Journal of Occupational Rehabilitation

, Volume 21, Issue 2, pp 126–133 | Cite as

A Conceptual Definition of Vocational Rehabilitation Based on the ICF: Building a Shared Global Model

  • Reuben EscorpizoEmail author
  • Michiel F. Reneman
  • Jan Ekholm
  • Julie Fritz
  • Terry Krupa
  • Sven-Uno Marnetoft
  • Claude E. Maroun
  • Julietta Rodriguez Guzman
  • Yoshiko Suzuki
  • Gerold Stucki
  • Chetwyn C. H. Chan


Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders’ participation.


ICF Vocational rehabilitation Employment Work Concept formation Theory 



The authors would like to thank Debra Homa (Department of Rehabilitation and Counseling, University of Wisconsin-Stout, Menomonie WI, USA), Eva Schonstein (Medibank Health Solutions and The University of Sydney, Sydney, Australia), Urban Studer (Schweizerische Bundesbahnen SBB, Bern, Switzerland), and Jos Verbeek (Finnish Institute of Occupational Health, Kuopio, Finland) for serving as reviewers of the manuscript prior to submission. We also would like to thank the other members of the International Work Rehabilitation Network (i-NetWork) for their active participation during the conference on the ICF Core Set Development for Vocational Rehabilitation: Alex Burdorf (The Netherlands), Tania Buys (South Africa), Jain Holmes (UK), Stefan Koch (Germany), Jan Kool (Switzerland), Dennis Nowak (Germany), Rahel Oertli (Switzerland), Soo-Kyung Park (South Korea), Robin Pickard (UK), Stefan Staubli (Switzerland), and Frank Staudenmann (Switzerland). i-NetWork is an informal network of researchers, practitioners, and advocates whose interest is to advance the field of work rehabilitation. Special thanks to Monika Finger and Miriam Lückenkemper for reviewing the manuscript prior to submission.


