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...     

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...     

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《国际功能、残疾和健康分类》的功能鉴别谱

目的:为《国际功能、残疾和健康分类》(ICF)建立条目间的功能鉴别关系图谱,用于指导康复实践.方法:采用知识图谱建模和分析方法,从ICF知识库中提取每个条目的排除项,以之设立为功能鉴别关系,构建条目之间鉴别关系网络,作为功能鉴别谱.从网络中提取主组元和k-核,分析最致密的核团所持条目在世界卫生组织发布的疾病综合核心组合...     

国际功能、残疾和健康分类脑卒中核心功能组合在不同时期脑卒中患者中的应用

目的在脑卒中患者中应用ICF脑卒中核心功能组合,分析不同时期脑卒中住院患者的评估特点,为ICF脑卒中核心功能组合的临床使用提供依据。 方法根据入院先后顺序选取自愿参加本研究的50例脑卒中住院患者,病程<1个月的25例患者为急性期组,病程&rt;1个月的25例患者为亚急性和慢性期组,获取患者的一般资料,采用常用Glasgow评分、Rankin分级和Barthel指数对2组患者进行评定。应用ICF脑卒中核心功能组合对患者进行评估,各评估项目按照严重程度分级,用频数表表示,并对2组之间对应项目进行列联表2检验。应用SPSS 12.0版统计软件进行统计分析。 结果2组患者一般情况比较,大部分项目组间差异无统计学意义;2组患者Rankin分级和Barthel指数评定比较,差异有统计学意义（P<0.05）,急性期组功能状态比亚急性和慢性期组好。2组患者ICF脑卒中核心功能组合评估中个别项目,如意识、眼相邻结构功能、听、替代发声、辅助呼吸、温度调节、皮肤的保护功能等差异无统计学意义（P&rt;0.05）;亚急性和慢性期组关节活动功能、关节稳定功能、肌肉耐力功能和随意运动控制能力严重受损的人数明显多于急性期组（P<0.05）;环境因素中的绝大部分评估项目对2组患者都存在不同程度的影响。 结论ICF脑卒中的核心功能组合评估项目中的关节活动功能、关节稳定功能、肌肉耐力功能和随意运动控制能力能反映不同时期脑卒中患者的功能损伤特点。     

糖尿病国际功能、残疾和健康分类综合核心组套的图建模

目的:绘制基于国际功能、残疾和健康分类(ICF)的糖尿病功能地形图,为糖尿病的功能研究提供新的依据。方法:收集200例糖尿病患者的便利样本,以糖尿病ICF综合核心组套中的99个分类项目为变量进行图建模。缺失值以多重填补法进行填补,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强化模型的信度和效度,以R软件和Pajek2.04进行建模和分析。结果:在99个分类项目中,有61个相互联系构成了功能地形图中的最大的独立结构,并且可以解析出一个由44个分类项目组成的2-核。"s220"(眼球的结构)、"s6100"(肾)、"d760"(家庭人际关系)、"d455"(到处移动)和"d450"(步行)因连接范围较大而居于地形图的中心地位。结论:图建模所绘制的糖尿病功能地形图可以揭示功能类别之间的复杂的关系结构。这些关系结构既可以从临床知识中寻找到依据,也可以为应用ICF指导糖尿病康复的临床实践和科学研究提供线索。     

基于ICF的脑卒中吞咽障碍患者整体功能评估类目研究

目的:为弥补现有吞咽障碍量表的不足,从整体功能评估的视角,基于“国际功能、残疾、健康分类”(ICF)初步确定脑卒中吞咽障碍患者功能评估的类目。方法:检索Cochrane Library、PubMed、Ebsco、CNKI、wanfang、Sinomed等数据库中关于脑卒中吞咽障碍近10年来相关文献,由2名研究人员按照ICF标准链接规则独立对文章进行概念提取及ICF类目链接。结果:最终纳入288篇文献,去重后得到111个功能评价指标,21个功能评价量表,链接到78条ICF唯一类目,其中共有33条出现在超过5%的文献中,包括18条身体功能条目,2条身体结构条目,7条活动与参与条目,6条环境因素条目。结论:初步确定了基于ICF的脑卒中吞咽障碍全面功能评估的类目框架,后续需要进一步的临床应用和专家咨询,以期为临床患者提供综合全面的评估以及个性化、动态化的治疗与护理方案。     

