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 Table of Contents  
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 122-124

6.4 Scientific background of physical and rehabilitation medicine: Human functioning sciences

Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany

Date of Web Publication11-Jun-2019

Correspondence Address:
Prof. Christoph Gutenbrunner
Department of Rehabilitation Medicine, Hannover Medical School, Hannover
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisprm.jisprm_28_19

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How to cite this article:
Gutenbrunner C, Nugraha B. 6.4 Scientific background of physical and rehabilitation medicine: Human functioning sciences. J Int Soc Phys Rehabil Med 2019;2, Suppl S1:122-4

How to cite this URL:
Gutenbrunner C, Nugraha B. 6.4 Scientific background of physical and rehabilitation medicine: Human functioning sciences. J Int Soc Phys Rehabil Med [serial online] 2019 [cited 2019 Aug 20];2, Suppl S1:122-4. Available from: http://www.jisprm.org/text.asp?2019/2/2/122/259354

  Introduction Top

The human functioning sciences start from models and theories to understand functioning and disability from a scientific perspective. Such approaches are of great relevance too in order to understand rehabilitation and to define goals for physical and rehabilitation medicine (PRM) programs. The most common model is the comprehensive model of functioning of the World Health Organization as described in the International Classification of Functioning, Disability, and Health (ICF).[1] It defines functioning and disability as two polar aspects of the interaction of a person with a health condition and the environment. Thereafter, functioning comprises the domains, body structures and functions, activities, and participation. The environmental and personal factors are comprised as context [Figure 1].[2] This model also has been used to operationalize health as it has been defined by the WHO in its Alma Ata-declaration.[3],[4] However, other theories of the social integration of persons with health conditions are discussed, for example, the theory of social productivity.[5]
Figure 1: Functioning and disability as an interaction of a person with a health condition and parallel domains from the WHO's comprehensive model of functioning[2] (with permission)

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  Background Top

The WHO's comprehensive model of functioning, disability, and health have been to conceptually describe rehabilitation as a health strategy[6] and PRM[7] and is the basis of many works conceptualizing rehabilitation services and to develop concepts of rehabilitation quality management.[8]

To apply the ICF model in epidemiology and clinical work relevant domains and categories of functioning needs to be identified, which is done in the ICF-classification. However, scientific work still was needed to identify the most relevant domains in relation to specific clinical situations (diseases and settings). For this purpose, so-calls ICF-Core-Sets have been developed and tested in many scientific projects.[9],[10],[11] They also can serve as a basis to assess functioning and to measure the effects of functioning interventions and outcomes of PRM programs. Last but not least, generic Core-Sets with smaller numbers of domains can serve as a basis of including functioning in general health reporting[12] and to assess rehabilitation outcomes at population levels.[4] Last but not least, models of functioning and disability are of relevance in developing tools for the assessment of disability at population levels such as the Washington Group Questionnaire[13] and the Model Disability Survey.[14] The practical relevance of such approaches is evident if it comes to the need to analyze the rehabilitation service provision at country levels[15] and to develop recommendations for implementation of rehabilitation in health systems.[16] It also is crucial for developing methods to establish epidemiology of functioning.[17],[18]

  Scope of Human Functioning Sciences Top

Human Functioning Sciences also include ethical aspects and human rights of disability and rehabilitation. Regarding human rights of the UN-Convention on the rights of people with disabilities[19] was a milestone toward the enjoyment of equal human rights for every person with the disability and at the same time promoted the provision of rehabilitation as the health strategy to reduce or compensate disability. It was the starting point of several resolutions of the WHO highlighting the importance of rehabilitation[20],[21] as well as the World Report on Disability[22]) and the Global Disability Action Plan.[23] This can be seen as “purely” political; however, due to its huge impact on service provision and thus on the interaction of PRM and its patients or clients,[2],[24] it must be analyzed and further developed using systematic approaches.

Regarding ethics, there is common consensus that the principles of medical ethics “respect for autonomy,” “beneficence,” “nonmaleficence,” and “justice (fair distribution, respect for people's rights, respect for morally acceptable laws)” fully apply for PRM. However, some specific ethical issues need to be taken into consideration. Being aware of the facts that people with disabilities.

