超重和肥胖多囊卵巢综合征功能变量关系结构解析

目的:构建反映多囊卵巢综合征(PCOS)功能变量间关系结构的图模型,分析其结构特征,为PCOS康复的临床和科研提供新依据。方法:肥胖或超重PCOS患者57例,以肥胖的国际功能、残疾和健康分类(ICF)综合核心组套的109个分类项目为变量。采用"最小的绝对缩减和变量选择算子"发掘变量之间的条件依存关系,采用自举法重采样技术和置信区间检验法来加强模型的稳定性,以R软件和Pajek2.04建模。采用Ucinet6.360和Pajek2.04对建成的模型进行组元分析、聚类分析和k核解析。结果:在最终构建的图模型中,有17对两两相连的双项目结构。有31个项目相互联系构成了图模型中最大的独立组元,其中b650(月经功能)与b555(内分泌腺功能)和e580(卫生的服务、体制和政策)相连,而b555还与s580(内分泌腺结构)、s630(生殖系统的结构)、e455(与卫生有关专业人员的个人态度)和e465(社会准则、实践和观念)相关。对该主组元的马可夫聚类分析可得到10个聚类。b126(气质和人格功能)是图模型中最具影响力的ICF项目,其所属聚类也是影响力最大的聚类。结论:PCOS功能变量间存在复杂的关系结构。图建模可以揭示其中的结构特征,从中可以找到符合已有临床知识的结构特征,并且可以为应用ICF指导PCOS康复的临床实践和科学研究提供新的线索。     

基于图模型的脑卒中功能变量关系结构探析

目的:为国际功能、残疾和健康分类(ICF)在脑卒中康复中的应用提供新思路和新依据。方法:选取100例脑卒中患者组成的便利样本,访谈法评定国际版脑卒中ICF综合核心组合的166个条目。以条目为节点,条目间的风险相关性为连线,构建图模型。采用R软件(3.2.2版)建模,用Pajek64(5.02版)进行网络分析和可视化。结果:在图模型总体内,存在主组元结构,并且可以从中提取具有稳定路径结构的3-核结构。主组元中还可以提取具有牢固连接关系的主岛屿结构。其中"d450步行"既属于通用组合,又属于简要核心组合,并且占据了重要位置。简要核心组合条目在总图中的子网络,以及这些条目在各级限定值上的频数分布,可以提供相互参照和相互补充的功能变量知识。结论:ICF综合核心组合的图模型,可反映脑卒中功能变量间的复杂关系结构。该组合的频数分布,可反映卒中功能变量的属性特征。从关系结构和属性特征两个不同视角进行分析,可以为ICF的康复应用提供综合策略。     

失语症第三方残疾功能变量的网络图分析

目的:构建失语症第三方残疾功能变量间相关关系的图模型,分析其网络特征,为失语症及其第三方残疾康复提供新的研究思路。方法:参考国外相关文献及综述,选取失语症第三方残疾功能变量的64个ICF条目,采用访谈法评估30例受试者的功能变量。构建图模型时,以每个条目作为节点,各条目间的风险相关性作为连线。建模采用R软件(3.6.2版),网络分析可视化采用Pajek软件(5.08版),用马赛克图表示各条目在各级限定值上的频数分布。结果:64个条目中,有14对两两相连的双条目组元,有18个相互联系的条目构成的功能地形图中最大的独立结构,为主组元结构。其中d855(无报酬的就业)占据了重要位置,分别与d920(娱乐与休闲)、b1263(精神稳定性)和e5750(全社会的支持服务)相连。双条目组元及主组元网络结合条目在马赛克图上的频数分布,既可以提供功能变量间的网络关系,又可以提供自身的属性特征,二者相互参照,以提供更多元的康复思路。结论:采用ICF功能变量构建的图模型,可反映失语第三方残疾功能变量间的复杂关系网络。各功能变量的频数分布,可反映属性特征。从这两个不同的角度进行相关分析,可以为疾病的康复提供多视角的策略。     

中国版简明版糖尿病《国际功能、残疾和健康分类》核心要素的初步探讨

目的:初步确定中国版简明版糖尿病《国际功能、残疾和健康分类》(ICF)核心要素。方法:选取50例糖尿病患者。采用两种调查问卷记录患者信息,按ICF限定值评定患者每一分类项目的严重程度,统计每一个分类项目的频率,将频率≥30%的ICF分类项目提取形成初步临床调查结果,将这些分类项目整合成专家调查问卷发给13位康复专家和12位内分泌专家,本研究设定的专家调查取舍点为50%,即将半数以上专家认为与糖尿病患者非常相关的分类项目保留作为最终结果。结果:最终确定的中国版简明版糖尿病ICF核心要素共51项,其中2级分类43项,3级分类8项。身体功能分类28项,身体结构分类4项,活动和参与分类5项,环境因素分类14项。结论:通过本研究初步确定了中国版简明版糖尿病ICF核心要素。     

简明版骨质疏松国际功能、残疾和健康分类核心分类组合的信效度研究

目的:探讨简明版骨质疏松国际功能、残疾和健康(ICF)核心分类组合的信度和效度。方法:122例骨质疏松症患者进行简明版骨质疏松ICF核心分类组合和欧洲骨质疏松症基金会生活质量问卷(QUALEFFO-41)评定。信度研究采用重测信度、观察者间信度和内部一致性信度,效度研究采用效标效度、结构效度和内容效度。重测信度和观察者间信度检验采用组内相关系数(ICC);内部一致性检验采用Cronbachα值分析;效标效度用Spearman相关;内容效度应用德尔菲法;结构效度采用因子分析法。结果:(1)信度:重测信度ICC 0.762—0.921;观察者间信度ICC 0.781—0.941;内部一致性信度Cronbachα系数0.953。(2)效度:校标效度:简明版骨质疏松ICF核心分类组合中功能和残疾部分总分与QUALEFFO-41总分呈中度相关(r=0.654);内容效度:经德尔菲法确定内容效度好;结构效度:公因子1包括条目d430、d450和d920,公因子2包括条目b710、b730、s750、s760,公因子3包括条目e110、e355、e580,公因子4包括条目b152、b280。结论:简明版骨质疏松ICF核心分类组合的信度、校标效度和内容效度较好。除b710和b730、s750和s760归为同一维度外,其余条目的结构效度与目前ICF成分结构一致。     

ICF通用组合在中国人群临床应用中的效度研究

目的:探讨ICF通用组合在中国人群临床功能评估中的结构效度,为其临床应用提供依据。方法:采用ICF通用组合功能评估量表,于入院和出院时两个时间点对来自全国21个省份和自治区50家医院康复医学科、神经内科或脑外科、心血管科、呼吸科和骨科4510名患者进行评估。所得数据用于评价ICF通用组合在临床功能评估中的结构效度。结果:"d850有报酬的就业"不适用于NRS评分,缺失值较大。除去此项,患者出院时ICF通用组合评分(15.25±13.48)分,低于入院时(23.76±15.15)分,差异有显著性意义(P0.001)。探索性因子分析结果表明,抽取特征根1的公因子共有2个,累积贡献率为78.018%。采用结构方程模型方法,拟合了"b130能量和驱力功能"、"b152情感功能"、"b280痛感"、"d230执行日常事务"、"d450步行"、"d455到处移动"关系模型,结构方程模型调整的拟合优度指数RMSEA=0.026,NFI=0.999,CFI=0.999,AGFI=0.994,模型较好的拟合了数据。结论:ICF通用组合能反映出、入院时患者的不同功能状态且其结构效度良好,是一种临床上有效的测量患者功能状态的工具。     

