A code set representing the level of difficulty experienced in executing an activity from the Activities and Participation component of the International Classification of Functioning, Disability and Health (ICF 2001).
In the context of health, an activity is the execution of a task or action by an individual. Activity limitations are difficulties an individual may have in executing an activity.
Activity limitation varies with the environment and is assessed in relation to a particular environment; the absence or presence of assistance, including aids and equipment, is an aspect of the environment.
The area in which an individual experiences an activity limitation is indicated in the metadata item Activities and participation code N[NNN]. The presence of an activity limitation with a given domain is indicated by a non-zero response in this value domain. Activity is limited when an individual, in the context of a health condition, either has difficulty performing an activity in an expected manner, or cannot perform the activity at all.
Difficulties with activities can arise when there is a qualitative or quantitative alteration in the way in which these activities are carried out. Difficulty includes matters such as 'with pain', 'time taken', 'number of errors', clumsiness', 'modification of manner in which an activity is performed' e.g. sitting to get dressed instead of standing. 'Difficulty' is a combination of the frequency with which the problem exists, the duration of the problem and the intensity of the problem. Activity limitations are assessed against a generally accepted population standard, relative to cultural and social expectations.
This metadata item contributes to the definition of the concept 'Disability' and gives an indication of the experience of disability for a person.
Many existing assessment tools are in use, and are embedded in measurement and payment methods in services in Australia. Calibration and mapping of existing tools within this international framework will be an important process towards greater national consistency of data on the level of difficulty with activities.
Capacity is assessed in a standardised environment and 'reflects the highest probable level of functioning that a person may reach in a given domain at a given moment' (WHO 2001). A standardised environment may be '(a) an actual environment commonly used for assessment in test settings; or (b) in cases where this is not possible, an assumed environment which can be thought to have a uniform impact' (WHO 2001). Capacity is achieved in an environment that enhances the individual's ability to execute a task or an activity.
Performance describes what an individual does in his or her usual environment. Performance varies according to the environmental context an individual lives and experiences. Assessment of environmental factors (physical, social and attitudinal) in conjunction with this value domain indicates performance in person specific environments. The gap between capacity and performance reflects the difference between the impacts of usual and uniform environments, and provides a useful guide as to what can be done to the environment of the individual to improve performance.
Performance and capacity can be assessed by the absence or presence of assistance.
The 'standardised environment' has not been generally operationalised. However, the recognition of these two constructs in the ICF underscores the importance of recording the environment in which activities are being performed.
Source and reference attributes
Australian Institute of Health and Welfare, which is the Australian Collaborating Centre for the World Health Organization (WHO) Family of International Classifications.
World Health Organization (WHO) 2001. ICF: International Classification of Functioning, Disability and Health. Geneva: WHO
Australian Institute of Health and Welfare (AIHW) 2003. ICF Australian User Guide V1.0. Canberra: AIHW
Further information on the ICF can be found in the ICF itself and the ICF Australian User Guide (AIHW 2003) at the following websites: