Journal of Rehabilitation Medicine 51-4inkOmslag | Page 13

Academic debate on ICF and a theory of social productivity
247
is not whether consumptive and productive activities
can be approached without being normative. The ques-
tion is whether they should be considered important
for the human being, and consequently introduced
in the ICF as central issues of participation. If this is
true, the approach to them should not be normative
as correctly proposed. Jerome Bickenbach indicated
that he does not see a difference between activity
and participation, which for him is a continuum. We
probably need more clarity on this matter. In fact, one
could argue that a difference clearly comes from the
most important point he raised, i.e. that we must not
be normative in the ICF. As physicians, the absence
of norms can be considered true only for participa-
tion (better or worse mobility should be judged only
by the patient themself), while we absolutely need
to be normative in activities, measuring and defining
what is the “normal” activity for a human being as a
reference to judge the presence or not of an activity
limitation. In this sense, for physicians there is a clear
distinction between activity and participation, and this
should be maintained. For Negrini this also explains
why the PRM specialty is clearly primarily focused
on activities and impairments, while participation is
ultimately the goal, but not one of our main fields of
competence. itself, e.g. the problem of not classifying personal
factors and to not distinguish between activities and
participation.
• There was no doubt that there is a need for scienti-
fic theories to describe functioning and health. The
theory of social productivity seems to be an important
contribution towards this goal. However, here some
major questions have been raised:
• The definition of well-being (and quality of life) in
relation to the operationalization of functioning and
health needs to be further developed. The theory of
social productivity provides one approach, but other
approaches seem to be necessary.
• The theory of social productivity addresses one
important factor to operationalize functioning;
however, the questions remains unanswered as to
whether other (additional) approaches are needed
and whether this theory is applicable across cultures.
CONCLUSION The authors would like to thank the members of the European
Academy of Rehabilitation Medicine for their participation in
the debate in Budapest, September 2016: Kristian Borg, Anne
Chamberlain, Gabor Fazekas, Charles Gobelet, Alvydas Juoce-
vicius, Jaro Karppinen, Gustaaf Lankhorst, Angela McNamara,
Xanthi Michail, Johan Rietman, Joao Pascoa Pinheiro, Jean
Paysant, Diane Playford, Bengt Sjölund, Henk Stam, Gerold
Stucki, Brigitte Perrouin-Verbe, Mauro Zampolini.
All in all, the first structured academic debate within
the EARM focussed on a very relevant topic: is it pos-
sible to provide a theory neutral framework to describe
the lived experience of health, or is there an appropriate
theory to understand what constitute the most relevant
factors of health (and well-being) (and how they can
be operationalized).
The ICF provides a framework to operationalize
health and functioning and is supposed to be “theory
neutral”. The emerging questions from the debate relate
to 2 main issues:
• The independence of the ICF model from any theory
must be further elucidated both in reviewing the pro-
cess of its development including comparisons with
already existing theories on health and participation,
and in demonstrating its feasibility to be used in dif-
ferent theories on health and participation as well as
in different settings and cultures.
• With regard to the feasibility of the use of the ICF, it
seems that the efforts to make the classification more
user-friendly should continue. In addition, some
questions about the ICF remain open, e.g. whether it
can be understood across cultures. Last, but not least,
the debate showed some issues of the classification
Last, but not least, the conclusion cannot be an “either-
or” (classification vs theory). More work should be
invested and projects should be set up both to further
develop the ICF and refine (or develop new) theories.
Further debates, scientific projects and symposia
around these topics should be organized.
ACKNOWLEDGEMENTS
The authors have no conflicts of interest to declare.
REFERENCES
1. Sjölund BH, Stucki G, Michail X. Debates in rehabilitation
medicine: a collaborative initiative of the European Aca-
demy of Rehabilitation Medicine and the Journal of Rehabili-
tation Medicine & dear readers and authors of the Journal of
Rehabilitation Medicine. J Rehabil Med 2016; 48: 485–480.
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: 486–493.
3. Siegrist J, Fekete C. Fair opportunities, social productivity
and wellbeing in disability: Towards a theoretical founda-
tion. J Rehabil Med 2016; 48: 494–499.
4. Bickenbach J. Reply to „Fair opportunities, social produc-
tivity and wellbeing in disability: Towards a theoretical
foundation.“ J Rehabil Med 2016; 48: 500–501.
5. WHO. International Classification of Functioning, Disability
and Health. Geneva: World Health Organization, 2001.
Available from: http://www.who.int/classifications/icf/en/.
6. Milton Mayeroff. On caring. Available from: https://www.
librarything.com/work/734554.
J Rehabil Med 51, 2019