  1. 1.
    International Labour Organization. About the ILO. Available from: 2010.
  2. 2.
    World Health Organization. Workers’ health: global plan of action. 60th World Assembly. WHA60.26. 2007.Google Scholar
  3. 3.
    World Health Organization. International Classification of Functioning, Disability, and Health: ICF. Geneva, Switzerland; 2001.Google Scholar
  4. 4.
    Gobelet C, Franchignoni F. Vocational rehabilitation. Paris: Springer; 2006.Google Scholar
  5. 5.
    Ellenbogen PS, Meade MA, Jackson MN, Barrett K. The impact of spinal cord injury on the employment of family caregivers. J Vocat Rehabil. 2006;25(1):35–44.Google Scholar
  6. 6.
    Boden LI. Running on empty: families, time, and workplace injuries. Am J Public Health. 2005;95(11):1894–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Williams RM, Westmorland M. Perspectives on workplace disability management: a review of the literature. Work. 2002;19(1):87–93.PubMedGoogle Scholar
  8. 8.
    Tate DG. Workers’ disability and return to work. Am J Phys Med Rehabil. 1992;71(2):92–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Kuoppala J, Lamminpaa A. Rehabilitation and work ability: a systematic literature review. J Rehabil Med. 2008;40(10):796–804.PubMedGoogle Scholar
  10. 10.
    Straaton KV, Fine PR. Addressing work disability through vocational rehabilitation services. Bull Rheum Dis. 1997;46(3):1–3.PubMedGoogle Scholar
  11. 11.
    Shrey DE. Worksite disability management model for effective return-to-work planning. Occup Med. 2000;15(4):789–801.PubMedGoogle Scholar
  12. 12.
    Briand C, Durand MJ, St-Arnaud L, Corbiere M. How well do return-to-work interventions for musculoskeletal conditions address the multicausality of work disability? J Occup Rehabil. 2008;18(2):207–17.PubMedCrossRefGoogle Scholar
  13. 13.
    Schultz IZ, Stowell AW, Feuerstein M, Gatchel RJ. Models of return to work for musculoskeletal disorders. J Occup Rehabil. 2007;17(2):327–52.PubMedCrossRefGoogle Scholar
  14. 14.
    Schultz IZ. Disentangling the disability quagmire in psychological injury: part 1- disability and return to work: theories, methods, and applications. Psychol Inj and Law. 2008;1:94–102.CrossRefGoogle Scholar
  15. 15.
    Escorpizo R, Ekholm J, Gmunder HP, Cieza A, Kostanjsek N, Stucki G. Developing a core set to describe functioning in vocational rehabilitation using the international classification of functioning, disability, and health (ICF). J Occup Rehabil. 2010;20(4):502–11.PubMedCrossRefGoogle Scholar
  16. 16.
    Peterson DB. Psychological aspects of functioning, disability, and health. New York, NY: Springer Publishing Company; 2011.Google Scholar
  17. 17.
    Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129–36.PubMedCrossRefGoogle Scholar
  18. 18.
    Peterson DB. International classification of functioning, disability and health (ICF): an introduction for rehabilitation psychologists. Rehabil Psychol. 2005;50:105–12.CrossRefGoogle Scholar
  19. 19.
    Loisel P, Durand P, Abenhaim L, Gosselin L, Simard R, Turcotte J, et al. Management of occupational back pain: the Sherbrooke model. Results of a pilot and feasibility study. Occup Environ Med. 1994;51(9):597–602.PubMedCrossRefGoogle Scholar
  20. 20.
    Franche RL, Krause N. Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors. J Occup Rehabil. 2002;12(4):233–56.PubMedCrossRefGoogle Scholar
  21. 21.
    Schultz IZ, Crook J, Meloche GR, Berkowitz J, Milner R, Zuberbier OA, et al. Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model. Pain. 2004;107(1–2):77–85.PubMedCrossRefGoogle Scholar
  22. 22.
    Feuerstein M. A multidisciplinary approach to prevention, evaluation, and management of work disability. J Occup Rehabil. 1991;1(1):5–12.CrossRefGoogle Scholar
  23. 23.
    Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ. 2010;340:c1035.PubMedCrossRefGoogle Scholar
  24. 24.
    Anema JR, Steenstra IA, Bongers PM, de Vet HC, Knol DL, Loisel P, et al. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine. 2007;32(3):291–300.PubMedCrossRefGoogle Scholar
  25. 25.
    Steenstra IA, Anema JR, van Tulder MW, Bongers PM, de Vet HC, van Mechelen W. Economic evaluation of a multi-stage return to work program for workers on sick-leave due to low back pain. J Occup Rehabil. 2006;16(4):557–78.PubMedCrossRefGoogle Scholar
  26. 26.
    Young AE, Roessler RT, Wasiak R, McPherson KM, van Poppel MN, Anema JR. A developmental conceptualization of return to work. J Occup Rehabil. 2005;15(4):557–68.PubMedCrossRefGoogle Scholar
  27. 27.
    Xu YW, Chan CC, Lam CS, Li-Tsang CW, Lo-Hui KY, Gatchel RJ. Rehabilitation of injured workers with chronic pain: a stage of change phenomenon. J Occup Rehabil. 2007;17(4):727–42.PubMedCrossRefGoogle Scholar
  28. 28.
    Li-Tsang WPC, Chan HHK, Lam CS, Lo-Hui KYL, Chan CCH. Psychosocial aspects of injured workers’ returning to work (RTW) in Hong Kong. J Occup Rehabil. 2006;17:279–88.CrossRefGoogle Scholar
  29. 29.
    Holmes J. Vocational rehabilitation. Oxford, UK: Blackwell Publishing; 2007.Google Scholar
  30. 30.
    Kielhofner G, Burke JP. A model of human occupation, part 1. Conceptual framework and content. Am J Occup Ther. 1980;34(9):572–81.PubMedGoogle Scholar
  31. 31.
    Fadyl JK, McPherson KM. Approaches to vocational rehabilitation after traumatic brain injury: a review of the evidence. J Head Trauma Rehabil. 2009;24(3):195–212.PubMedCrossRefGoogle Scholar
  32. 32.
    Trexler LE, Trexler LC, Malec JF, Klyce D, Parrott D. Prospective randomized controlled trial of resource facilitation on community participation and vocational outcome following brain injury. J Head Trauma Rehabil. 2010;25(6):440–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Bond GR. Supported employment: evidence for an evidence-based practice. Psychiatr Rehabil J. 2004;27(4):345–59.PubMedCrossRefGoogle Scholar
