This paper explores new boundaries relating to comparisons of German, Portuguese, Italian, Spanish, Chinese, and South African publications in a systematic literature review of research publications related to the International Classification of Functioning, Disability and Health (World Health Organisation, 2001, ICF) and education. New ground-breaking methodological approaches are required when comparing multi-language data from an international systematic review, similarly there are practical issues when working globally relating to cross-cultural understandings, work practices and time-zones.

This study is the outcome of a systematic literature review on the use of the ICF and its Children and Youth version (WHO, 2007, the ICF-CY) in the field of education and specifically education for children with disabilities, special educational needs and those requiring additional support in school. In 2010 Moretti, Alves, and Maxwell (Maxwell et al, 2012; Moretti et al., 2012) carried out a similar review and set the scene for how the ICF is used in the education field. In the intervening decade much has developed with the ICF and it is time for another measure of the situation. Throughout this paper we will refer the “ICF” as both the ICF (2001) and the ICF-CY (2007), unless otherwise specifically indicated. 

The ICF is a bio-psycho-social classification framework developed by the World Health Organization based on a non-categorical approach to human functioning contextualizing the functioning of an individual in their current environment without the use of ‘traditional’ categories or diagnoses. The framework incorporates 'all components of health described at body, individual and societal levels’ (WHO, 2007). The ICF is intended for all people but is particularly applicable and appropriate for persons with disability.

The term education in this article means the “development of human potential...personality, talents and creativity as well as...mental and physical abilities”(United Nations, 2006) made in a formal context, usually a school or other setting in which the main aim is not medical or clinical rehabilitation. All education levels are taken into account, from early years, compulsory schooling, further education, and lifelong learning of persons with disabilities and those working with persons with disabilities in a formal educational setting. The educational environment or setting is of importance both in terms of setting the scene in which an activity occurs and as a factor that can facilitate or hinder participation in a setting. The environment can be represented as dimensions that relate to the availability, accessibility, affordability, accommodability and acceptability of the participation situation or experience (Maxwell, 2012). By investigating the educational environment, we can shed more light on effective inclusive practices by providing more accurate representations and measures of the participation of children.

The current paper explores the methodological challenges and consequences of carrying out an international, multi-lingual, cross-comparison in-depth review of the main findings from a systematic literature search. Data come from systematic database searches using selected search terms in different languages in national databases in the partner countries. Searches were carried out in Portuguese, Italian, Spanish, English, Afrikaans, German, and Mandarin.

The main literature review aimed to explore how the ICF is currently situated in the field of education in different global contexts with a specific focus on children with disabilities, Special Educational Needs (SEN) and those requiring additional support in school. With a comparison of how the ICF is applied a different levels and processes in various global contexts, this paper aims to:

• Explore the methodological consequences of carrying out an in-depth systematic review of the ICF and education in different global contexts.
• Describe the practical implications of carrying out the review.

While the main study itself aims to explore how the ICF is situated in the field of education in different global contexts, this paper focuses specifically on the final cross-country comparison. A systematic review of the literature was carried out using database electronic searches performed during the second half of 2021 and in to 2022 analysing studies published from 2001 in English, German, Spanish, Afrikaans, Italian, Portuguese, and Chinese. Journal articles, books and book chapters, and reports were included in the initial search. Database search terms referring to the ICF components and education were combined. Each language required its own selection and refinement of search terms. The relevance of the chosen search terms was explored through discussions among the authors, with experts in the field, and expert research librarians. The search terms were chosen based on the focus of the study and current debate and were refined to include widely used variations and abbreviations. Search terms had to be related to the ICF (e.g. ICF, International Classification of functioning, environment*, personal factors, participation) and to education (school, education*, inclusion/inclusive, eligibility, goals, identification) and various abbreviations/ combinations of the phrase special education needs (SNE, SEN, “special needs”, Special Ed, SpecEd, SPED). The final searches were run after qualitative test searches to establish the suitability of the terms: four combinations of the search terms were initially trialled; however, difficulties arose relating to translating a number of the terms and concepts into the various languages involved in this study so the search string was condensed into one: • ("ICF" OR “International Classification of functioning”) AND (school OR inclus* OR SNE OR SEN OR “special needs” OR Special Ed OR SpecEd OR SPED) The string was translated into Italian, German, Portuguese, Spanish, Afrikaans, and Mandarin, and applied to various national databases. In each national context the selection of studies was then refined further using three protocols: inclusion and exclusion protocols at abstract and full text and extraction levels. Studies exploring the direct relationship between education and the ICF were sought. A multi-lingual cross-comparison between countries was then carried out where descriptive summaries of the findings based on the extraction-level protocol were translated back into English in order to provide a common working language. Initial comparisons were piloted between two of the language groups (Portuguese and Chinese) before the addition of the other language groups occurred step-wise: German, Italian, South African, the Spanish.

Articles were mainly published in special education journals. Overall, the most used ICF components are activity and participation, and environmental factors. The ICF is still used as a research tool, theoretical framework, and tool for implementing educational processes. Although the review does not report a high incidence of the use of the ICF in education, the results show that within certain local context (e.g. Portugal, Zürich, and Italy) the ICF model and classification have shown potential to be applied in education systems. In terms of the methodological consequences of carrying out an in-depth systematic review of the ICF and education in different global contexts, this study highlights the viability of such an approach if suitable consideration is taken to language translation and cultural differences. A descriptive summary of the third protocol helped enable cross-comparisons. Differences exist in cultural and linguistic understandings of things and awareness of which of these are being analysed is essential to ensure reliable data interpretation; different understandings of concepts such as disability, and personal or environmental factors are common. Diversity also varies as a concept across languages and cultures. Differences are also seen with the differing use of the ICF and whether the focus was on rehabilitation, intervention, or education. The ICF’s role in the discourse of the concept of inclusion within the field of education also varied considerably with contexts. Practical implications mainly relate to the technology of working at a distance and the real challenge of time zones – people will have work early and late when trying to meet live and online with colleagues in Brazil, Europe, South Africa, and Asia!

Maxwell, G. (2012). Bringing More to Participation: Participation in School Activities of Persons with Disability Within the Framework of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). 16 Doctoral thesis, Comprehensive summary, School of Education and Communication, Jönköping. Available online at: http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-18079DiVAdatabase Maxwell, G., Alves, I., and Granlund, M. (2012). Participation and environmental aspects in education and the ICF and the ICF-CY: findings from a systematic literature review. Dev. Neurorehabil. 15, 63–78. doi: 10.3109/17518423.2011.633108 Moretti, M., Alves, I., & Maxwell, G. (2012). A systematic literature review of the situation of the international classification of functioning, disability, and health and the international classification of functioning, disability, and health–children and youth version in education: a useful tool or a flight of fancy?. American Journal of Physical Medicine & Rehabilitation, 91(13), S103-S117. United Nations (2006). UN Convention on the Rights of Persons with Disabilities. New York, United Nations. World Health Organization (2001). International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization. World Health Organization (2007). International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY. Geneva: World Health Organization.