Open Access Research article

Staging of mobility, transfer and walking functions of elderly persons based on the codes of the International Classification of Functioning, Disability and Health

Jiro Okochi1*, Tai Takahashi2, Kiyoshi Takamuku34 and Reuben Escorpizo5678

Author Affiliations

1 Tatsumanosato Geriatric Health Service Facility, Tatsuma, Daitou, Osaka, Japan

2 International University of Health and Welfare, Aoyama, Tokyo, Japan

3 Souseien Geriatric Health Service Facility, Nakatsu, Oita, Japan

4 Japan Association of Geriatric Health Service Facilities, Shiba, Tokyo, Japan

5 ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classification in Germany (DIMDI), Nottwil, Switzerland

6 Swiss Paraplegic Research, Nottwil, Switzerland

7 Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland

8 Department of Physical Therapy, Louisiana State University Health Sciences Center, New Orleans, LA, USA

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BMC Geriatrics 2013, 13:16  doi:10.1186/1471-2318-13-16

Published: 15 February 2013



The International Classification of Functioning, Disability and Health (ICF) was introduced by the World Health Organization as a common taxonomy to describe the burden of health conditions. This study focuses on the development of a scale for staging basic mobility and walking functions based on the ICF.


Thirty-three ICF codes were selected to test their fit to the Rasch model and their location. Of these ICF items, four were used to develop a Guttman- type scale of “basic mobility” and another four to develop a“walking” scale to stage functional performance in the elderly. The content validity and differential item functioning of the scales were assessed. The participants, chosen at random, were Japanese over 65 years old using the services of public long-term care insurance, and whose functional assessments were used for scale development and scale validation.


There were 1164 elderly persons who were eligible for scale development. To stage the functional performance of elderly persons, two Guttman-type scales of “basic mobility” and “walking” were constructed. The order of item difficulty was validated using 3260 elderly persons. There is no differential item functioning about study location, sex and age-group in the newly developed scales. These results suggested the newly developed scales have content validity.


These scales divided functional performance into five stages according to four ICF codes, making the measurements simple and less time-consuming and enable clear descriptions of elderly functioning level. This was achieved by hierarchically rearranging the ICF items and constructing Guttman-type scales according to item difficulty using the Rasch model. In addition, each functional level might require similar resources and therefore enable standardization of care and rehabilitation. Illustrations facilitate the sharing of patient images among health care providers. By using the ICF as a common taxonomy, these scales could be used internationally as assessment scales in geriatric care settings. However these scales require further validity and reliability studies for international application.