Open Access Research article

Towards comprehensive and transparent reporting: context-specific additions to the ICF taxonomy for medical evaluations of work capacity involving claimants with chronic widespread pain and low back pain

Urban Schwegler12*, Jessica Anner3, Andrea Glässel1, Mirjam Brach1, Wout De Boer3, Alarcos Cieza4 and Bruno Trezzini1

Author Affiliations

1 Swiss Paraplegic Research (SPF), Nottwil, Switzerland

2 Department of Health Sciences and Health Policy, University of Lucerne and SPF, Nottwil, Switzerland

3 asim, Academy of Swiss Insurance Medicine, University Hospital Basel, Basel, Switzerland

4 Faculty of Social and Human Sciences, School of Psychology, University of Southampton, Southampton S017 1BJ, UK

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BMC Health Services Research 2014, 14:361  doi:10.1186/1472-6963-14-361

Published: 29 August 2014



Medical evaluations of work capacity provide key information for decisions on a claimant’s eligibility for disability benefits. In recent years, the evaluations have been increasingly criticized for low transparency and poor standardization. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive spectrum of categories for reporting functioning and its determinants in terms of impairments and contextual factors and could facilitate transparent and standardized documentation of medical evaluations of work capacity. However, the comprehensiveness of the ICF taxonomy in this particular context has not been empirically examined. In this study, we wanted to identify potential context-specific additions to the ICF for its application in medical evaluations of work capacity involving chronic widespread pain (CWP) and low back pain (LBP).


A retrospective content analysis of Swiss medical reports was conducted by using the ICF for data coding. Concepts not appropriately classifiable with ICF categories were labeled as specification categories (i.e. context-specific additions) and were assigned to predefined specification areas (i.e. precision, coverage, personal factors, and broad concepts). Relevant specification categories for medical evaluations of work capacity involving CWP and LBP were determined by calculating their relative frequency across reports and setting a relevance threshold.


Forty-three specification categories for CWP and fifty-two for LBP reports passed the threshold. In both groups of reports, precision was the most frequent specification area, followed by personal factors.


The ICF taxonomy represents a universally applicable standard for reporting health and functioning information. However, when applying the ICF for comprehensive and transparent reporting in medical evaluations of work capacity involving CWP and LBP context-specific additions are needed. This is particularly true for the documentation of specific pain-related issues, work activities and personal factors. To ensure the practicability of the multidisciplinary evaluation process, the large number of ICF categories and context-specific additions necessary for comprehensive documentation could be specifically allocated to the disciplines in charge of their assessment.

International Classification of Functioning; Disability and Health (ICF); Medical evaluation of work capacity; Disability evaluation; Chronic widespread pain; Low back pain; Context-specific additions