All Talk, No Action? The Global Diffusion and Clinical Implementation of the International Classification of Functioning, Disability, and Health

Objective: We aimed to review the global diffusion and clinical implementation of the International Classification of Functioning, Disability, and Health (ICF) endorsed by the World Health Assembly in 2001. Design: First, we analyzed the diffusion process of the ICF, with a special focus on clinical rehabilitation. This was done by researching the spread of ICF-related terms in Pubmed and Google from 2001 to 2010. Second, we examined the clinical implementation of the ICF in rehabilitation settings by a systematic review of the literature in the databases Pubmed and Embase. Eligible were studies evaluating the current application and impact of the ICF in the daily practice of clinical rehabilitation. Results: We found that the diffusion of the ICF as a mere term and concept in the area of rehabilitation is successful. However, the implementation in clinical rehabilitation practice is highly idiosyncratic and rarely evaluated appropriately. The question arises whether this idiosyncratic implementation can be regarded as a process toward standardization at all. Evidence of concrete benefits of a clinical ICF implementation for team members or even patients is at best weak. Conclusions: We suggest more comprehensive and comparable multicenter studies to solve the urgent need for best practice recommendations on ICF implementation in clinical rehabilitation.