  34. 34.
    Pransky G, Gatchel R, Linton SJ, Loisel P. Improving return to work research. J Occup Rehabil. 2005;15(4):453–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Stucki G, Cieza A, Melvin J. The International classification of functioning, disability and health (ICF): a unifying model for the conceptual description of the rehabilitation strategy. J Rehabil Med. 2007;39(4):279–85.PubMedCrossRefGoogle Scholar
  36. 36.
    Selander J. Unemployed sick-leavers and vocational rehabilitation - a person-level study based on a national social insurance material; PhD thesis, Karolinska Institutet, Department of Rehabbilitation Medicine, Stockholm, Sweden. 1999.Google Scholar
  37. 37.
    Marnetoft S-U. The Challenges of Vocational Rehabilitation in Sweden. Kuntoutus Fin J Rehabil. 2009;4:5–10Google Scholar
  38. 38.
    Verbeek JH. How can doctors help their patients to return to work? PLoS Med. 2006;3(3):e88.PubMedCrossRefGoogle Scholar
  39. 39.
    Parker RM, Szymanski EM, Patterson JB. editors. Rehabilitation counseling: basics and beyond. 4th ed. Austin: Pro-Ed; 2005.Google Scholar
  40. 40.
    Sandqvist JL, Henriksson CM. Work functioning: a conceptual framework. Work. 2004;23(2):147–57.PubMedGoogle Scholar
  41. 41.
    MacDonald-Wilson K, Rogers ES, Anthony WA. Unique issues in assessing work function among individuals with psychiatric disabilities. J Occup Rehabil. 2001;11(3):217–32.PubMedCrossRefGoogle Scholar
  42. 42.
    Maronner J, Gandolfo C, Gold M, Hoff D. If you think work is bad for people with mental illness, then try poverty, unemployment, and social isolation. Psychiatr Rehabil J. 2000;23(2):187–93.Google Scholar
  43. 43.
    Suzuki Y, Kikuchi E, Watanabe S. Assessment of vocational opportunities and continuing job placement for persons with mental disabilities: factors indicating levels of necessary support. Work. 2008;30(2):185–94.PubMedGoogle Scholar
  44. 44.
    Council on Rehabilitation Education. Revised core accreditation standards. Section II CORE accreditation manual. 2010;1–21.Google Scholar
  45. 45.
    Imrie R. Demystifying disability: a review of the international classification of functioning, disability and health. Soc Health Illn. 2004;26(3):287–305.CrossRefGoogle Scholar
  46. 46.
    Borell L, Asaba E, Rosenberg L, Schult ML, Townsend E. Exploring experiences of “participation” among individuals living with chronic pain. Scand J Occup Ther. 2006;13(2):76–85.PubMedCrossRefGoogle Scholar
  47. 47.
    Whalley-Hammell K. Deviating from the norm: a skeptical interrogation of the classificatory practices of the ICF. Br J Occup Ther. 2004;67(9):408–11.Google Scholar
  48. 48.
    Stubbs J, Deaner G. When considering vocational rehabilitation: describing and comparing the Swedish and American systems and professions. Work. 2005;24(3):239–49.PubMedGoogle Scholar
  49. 49.
    Young AE. Return to work following disabling occupational injury - facilitators of employment continuation. Scand J Work Environ Health. 2010;36(6):473–83.PubMedCrossRefGoogle Scholar
  50. 50.
    Wasiak R, Young AE, Roessler RT, McPherson KM, van Poppel MN, Anema JR. Measuring return to work. J Occup Rehabil. 2007;17(4):766–81.PubMedCrossRefGoogle Scholar
  51. 51.
    Lagerveld SE, Bultmann U, Franche RL, van Dijk FJ, Vlasveld MC, van der Feltz-Cornelis CM, et al. Factors associated with work participation and work functioning in depressed workers: a systematic review. J Occup Rehabil. 2010;20(3):275–92.PubMedCrossRefGoogle Scholar
  52. 52.
    Sanderson K, Nicholson J, Graves N, Tilse E, Oldenburg B. Mental health in the workplace: using the ICF to model the prospective associations between symptoms, activities, participation and environmental factors. Disabil Rehabil. 2008;30(17):1289–97.PubMedCrossRefGoogle Scholar
  53. 53.
    Heerkens Y, Engels J, Kuiper C, Van der Gulden J, Oostendorp R. The use of the ICF to describe work related factors influencing the health of employees. Disabil Rehabil. 2004;26(17):1060–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Kirsh B, Krupa T, Cockburn L, Gewurtz R. A Canadian model of work integration for persons with mental illnesses. Disabil Rehabil. 2010;32(22):1833–46.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Reuben Escorpizo
    • 1
    • 2
    • 3
    Email author
  • Michiel F. Reneman
    • 4
  • Jan Ekholm
    • 5
  • Julie Fritz
    • 6
  • Terry Krupa
    • 7
  • Sven-Uno Marnetoft
    • 8
  • Claude E. Maroun
    • 9
  • Julietta Rodriguez Guzman
    • 10
  • Yoshiko Suzuki
    • 11
  • Gerold Stucki
    • 1
    • 2
    • 3
  • Chetwyn C. H. Chan
    • 12
  1. 1.Swiss Paraplegic Research (SPF)NottwilSwitzerland
  2. 2.ICF Research Branch in Cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI)NottwilSwitzerland
  3. 3.Department of Health Sciences and Health PolicyUniversity of Lucerne, and at SPFNottwilSwitzerland
  4. 4.Center for Rehabilitation and Department of Rehabilitation MedicineUniversity Medical Center GroningenGroningen/HarenThe Netherlands
  5. 5.Department of Clinical Sciences DSKarolinska InstitutetStockholmSweden
  6. 6.Department of Physical TherapyUniversity of Utah College of HealthSalt Lake CityUSA
  7. 7.School of Rehabilitation TherapyQueen’s UniversityKingstonCanada
  8. 8.Department of Health SciencesMid Sweden UniversityÖstersundSweden
  9. 9.American University of Beirut Medical CenterBeirutLebanon
  10. 10.Occupational Health Graduate Program, Faculty of MedicineUniversidad El BosqueBogotaColombia
  11. 11.Tokyo Metropolitan Rehabilitation Center for the Physically and Intellectually DisabledMejiro UniversityTokyoJapan
  12. 12.Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityHong KongChina

Personalised recommendations