IMIM - Institut Hospital del Mar d'Investigacions Mèdiques

Health services - Research lines Jordi Alonso


Health status evaluation of the general Spanish population using the International Classification of Functioning, Disability and Health (ICF)

Research group: Montse Ferrer (IP), Olatz Garin, Jordi Alonso, Josué Almansa, José María Valderas, Alarcos Cieza.

Objective: This project’s aim is the application and evaluation of the International Classification of Functioning, disability and Health (ICF) as a pattern to analyze the health status and disability of the general population. Specific objectives:

  • Development of linkage models (mapping) among the ICF and the main generis instrument of HRQL used in Health Surveys.
  • Evaluation of the validity and reliability of these models of correspondence or linkage.
  • Obtaining severity values for ICF codes in the hierarchical, uni-dimensional, and additive continuum of Health-Disability.
  • Identification of cut-off points to define disability according to the ICF model, and their correspondence with each of the assessed instruments.

Methodology: The European Project of Mental Health (ESEMeD), is a cross-sectional study (2001-2002) which includes a representative sample of the general Spanish population with al least 18 years (n=5.473 individuals). The MHADIE project (Measuring Health and Disability in Europe) is a longitudinal study among clinical and rehabilitation settings on patients (n=1119) suffering from a chronic condition (12 selected). The ESEMeD included 3 generic HRQL measures: the SF-12, the EQ-5D, and the WHODAS-II. The MHADIE include the ICF Check list, the SF-36, the WHODAS-II, and the WHOQOL-8.


  • The bibliographic search ans critic literature review has been carried out looking for linkage models or mapping the ICF with the HRQL instruments. New variables have been created on the ESEMeD-Spain data base, regarding the ICF codes.
  • The WHODAS questionnaire has been identify as the one nearest to the ICF conceptual model, and the metric properties’ study of two WHODAS versions (ESEMeD and MHADIE) has confirmed their reliability, validity and responsiveness.
  • The study of the structure Capacity, Performance and Environmental factors of the ICF through Factorial Exploratory Analysis and Factorial Confirmatory Analysis has proved its unidimensionality
  • The Spanish National Disability Survey (1997) structure has been evaluated using exploratory factor analysis, and results shown a lack of dimensionality, needed to create continuum scores.

Status: Conducting new analyses and working on dissemination of results. Two manuscripts are on publication process, and several oral presentations on national and international congresses have already been done: Congreso de la Sociedad Española de Salud Pública y Administración Sanitaria (June 2007; and March 2009), 14th Annual Conference of the International Society for Quality of Life Research (October 2007) and III European Congress of Methodology (July 2008).

Keywords: Disability, Patient reported outcomes, Measurement assessment.

Financing: ISCIII_FIS PI 061579 and PI 051542.

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