing agencies need integrating with (healthcare) systems to reduce illness. More treatments aimed at contextual factors, not at disease, should be developed

Successful treatment of an illness may require multiple interventions

Reduced mobility after stroke may require alleviation of osteoarthric hip pain, practice at walking, an ankle foot orthosis, and adapting the home

Multiprofessional specialist teams should be developed for common problems to deliver multifocal treatments over time; payment should not be tied to individual treatments