Abstract:

Objective To systematically compare five physical disability-related standards widely used in the fields of insurance, work related injury, forensic appraisal, and disability evaluation. The comparison covers definition, coding, classification, grading, and assessment methods to reveal each standard's framework and methodology, and to provide evidence for integrating and optimizing physical disability standards.

Methods Based on International Classification of Functioning, Disability and Health (ICF) and International Classification of Diseases, 11th Revision (ICD-11), we analyzed and compared five physical disability-related standards, including Disability Assessment and Code for Life Insurance (Insurance Standard), Grading of Disability due to Human Body Injury (Judicial Standard), Standard for Identify Work Ability—Gradation of Disability Caused by Work-related Injuries and Occupational Diseases (Work Injury Standard), Standard for Assessment of Disability Grades of Military Personnel(Military Standard), and Classification and Grading Criteria of Disability (Disability Classification Standard). We examined definition, coding systems, classification, grading scales and assessment.

Results According to the ICF framework, at the level of body functions and structures, physical disability mainly involved neuromusculoskeletal and movement related functions (b7), including joint and bone functions (b710-b729), muscle functions (b730-b749), and movement functions (b750-b789). At the activities and participation level, it primarily concerned mobility (d410-d499) and self care (d510-d599). Related conditions were commonly found in Certain infectious or parasitic diseases (01), Diseases of the nervous system (08), Diseases of the musculoskeletal system or connective tissue (15), Developmental anomalies (20), and Injury, poisoning or certain other consequences of external causes (22), etc. Among the five standards, only Disability Classification Standard explicitly defined physical disability, yet its terminology did not followed ICF categories. Regarding coding, only the Insurance Standard adopted ICF codes; and the other four used self devised coding systems. The sub categories in these physical disability standards did not fully cover all ICF categories relevant to physical disability. In terms of grading, Disability Classification Standard used a four level grading, whereas the other four standards employed ten level grading. Concerning assessment, all five emphasized evaluation of body structures and functions and involved daily activity capacity; however, WHO Disability Assessment Schedule (WHODAS 2.0) for comprehensive functional assessment, had not been proposed for evaluation of general functioning.

Conclusion China has developed different physical disability standards to meet diverse needs. There are differences in definition, structure and content. It is necessary to revise and refine the relevant components of physical disability, including definition, classification, grading, coding and assessment, based on ICF and ICD-11, and to introduce WHODAS 2.0 as a comprehensive functional assessment tool.

Key words: physical disability, classification, grading, assessment, International Classification of Functioning, Disability and Health