国际功能、残疾和健康分类在脑卒中后吞咽功能障碍中的临床应用

目的观察国际功能、残疾和健康分类（ICF）60条吞咽障碍核心条目在临床脑卒中后吞咽功能障碍评定和治疗中的作用。 方法选取脑卒中后吞咽功能障碍患者60例,按随机数字表法分为ICF组和对照组,每组30例。ICF组患者于收治后即开始Threats 60条吞咽障碍核心条目评定,对照组患者则进行康复医学科常规吞咽功能障碍评定。评定结束后,2组患者均进行吞咽功能障碍常规康复治疗,ICF组患者在此基础上,依据ICF评估时发现的功能障碍给予相应的干预。2组患者均于治疗前、治疗4周和8周后进行洼田饮水试验分级评定,并于评估结束后行表面肌电图(sEMG)检查。 结果治疗4周和8周后,ICF组的洼田饮水试验分级分别为（2.56±0.76）级和（1.46±0.32）级,分别与组内治疗前和对照组治疗后同时间点比较,差异均有统计学意义P<0.05）;治疗4周和8周后,2组患者各肌群的吞咽时程和募集最大振幅较组内治疗前均显著改善（P<0.05）,且ICF组各肌群的吞咽时程和募集最大振幅均显著优于对照组同时间点,差异均有统计学意义（P<0.05）。 结论在常规吞咽功能障碍治疗的基础上,根据ICF Threats 60条吞咽障碍核心条目的评定结果对脑卒中后吞咽功能障碍患者进行有针对性的干预,可显著改善吞咽障碍患者的洼田饮水试验分级以及各肌群吞咽时程和募集最大振幅。     

肢体残疾分级和ICF中功能与结构的关系

198 7年全国残疾人抽样调查肢体残疾标准中 ,将肢体残疾定义为“人的四肢残缺或四肢麻痹、畸形 ,导致人体运动系统不同程度的功能丧失或功能障碍”[1] 。该定义表明 ,肢体残疾既有身体解剖结构损伤 ,又有身体生理功能损伤 ,而国际功能、残疾和健康分类 (InternationalClassificationofFunctioning ,Disabili tyandHealth ,ICF)中有关身体结构和功能的描述与该定义有何异同 ?笔者将对此予以探讨。1肢体残疾包括的内容肢体残疾包括的内容为 :①上肢或下肢因外伤、病变而截肢或先天性残缺 ;②上肢或下肢因外伤、病变或发育异常所致畸形或功…     

基于ICF的脑卒中功能障碍的测量:理论、方法及研究进展

基于《国际功能、残疾和健康分类》(ICF)和心理测量学,系统分析脑卒中功能和残疾测量工具开发和标准化的理论与方法,综述国内外基于ICF的脑卒中功能和残疾测量的最新进展。     

Social participation following a stroke: an assessment in accordance with the international classification of functioning,disability and health

Objective: Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation.

Methods: An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (<12?months or >12?months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation.

Results: Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F?=?2.46; 95% confidence interval (CI)?=??23.67–0.34; p?=?0.05), degree of functional independence (F?=?2.40; 95% CI?=??33.0 to ?18.93; p?<?0.001) and marital status (married or widowed) (F?=?2.6; p?=?0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F?=?99.2; r²?=?0.57; p?<0.001) and the occurrence of depressive symptoms was a moderate predictor (F?=12.78; r²?=?0.40; p?=?0.001).

Conclusions: Twenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the “social roles” domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke.

• Implications for Rehabilitation

• The Brazilian stroke individuals analyzed exhibited a moderate level of participation.

• Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation.

• Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life.

• Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health.

• This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice.

     

脑卒中国际功能残疾和健康分类简要核心组合的信度与效度研究

目的:分析研究脑卒中国际功能、残疾和健康分类(ICF)简要核心组合的信度和效度。方法:选择50例脑卒中患者,采用国际脑卒中ICF简要核心组合、美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动功能量表(FM)、Barthel指数(BI)进行评定。评定者间信度采用Kappa一致性分析方法;同步效度采用Spearman相关分析。结果:身体功能中的四个类目意识功能、定向功能、语言精神功能和肌肉力量功能的kappa值为0.664—1.000,信度中度到优;身体结构的类目脑的结构kappa值为0.976,信度优;活动和参与的四个类目的kappa值为0.696—0.846,信度中度到优;环境因素的类目直系亲属家庭kappa值为0.450,信度中度。ICF除"e310直系亲属家庭"外的其他项目的总分与NIHSS、Fugl-Meyer、BI评分的Spearman相关系数分别为0.795、-0.866、-0.795(P<0.01)。结论:采用国际脑卒中ICF简要核心组合对脑卒中患者进行综合评定可靠有效。     

Perceptions and attitudes towards the implementation of a disability evaluation system based on the international classification of functioning,disability, and health among people with disabilities in Taiwan

Purpose: To explore the perceptions and attitudes among people with disabilities towards the newly implemented International Classification of Functioning, Disability and Health-based disability evaluation system (the new system) in Taiwan.

