Applying the who ICF framework to the outcome measures used in the evaluation of long-term clinical outcomes in coronavirus outbreaks

Kajal Patel, Sofia Straudi, Ng Yee Sien, Nora Fayed, John L. Melvin, Manoj Sivan

Research output: Contribution to journalArticlepeer-review


(1) Objective: The World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) classification is a unified framework for the description of health and health-related states. This study aimed to use the ICF framework to classify outcome measures used in follow-up studies of coronavirus outbreaks and make recommendations for future studies. (2) Methods: EMBASE, MEDLINE, CINAHL and PsycINFO were systematically searched for original studies assessing clinical outcomes in adult survivors of severe acute respiratory distress syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease-19 (COVID-19) after hospital discharge. Individual items of the identified outcome measures were linked to ICF second-level and third-level categories using ICF linking rules and categorized according to an ICF component. (3) Results: In total, 33 outcome measures were identified from 36 studies. Commonly used (a) ICF body function measures were Pulmonary Function Tests (PFT), Impact of event scale (IES-R) and Hospital Anxiety and Depression Scale (HADS); (b) ICF activity was 6-Minute Walking Distance (6MWD); (c) ICF participation measures included Short Form-36 (SF-36) and St George’s Respiratory Questionnaire (SGRQ). ICF environmental factors and personal factors were rarely measured. (4) Conclusions. We recommend future COVID-19 follow-up studies to use the ICF framework to select a combination of outcome measures that capture all the components for a better understanding of the impact on survivors and planning interventions to maximize functional return.
Original languageEnglish
Pages (from-to)1-15
Number of pages15
JournalInternational Journal of Environmental Research and Public Health
Issue number18
Publication statusPublished - 5 Sept 2020


  • COVID-19
  • Exercise tolerance
  • Follow-up studies
  • Lung function
  • MERS
  • Mental health
  • Outcome measures
  • Prevalence
  • Quality of life
  • SARS


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