孤独症谱系障碍儿童《国际功能、残疾和健康分类》功能变量关系图模型探析

目的:在世界卫生组织(WHO)发布的孤独症谱系障碍(ASD)核心组合基础上,建立反映功能变量关系图模型,探索ASD治疗的ICF靶条目。方法:ASD便利样本77例,0-5岁和6-16岁患儿共有ICF组合条目67条。根据条目的频数计算障碍率。通过图建模建立条目间风险相关关系网络,继而进行主岛屿提取、k-核解析和网络参数(点度、介数、接近度和拉普拉斯度)计算。分析障碍率与网络参数之间的相关关系,并对k-核结构进行可视化分析。结果:障碍率在10%-90%的34个ICF条目借助风险相关关系处于主岛屿结构中。条目的障碍率与各个网络参数之间无明显相关关系。从核心网络中提取的关键条目具有中等程度的障碍率(0.4-0.8),以其作为可干预的ICF靶条目符合已有的ASD治疗认识。结论:基于频数分析的ICF条目障碍率和基于图建模的网络参数之间无明显相关关系,在核心组合基础上建立功能图谱,并从中提取核心网络和关键条目,有可能为发掘可干预ICF靶条目提供新思路。     

基于循证和《国际功能、残疾和健康分类（ICF）》确定慢性心力衰竭功能评估类目的研究

目的:初步确定慢性心力衰竭(CHF)患者功能评估的《国际功能、残疾和健康分类(ICF)》类目。方法:检索Cochrane Library、PubMed、Embase、CNKI、WanFang、CBM数据库近5年有关CHF的临床研究,由两名研究员按照标准链接规则独立进行指标的概念提取、ICF类目链接。结果:最终纳入116篇文献,去重后得177个功能评价指标,链接到116条ICF二级类目,其中66条出现在5%以上的文献中(25个身体功能,2个身体结构,31个活动与参与,8个环境因素)。频数最高的6个ICF类目分别为b410心脏功能(n=90)、s410心血管系统结构(n=49)、b415血管功能(n=43)、b440呼吸功能(n=41)、b455运动耐受功能(n=40)、d450步行(n=40)。结论:链接到较多的ICF类目反应CHF患者功能损伤的异质性,同时确定了ICF可以作为对该类患者全面功能评估的框架,进一步的临床调查与Delphi专家咨询可以为构建CHF-ICF核心组合提供科学依据,有利于后续开展基于综合评估的CHF患者个体化、详尽化、动态化的治疗与护理措施。     

《国际功能、残疾和健康分类》在比较骨关节炎-功能-计算机适应性测试内容评估中的应用

目的:将新型膝髋骨关节炎功能结局测量工具骨关节炎-功能-计算机适应性测试(OA-FUNCTION-CAT)与《国际功能、残疾与健康分类》(ICF)进行内容匹配。比较OA-FUNCTION-CAT、骨关节炎测量量表(WOMAC)与ICF骨关节炎核心分类的一致性。方法:基于国际最新的ICF匹配原则,两个相互独立的医疗卫生人员将OA-FUNCTION-CAT测量工具与ICF进行内容匹配,当结果不一致时,由第三位医疗卫生人员介入并完成最后决策。通过计算kappa系数确定两医疗人员的匹配一致性。结果:OA-FUNCTION-CAT测量工具的125个项目包含279个概念,全部能与ICF类目的二级水平匹配。其中125个概念属于b身体功能,占44.80%,140个能与d活动与参与相匹配,占50.18%,余下14个属于e环境因素,占5.02%。279个概念中仅有21个未能与骨关节炎ICF核心分类匹配。一级水平kappa系数为0.98,95%CI为0.95—0.99;二级水平kappa系数为0.89,95%CI为0.84—0.93。结论:OA-FUNCTION-CAT中的绝大多数概念可与ICF以及ICF骨关节炎核心分类建立联系,主要应用于测量髋膝骨关节炎疼痛和具体活动形式。     

