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AIMS Public Health

2025, Volume 12, Issue 3: 796-811. doi: 10.3934/publichealth.2025040
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Research article Special Issues

Disparity between capacity and performance in the International Classification of Functioning: implications for functionality in older adults

  • 1.
    Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
  • 2.
    Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
  • Published: 05 August 2025
  • Background 

    Functioning, recognized as the third health indicator and a key metric for rehabilitation, can be assessed by measuring capacity and performance.

    Objective 

    To quantify the prevalence of disability and cognitive impairment in individuals aged 50+ and evaluate the reliability and clinical relevance of capacity and performance qualifiers in the activity and participation domains of the international classification of functioning checklist (ICF checklist).

    Methods 

    A cross-sectional study was conducted in a population from rural and urban areas of Aragón (Spain), including 1707 participants. Disability and cognitive impairment were assessed using the WHO Disability Assessment Schedule 12-item version (WHODAS 12) and mini-mental state examination. A randomly selected subsample (n = 129) underwent a detailed functional evaluation. The ICF checklist was used to compare capacity and performance, analyzing their agreement and differences.

    Results 

    Disability was present in 50.6% of participants. Severe or total disability was most prevalent in general tasks/demands (10.1%) and domestic life (7.1%), reflecting significant daily functioning limitations. The largest capacity-performance discrepancies were in domestic life, self-care, and learning, indicating key intervention areas. Notably, 40.5% of participants had lower performance in domestic life, followed by learning/knowledge (28%) and mobility (17%). Conversely, performance exceeded capacity in community living (13.3%) and personal relationships (5.5%), highlighting the influence of environmental factors.

    Conclusions 

    Disability is highly prevalent in adults aged 50+, notably affecting daily functioning. Gaps between ability and performance indicate environmental barriers, especially at home and in learning contexts. Improved outcomes in social domains suggest enabling conditions. Findings support the ICF checklist's clinical value and advocate for integrating environmental factors into disability care.

    Citation: María Cristina Ruiz-Garrós, Ana Alejandra Laborda Soriano, Alba Cambra-Aliaga, Pilar Dominguez-Oliván, Marta Perez-de-Heredia-Torres, Laura Gonzalo-Ciria, Ana Gascón-Catalán. Disparity between capacity and performance in the International Classification of Functioning: implications for functionality in older adults[J]. AIMS Public Health, 2025, 12(3): 796-811. doi: 10.3934/publichealth.2025040

    Related Papers:

  • Background 

    Functioning, recognized as the third health indicator and a key metric for rehabilitation, can be assessed by measuring capacity and performance.

    Objective 

    To quantify the prevalence of disability and cognitive impairment in individuals aged 50+ and evaluate the reliability and clinical relevance of capacity and performance qualifiers in the activity and participation domains of the international classification of functioning checklist (ICF checklist).

    Methods 

    A cross-sectional study was conducted in a population from rural and urban areas of Aragón (Spain), including 1707 participants. Disability and cognitive impairment were assessed using the WHO Disability Assessment Schedule 12-item version (WHODAS 12) and mini-mental state examination. A randomly selected subsample (n = 129) underwent a detailed functional evaluation. The ICF checklist was used to compare capacity and performance, analyzing their agreement and differences.

    Results 

    Disability was present in 50.6% of participants. Severe or total disability was most prevalent in general tasks/demands (10.1%) and domestic life (7.1%), reflecting significant daily functioning limitations. The largest capacity-performance discrepancies were in domestic life, self-care, and learning, indicating key intervention areas. Notably, 40.5% of participants had lower performance in domestic life, followed by learning/knowledge (28%) and mobility (17%). Conversely, performance exceeded capacity in community living (13.3%) and personal relationships (5.5%), highlighting the influence of environmental factors.

    Conclusions 

    Disability is highly prevalent in adults aged 50+, notably affecting daily functioning. Gaps between ability and performance indicate environmental barriers, especially at home and in learning contexts. Improved outcomes in social domains suggest enabling conditions. Findings support the ICF checklist's clinical value and advocate for integrating environmental factors into disability care.



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    Acknowledgments


    The authors would like to thank the Aragon Regional Authority Departments of Health & Social Affairs for their institutional support, and the Arrabal Health Center for its assistance with administrative and logistic tasks. The authors would also like to express their gratitude to all the family physicians, psychiatrists, social workers, and staff of the primary care centers and nursing homes of Cinco Villas for their willingness to participate in this study.
    Financial support came from the Carlos III Institute of Health (projects EPI 1637/06 and 1530/07; Health Research Fund FIS PI06/1098 and PI07/90206), CIBERNED Network, Diputación de Zaragoza and Farasdués Foundation.

    Authors' contributions


    MC.R.G. was primarily responsible for the conceptualization and design of the study. Methodology: MC.R.G., and A.G.C.; formal analysis: MC.R.G., and A.G.C.; investigation: MC.R.G., and A.G.C.; resources: MC.R.G., A.A.L.S., and A.C.A. The remaining authors made substantial contributions to the writing, and critically reviewed and edited the manuscript. All authors have read and agreed to the published version of the manuscript.

    Conflict of interest


    The authors report no conflicts of interest to declare.

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