  • Experience inequalities, for example, when they are denied equal access to health care, employment, education, or political participation because of their disability
  • Are subject to violations of dignity, for example, when they are subjected to violence, abuse, prejudice, or disrespect because of their disability
  • May be denied autonomy, for example, when they are subjected to involuntary sterilization, or when they are confined in institutions against their will, or when they are regarded as legally incompetent because of their disability,[22] PRM doctors must ensure their ethical standards in communicating with patients suffering from severe impairment (e.g., intellectual deficits and communication disorders). In particular, PRM physicians must thoroughly make sure not to manipulating the decisions made during rehabilitation and make sure that the persons are making their own decision based on the best available information. Another frequent issue is decisions at the end of life as many patients will be taken care of PRM doctors in rehabilitation and/or palliative care setting.

In its World Report on Disability, the WHO formulated some guiding principles for ethics in the context of disability and rehabilitation, such as:

  • Respect for the inherent dignity, individual autonomy, including the freedom to make one's own choices, and independence of persons
  • Nondiscrimination
  • Full and effective participation and inclusion in society
  • Respect for difference and acceptance of persons with disabilities as part of human diversity and humanity
  • Equality of opportunity
  • Accessibility
  • Respect for the continued dignity and value of persons with disabilities as they grow older
  • And others.

It seems necessary to work more on the problems using systematic approaches both in assessing the uses (or disruption) of ethical standards as well as further development of ethical principles and tools to ensure its implementation.

In this context, it must be stressed that jurisdiction and political sciences and the theoretical basis of the development of human rights and norms are relevant approaches.

As rehabilitation aims at the integration of persons experiencing disability in society and one of its principles is to taking into account the individual's live plan, cultural aspects of disability, and rehabilitation must be subjected to scientific work. Many issues have to be taken into consideration here, some examples are:[25]

  • Possible cultural traditions of including or excluding persons with disabilities from society
  • Cultural influences on the rehabilitation goal setting, which is highly influenced by general societal goals and values
  • Respecting societal norms in rehabilitation service provision (e.g., gender separation)
  • Religious and animistic norms and convictions influencing the treatment of and interaction with persons with disabilities
  • And many others.

For a scientific approach to such aspects of disability and rehabilitation methods of social and cultural sciences are needed as well as historical approaches to better understand the actual situation and its background.

  Summary Top

The human functioning sciences start from models and theories to understand functioning and disability. It includes ethical aspects, human rights of disability and rehabilitation. Cultural aspects should be taken into consideration in order to better understand the actual situation and its background.

