Note to reader: How to read the classification

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Health states are classified using 11 attributes, each with 4 or 5 levels.  Level 1 indicates no limitations, while level 4 or 5 are the most severe limitations. Please note that these levels are a shorthand for the classification: they are not measurements on an interval scale (For instance, the difference between level 1 and level 2 is not the same as between level 3 and level 4. In addition, attributes are not equally important in terms of health state preferences. For more information on health state preferences developed from these scores, please see http://www.phac-aspc.gc.ca/phi-isp/index.html).  A complete list of the attributes and levels appears in the table that follows (Classification and Measurement System of Functional Health (CLAMES)).

As an example, we can look at two health states, the first describing the health state at diagnosis for cancers with very good prognosis and the second describing the health state for a more advanced cancer during the last month of life, during terminal care.

Individuals with early stage breast cancer (a very good prognosis) could be described by the following:

• Somewhat unhappy (level 3 of Emotional State)
• Mild limitations in the capacity to sustain social relationships (level 2 of Social Relationships)
• Moderate levels of anxiety experienced regularly (level 3 of Anxiety)

Classification (example describing the health state at diagnosis for cancers with very good prognosis)

By contrast, the following describes terminal care:

• Severe pain or discomfort (level 4 of Pain or Discomfort)
• Severe limitations in physical functioning (level 4 of Physical Functioning)
• Very unhappy (level 4 of Emotional State)
• Always feel tired, and have no energy (level 4 of Fatigue)
• Somewhat forgetful, and have some difficulty when trying to think or solve day-to-day problems (level 4 of Memory and Thinking)
• Severe limitations in the capacity to sustain social relationships (level 4 of Social Relationships)
• Moderate levels of anxiety experienced regularly (level 3 of Anxiety)
• Limitations in the use of hands and fingers, require the help of another person for some tasks (level 4 of Use of Hands and Fingers)

Classification (example describing the health state for a more advanced cancer during the last month of life, during terminal care)

Classification of the major health states in the progression and treatment of mental illnesses are provided in the summary table.

Classification and Measurement System of Functional Health (CLAMES)

Core attributes

Pain or discomfort

1. Generally free of pain and discomfort
2. Mild pain or discomfort
3. Moderate pain or discomfort
4. Severe pain or discomfort

Physical functioning

1. Generally no limitations in physical functioning
2. Mild limitations in physical functioning
3. Moderate limitations in physical functioning
4. Severe limitations in physical functioning

Emotional state

1. Happy and interested in life
2. Somewhat happy
3. Somewhat unhappy
4. Very unhappy
5. So unhappy that life is not worthwhile

Fatigue

1. Generally no feelings of tiredness, no lack of energy
2. Sometimes feel tired, and have little energy
3. Most of the time feel tired, and have little energy
4. Always feel tired, and have no energy

Memory and thinking

1. Able to remember most things, think clearly and solve day-to-day problems
2. Able to remember most things but have some difficulty when trying to think and solve day-to-day problems
3. Somewhat forgetful, but able to think clearly and solve day-to-day problems
4. Somewhat forgetful, and have some difficulty when trying to think or solve day-to-day problems
5. Very forgetful, and have great difficulty when trying to think or solve day-to-day problems

Social relationships

1. No limitations in the capacity to sustain social relationships
2. Mild limitations in the capacity to sustain social relationships
3. Moderate limitations in the capacity to sustain social relationships
4. Severe limitations in the capacity to sustain social relationships
5. No capacity or unable to relate to other people socially

Supplementary attributes

Anxiety

1. Generally not anxious
2. Mild levels of anxiety experienced occasionally
3. Moderate levels of anxiety experienced regularly
4. Severe levels of anxiety experienced most of the time

Speech

1. Able to be understood completely when speaking with strangers or friends
2. Able to be understood partially when speaking with strangers but able to be understood completely when speaking with people who know you well
3. Able to be understood partially when speaking with strangers and people who know you well
4. Unable to be understood when speaking to other people

Hearing

1. Able to hear what is said in a group conversation, without a hearing aid, with at least three other people
2. Able to hear what is said in a conversation with one other person in a quiet room, with or without a hearing aid, but require a hearing aid to hear what is said in a group conversation with at least three other people
3. Able to hear what is said in a conversation with one other person in a quiet room, with or without a hearing aid, but unable to hear what is said in a group conversation with at least three other people
4. Unable to hear what others say, even with a hearing aid

Vision

1. Able to see well enough, with or without glasses or contact lenses, to read ordinary newsprint and recognize a friend on the other side of the street
2. Unable to see well enough, even with glasses or contact lenses, to recognize a friend on the other side of the street but can see well enough to read ordinary newsprint
3. Unable to see well enough, even with glasses or contact lenses, to read ordinary newsprint but can see well enough to recognize a friend on the other side of the street
4. Unable to see well enough, even with glasses or contact lenses, to read ordinary newsprint or to recognize a friend on the other side of the street

Use of hands and fingers

1. No limitations in the use of hands and fingers
2. Limitations in the use of hands and fingers, but do not require special tools or the help of another person
3. Limitations in the use of hands and fingers, independent with special tools and do not require the help of another person
4. Limitations in the use of hands and fingers, require the help of another person for some tasks
5. Limitations in the use of hands and fingers, require the help of another person for most tasks