Method: Using a self-administered questionnaire, we conducted a nationwide survey. The questionnaire focused on the domains of quality, satisfaction, and revision of the new system. In total, 1073 persons (age,?≥18?years) with disabilities or their primary caregivers, who experienced both the old and the new system, responded to the questionnaire.

Results: Most participants were satisfied with the new system overall (58.7%) and the subscale of quality of structure (91.3%) and quality of outcome (63.6%). However, only 20.5% of the participants were favourable to the quality of process. The probability of being satisfied with the system overall was low for the quality of process subscale (adjusted odds ratio range, 0.3?～?0.4) and its item of long interval (0.2?～?0.6). Contrariwise, the probability was high for the other subscales (3.9?～?13.7) and the item of identifying needs (21.9?～?23.4).

Conclusions: Persons with disabilities and their primary caregivers have positive attitudes towards the new system. It is important to simplify the assessment tools and procedures to improve the system’s quality of process and facilitate its usability.

• IMPLICATIONS FOR REHABILITATION

• Persons with disabilities have positive attitudes towards the newly implemented International Classification of Functioning, Disability, and Health-based disability evaluation system in Taiwan. The system that provides comprehensive information about functioning and disability of persons with disabilities is able to capture the difficulties and needs of those individuals in their daily lives. The system hence helps people to mitigate the effects of disability and guide rehabilitation.

• The assessment items and processes of the system, however, were perceived to be complicated, time-consuming, and inconvenient. Simplifying the assessment items and processes, such as developing a short form version of the assessment tool and increasing the service time, may facilitate the usability of the system.

     

《国际功能、残疾和健康分类儿童和青少年版》类目在儿童脑外伤随访中的应用

摘要 目的：通过《国际功能、残疾和健康分类儿童和青少年版》（ICF-CY）在儿童脑外伤康复评定和随访的应用的研究,促进其在康复工作中的应用。 方法：建立2009年1月—2012年1月在温州医学院附属第二医院康复科首次住院脑外伤患儿的档案,选取19个ICF-CY身体功能及活动和参与的二级类目、Barthel指数（BI）、格拉斯哥结局量表（GOS）对受伤年龄在2岁以上的患儿伤后1—2年的预后情况进行随访评定,并分别对ICF-CY与BI、GOS进行相关分析。 结果：①47例住院患儿中,有结果的随访病例数40例（85.11%）,失访人数6例,死亡人数1例,随访时间平均（16.60±4.89）个月,随访结束时平均年龄（84.63±37.52）个月。②身体功能方面,智力功能（b117）、记忆功能（b144）、步态功能（b770）恢复情况较差。活动与参与方面,精巧手的使用（d440）、四处移动（d455）、盥洗自身（d510）、学校教育（d820）/学龄前教育（d815）、参与游戏（d880）恢复情况较差。③相关性分析提示ICF-CY评分与BI得分、GOS分级呈显著负相关。 结论：ICF-CY类目作为儿童脑外伤的随访内容,可以从整体水平上评估儿童脑外伤的健康状态,但要在临床上得到广泛应用仍需要很长的路要走。     

The Environment in the International Classification of Functioning,Disability and Health

Background The World Health Organization has adopted two classifications relating to disability, one was published in 1980 and the more recent one in 2001. Although the international classification of functioning, disability and health (ICF) was drafted as a revision of the international classification of impairments, disabilities and handicaps (ICIDH), the ICF is based on major changes when compared with the ICIDH. One of them has to do with the environment. Method Quotations from the classification manuals and related articles are presented in order to make clear the scope of the environment in the ICF. Results The ICF has a universal application. The gap between capacity and performance reflects the barriers created by the environment. Conclusions In the ICF, universalism and barriers have specific meanings, reflecting specific policy choices.     

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。