中国版脑外伤意识清醒期简明国际功能、残疾和健康分类核心要素的初步研究

目的:初步确定中国版脑外伤意识清醒期简明国际功能、残疾和健康分类(ICF)的核心要素。方法:选取100例脑外伤意识清醒期患者。1临床调查结果:采用调查问卷记录患者信息,统计每一个分类项目的频率,将频率≥30%的ICF分类项目提取形成临床调查结果;2专家调查结果:将包含139项ICF二级分类项目的调查表发给47位专家进行调查,要求专家选取认为与脑外伤患者相关性较强的100项,设定专家调查取舍点为50%,即将半数以上专家选择的,认为与脑外伤患者非常相关的分类项目保留作为专家调查结果;3取临床调查结果和专家调查结果的交集;4将该结果与通用版ICF项目进行整合,作为最终的结果。结果:最终确定的中国版脑外伤意识清醒期简明ICF核心要素共29项,其中身体功能分类10项,身体结构分类1项,活动和参与分类10项,环境因素分类8项。结论:通过本研究初步确定了中国版脑外伤意识清醒期简明ICF核心要素的组成。     

Assessing observer agreement when describing and classifying functioning with the International Classification of Functioning, Disability and Health.

OBJECTIVE: The International Classification of Functioning, Disability and Health (ICF) is used increasingly to describe and classify functioning in medicine without being a psychometrically sound measure. All categories of the ICF are quantified using the same generic 0-4 scale. The objective of this study was to assess observer agreement when describing and classifying functioning with the ICF. DESIGN: A second-level category of the ICF, d430 lifting and carrying objects, was used as an example. To the qualifiers of this category, clinically meaningful definitions were assigned. Data were collected in a cross-sectional survey with repeated measurement. We report raw, specific and chance-corrected measures or agreement, a graphical method and the results of log-linear models for ordinal agreement. SUBJECTS/PATIENTS: A convenience sample of patients requiring physical therapy in an acute hospital. RESULTS: Twenty-five patients were assessed twice by 2 observers. Raw agreement was 0.52. Kappa was 0.36, indicating fair agreement. Different hierarchical log-linear models indicated that the strength of agreement was not homogeneous over all categories. CONCLUSION: Observer agreement has to be evaluated when describing and classifying functioning using the ICF Qualifiers'scale. When assessing inter-observer reliability, the first step is to calculate a summary statistic. Modelling agreement yields valuable insight into the structure of a contingency table, which can lead to further improvement of the scale.     

Validation of the extended ICF core set for stroke from the patient perspective using focus groups

Purpose: The extended international classification of functioning, disability and health (ICF) core set for stroke is an application of the ICF of the World Health Organisation (WHO) with the purpose to represent the typical spectrum of functioning of persons with stroke. The objective of the study was to add evidence to the validation of the extended ICF core set for stroke from the perspective of patients using focus groups to explore the aspects of functioning and health important to persons with stroke. Method: The sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. After qualitative data analysis, the resulting concepts were linked to ICF categories and compared to the categories included in the extended ICF core set for stroke. Results: Sixty patients participated in 15 focus groups. The content of 131 out of 166 ICF categories contained in the extended ICF core set for stroke was reported by the persons with stroke. The content of 31 additional categories that are not covered in the extended ICF core set for stroke was raised. Conclusions: The existing version of the extended ICF core set for stroke could be confirmed almost entirely from patient perspective.

Implications for Rehabilitation:

• The extended ICF Core Set for stroke can be used to create a functioning profile for persons after stroke to identify problems and resources considering a client-centred approach.

• This study shows which aspects of the environment of persons after stroke are relevant from the clients’ perspective and should be integrated in the rehabilitation process.

• This study provides a basis for the further development of the ICF, especially with regard to its update in relevant aspects from clients’ perspective after stroke.

     

社区环境下2型糖尿病三种运动相关干预模式健康效益的系统综述

目的 基于世界卫生组织《国际功能、残疾和健康分类》(ICF)构建社区环境下2型糖尿病三种运动相关干预模式健康效益的范畴及研究架构,系统综述社区环境下2型糖尿病患者3种运动相关干预模式、干预方案及其健康效益。     

Identification of problems in the functioning of individuals with schizophrenia from the expert perspective: an Internet-based survey

Purpose: The purpose of the study was to identify aspects of functioning and related environmental factors that are relevant to schizophrenia from the perspective of health professionals experienced in treating individuals with this disorder using the International Classification of Functioning, Disability and Health (ICF).