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Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. International Classification of Functioning, Disability and Health: International Classification of Functioning. Geneva: World Health Organization; 2001.  Back to cited text no. 1
Gutenbrunner C, Nugraha B. Physical and rehabilitation medicine: Responding to health needs from individual care to service provision. Eur J Phys Rehabil Med 2017;53:1-6.  Back to cited text no. 2
Stucki G. Olle höök lectureship 2015: The World Health Organization's paradigm shift and implementation of the international classification of functioning, disability and health in rehabilitation. J Rehabil Med 2016;48:486-93.  Back to cited text no. 3
Stucki G, Rubinelli S, Bickenbach J. We need an operationalisation, not a definition of health. Disabil Rehabil 2018:1-3. DOI: 10.1080/09638288.2018.1503730.  Back to cited text no. 4
Tough H, Fekete C, Brinkhof MW, Siegrist J. Vitality and mental health in disability: Associations with social relationships in persons with spinal cord injury and their partners. Disabil Health J 2017;10:294-302.  Back to cited text no. 5
Meyer T, Gutenbrunner C, Bickenbach J, Cieza A, Melvin J, Stucki G, et al. Towards a conceptual description of rehabilitation as a health strategy. J Rehabil Med 2011;43:765-9.  Back to cited text no. 6
Gutenbrunner C, Meyer T, Melvin J, Stucki G. Towards a conceptual description of physical and rehabilitation medicine. J Rehabil Med 2011;43:760-4.  Back to cited text no. 7
Engkasan JP, Stucki G, Ali S, Yusof YM, Hussain H, Latif LA, et al. Implementation of clinical quality management for rehabilitation in Malaysia. J Rehabil Med 2018;50:346-57.  Back to cited text no. 8
Laxe S, Cieza A, Castaño-Monsalve B. Rehabilitation of traumatic brain injury in the light of the ICF. NeuroRehabilitation 2015;36:37-43.  Back to cited text no. 9
Cieza A, Stucki G, Weigl M, Kullmann L, Stoll T, Kamen L, et al. ICF core sets for chronic widespread pain. J Rehabil Med 2004;(44 Suppl):63-8.  Back to cited text no. 10
Cieza A, Stucki G, Weigl M, Disler P, Jäckel W, van der Linden S, et al. ICF core sets for low back pain. J Rehabil Med 2004;(44 Suppl):69-74.  Back to cited text no. 11
Prodinger B, Cieza A, Oberhauser C, Bickenbach J, Üstün TB, Chatterji S, et al. Toward the international classification of functioning, disability and health (ICF) rehabilitation set: A minimal generic set of domains for rehabilitation as a health strategy. Arch Phys Med Rehabil 2016;97:875-84.  Back to cited text no. 12
Washington Group on Disability Statistics. Washington Group Questoinnaire Washington: Washington Group on Disability Statistics. Available from: http://www.washingtongroup-disability.com/washington-group-question-sets/short-set-of-disability-questions/. [Last updated on 2018 Jan 18; Last accessed on 2019 Jan 03].  Back to cited text no. 13
World Health Organization, World Bank. Model Disability Survey; 2017 Available from: http://www.who.int/disabilities/data/mdson/en/. [Last accessed on 2017 Jan 25].  Back to cited text no. 14
Gutenbrunner C, Bickenbach J, Melvin J, Lains J, Nugraha B. Strengthening health-related rehabilitation services at national levels. J Rehabil Med 2018;50:317-25.  Back to cited text no. 15
Gutenbrunner C, Nugraha B. Principles of assessment of rehabilitation services in health systems: Learning from experiences. J Rehabil Med 2018;50:326-32.  Back to cited text no. 16
Gutenbrunner C, Ward A, Chamberlain MA; Union Europeenne des Medecins Specialistes SoPRM, European Board of PRM, Academie Europeenne de Medecine de R, European Society for P, Rehabilitation M. White book on physical and rehabilitation medicine in Europe. Eura Medicophys 2006;42:292-332.  Back to cited text no. 17
Gutenbrunner C, Ward A, Chamberlain MA, editors., white book on physical and rehabilitation medicine in Europe. J Rehabil Med 2007;39 Suppl 45:1-48.  Back to cited text no. 18
United Nations. Convention on the Rights of Persons with Disabilities; 2006. Available from: http://www.un.org/disabilities/convention/conventionfull.shtml. [Last accessed on 2018 Aug 02].  Back to cited text no. 19
World Health Organization. World Health Assembly 66th (WHA 66.9)-Disability 2013. World Health Organization; 4 January, 2017. Available from: http://www.apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R9-en.pdf. [Last accessed on 2018 Aug 02].  Back to cited text no. 20
World Health Organization. World Health Assembly Resolution WHA58.23 on Disability, Including Prevention, Management and Rehabilitation. Geneva, Switzerland: World Health Organization; 2005.  Back to cited text no. 21
World Health Organization, The World Bank. World Report on Disability. Geneva: World Health Organization; 2011.  Back to cited text no. 22
World Health Organization. Global Disability Action Plan. Geneva: World Health Organization; 2014.  Back to cited text no. 23
Bethge M, von Groote P, Giustini A, Gutenbrunner C. The world report on disability: A challenge for rehabilitation medicine. Am J Phys Med Rehabil 2014;93:S4-11.  Back to cited text no. 24
Soltani S, Takian A, Akbari Sari A, Majdzadeh R, Kamali M. Cultural barriers in access to healthcare services for people with disability in Iran: A qualitative study. Med J Islam Repub Iran 2017;31:51.  Back to cited text no. 25


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