Maarten van Egmond

14 Chapter 1 Functional status contains aspects of different domains of the International Classification of Functioning, disability and health (ICF). 30 The World Health Organization’s ICF-framework objectively explicates functional status and is considered as a standard for describing a patient’s level of functioning in daily life. Instead of focusing on mortality and disease, the ICF rather focuses on health and functioning of an individual with a certain health condition in its context. 30 The ICF describes different domains to illustrate the impact of a patient’s health condition on daily life, where body functions, activities and participation refer to functioning and where impairments, limitations and restrictions refer to disability. Furthermore, personal- and environmental factors are described that interact within these domains (Figure 3). 29 Moreover, health-related quality of life (HRQL) may be affected by cancer treatment. 31 Research has shown that pre-and postoperative physical functioning subscales of HRQL were independent predictors of survival in patients with esophageal cancer. 32 HRQL is not a domain of the ICF, but it also needs to be taken into account to understand a patient’s subjective perception of physical functioning and health. 31 Environmental factors Personal factors Health condition (disorder/disease) Body functions & structures ( Impairment ) Activities ( Limitation ) Participation ( Restriction ) Figure 3. International Classification of Functioning, disability and health (ICF) 29 Where the evidence for the effectiveness of physical exercise training on postoperative recovery in general is substantial, there is little evidence regarding the effectiveness of physiotherapy in patients diagnosed with esophageal cancer with an indication for surgery. 2,3