Method: An international pool of experts from diverse health care disciplines was surveyed to identify problems in functioning experienced by individuals with schizophrenia and the environmental factors that impact their functioning. On the basis of established rules, all answers were translated to the ICF by two independent researchers.

Results: One-hundred and eighty-nine experts from all six World Health Organization regions identified 4776 meaningful concepts, of which 92% were linked to 347 different ICF categories. Of the 347 categories, 194 were second-level categories, 151 were third-level categories and 2 were fourth-level categories. Ninety-five second-level ICF categories, 43 third-level categories and 1 fourth-level category reached percentage frequency of at least 5%. The majority of the categories were attributed to body functions, activities and participation, and environmental factors.

Conclusions: Health professionals identified a wide range of problems in functioning that reflect the complexity and breadth of schizophrenia, specifically activity limitations and participation restrictions that are particularly relevant for individuals with schizophrenia. Knowing these functioning problems can guide the design of patient-oriented rehabilitation programmes.

• Implications for rehabilitation

• Schizophrenia may result in impaired functioning in multiple daily life activities. The International Classification of Functioning, Disability and Health (ICF) can help in identifying the needs and problems of these individuals.

• The reported list of ICF categories can facilitate a systematic application of the ICF in schizophrenia and can help to design and implement coordinated and patient oriented rehabilitation programmes with a biopsychosocial approach.

• According to health professionals surveyed, activity limitations and participation restrictions are broadly affected in this population and are highly influenced by neurocognitive and social cognitive deficits and environmental factors.

     

肥胖康复流程与肥胖国际功能、残疾和健康分类核心组套的对比研究

目的:探索利用肥胖国际功能、残疾和健康分类(ICF)核心组套评价我科肥胖康复干预流程。方法:应用标准的ICF联系规则,将我科肥胖的临床康复流程与ICF核心组套相匹配。结果:在"身体功能"、"身体结构"、"活动和参与"、"环境因素"四大方面,匹配条目数分别为23条,24条,3条,11条,其中客观评价匹配所占比例分别为82.61%、90.91%、79.17%、100%。匹配的总条目数为61条,占肥胖ICF综合组套109条的55.96%。"身体结构"和"环境因素"的评估分别由临床医生和康复治疗师全部承担,"身体功能"和"活动和参与"的评估主要由康复治疗师承担,也有临床医生参与其中。结论:目前我科肥胖的临床康复流程基本符合WHO肥胖ICF核心组套的要求,在身体结构和环境因素方面还需完善。     

Development of the MG-DIS: an ICF-based disability assessment instrument for myasthenia gravis

Abstract

Purpose: To develop a preliminary version of a disease-specific, patient-reported disability assessment instrument for myasthenia gravis (MG) based on the International Classification of Functioning, Disability and Health (ICF): the MG-DIS. Methods: Five consecutive steps were taken: literature review and selection of outcome measures; linking of measures’ concepts to ICF categories and selection of those reported by 30% of the instruments; comparison of linking results with a previous selection of MG-relevant ICF categories; patient interview; development of questions based on retained ICF categories. Results: Thirty-one papers containing 21 different outcome measures were found: 13 ICF categories were linked to them. Fifty-five items were retained after the comparison with the list of MG-specific categories, and were used for patient interview. Thirteen interviews were conducted before saturation of data was reached and the final list was composed of 42 categories: based upon them, 44 questions were developed. Conclusions: The preliminary version of the MG-DIS contains more information than each single MG-specific tool, in particular, for the component of environmental factors. Further research is needed to test its psychometric properties.

• Implications for Rehabilitation

• It is important that patient-reported outcome is incorporated in MG patient’s assessment.

• MG features can be evaluated with ICF-based methods.

• An MG-specific patient-reported disability assessment instrument can be used to monitor changes of functioning in patients on MG-specific treatments, and can be used in clinical trials as outcome measure.