构建基于ICF的功能和残疾评定的理论和方法

《国际功能、残疾和健康分类》(ICF)是世界卫生组织发布的核心分类之一。本研究探讨了根据ICF的生物-心理-社会模式建立功能和残疾评定的统一的理论基础和术语系统,以及开发标准化功能和残疾评定工具的理论与方法。     

基于ICF的失能评估工具在临床应用中的信度研究

目的:验证基于国际功能、残疾和健康分类(ICF)的功能评定工具在失能评估中的信度。方法:选取江苏钟山老年康复医院存在功能障碍的住院患者371例参与本研究,以基于ICF的功能评定工具对患者进行失能评估,以数字化评定量表(0～10分)评估条目失能程度。分析失能评定工具的内在一致性、评估者间信度、评估者内信度。结果:基于IC...     

基于ICF构建学习障碍儿童功能分析与运动康复方案研究

目的 应用《国际功能、残疾和健康分类》(ICF)对学习障碍儿童的整体功能特点进行分析,并制定个别化运动康复方案。方法 基于ICF的理论架构和ICD-11的疾病诊断,从儿童发展和成长的角度,对学习障碍儿童的认知、理解、注意和思维等功能进行分析,并根据“生物-心理-社会”的健康模式及身体活动的身心交互理论,构建针对学习障碍儿童以功能为导向的个别化运动康复方案。结果 学习障碍儿童的身体功能障碍集中表现在精神功能方面,在活动和参与方面体现为学习和应用知识、完成一般任务、与人交流等的活动受限和参与局限,且学校环境中的教育用品和技术及其服务、政策和体制等因素也都会影响学习障碍儿童。运动康复有利于学习障碍儿童改善精神和运动功能,并有效提升智力、认知、注意力、沟通、活动等能力,促进儿童全面发展。根据《WHO关于身体活动和久坐行为的指南》以及相关国家身体活动指南中针对儿童的部分,选取适合学习障碍儿童的运动方案,进行中等强度到高强度的身体活动至少每天60 min,以及每周不少于3次的高强度训练,配合适宜的体育游戏和休闲体育活动可有效改善学习效果,降低学习障碍影响。结论 运用ICD-11和ICF对学习障碍儿童的疾病、功能障碍和运动特点进行系统分析,基于身心交互作用理论和ICF的生物-心理-社会的健康模式,建立了整体康复和功能导向的运动康复方案,这些方案推荐每天进行至少60 min的中等强度身体活动,包括有氧运动和体育游戏等,以及每周至少3次且时长不低于30 min的高强度身体活动,包括肌力训练和体育竞赛等。结合儿童的学习障碍和运动功能特点,制定基于功能的个别化运动康复方案,可有效改善学习障碍儿童认知、注意和思维等功能,改善学习障碍,促进儿童的全面发展。     

Conceptualizing the Construct of Participation in Adults With Disabilities

Participation is a key indicator of health and well-being and a critical rehabilitation goal for individuals with disabilities. Despite the numerous participation measures that have been developed, there is still an absence of agreement on the definition, domains, and dimensions of this construct. The result is that instruments intending to measure the same construct may actually measure quite different aspects of daily life and therefore yield significantly different findings. A solid conceptual model is needed to provide consistent guidance for measurement selection and development. In this article we identify the relevant content areas of participation and propose a conceptual model for adults that is intended to apply across diagnoses, conditions, and settings. We classified participation into 3 main domains: work and education, household, and community. Subdomains are defined within each. The model was reviewed using a semistructured survey by 8 rehabilitation measurement experts. Their feedback regarding the relevance, clarity, and comprehensiveness of the model led to the creation of an alternative structure in which the 3 main domains were recategorized as productivity, social, and community. The proposed conceptual model provides a clear framework for practitioners and researchers to understand the concept of participation and to guide selection or development of measures.     

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。     

基于ICF智力与发展性障碍儿童体质健康研究

目的 探讨接受特殊教育的智力与发展性障碍儿童体质健康功能状况及影响因素,基于《国际功能、残疾和健康分类》(ICF)建立结构化的体质分析与运动干预方案。方法 基于ICF架构和方法,分析智力与发展性障碍学生功能状态和体质特点以及影响因素,参照世界卫生组织(WHO)身体活动指南要求,构建基于功能的智力与发展性残疾儿童体质干预方案。结果 基于ICF对智力与发展性障碍儿童的整体功能状态,特别是与智力残疾相关智力功能、活动和参与以及环境因素进行系统分析,并且结合相关的运动功能和体质健康进行讨论。基于ICF,参照《WHO关于身体活动和久坐行为的指南》(儿童青少年)制定身体活动方案,研究相关的适应性支持策略。结论 基于ICF可以对智力与发展性障碍儿童进行整体功能状态分析,涉及身体功能(包括智力功能和运动功能)、活动和参与以及环境因素。基于《WHO关于身体活动和久坐行为的指南》和ICF架构,构建了适用于智力与发展性障碍儿童的针对体质健康的身体活动方案,以及实施方案的适应性和支持性教学与训练方法。     

脊髓损伤护理相关《国际功能、残疾和健康分类》类目的初步研究

目的:确定与脊髓损伤患者护理相关的《国际功能、残疾和健康分类》(ICF)类目。方法:首先在数据库中检索与脊髓损伤患者护理相关的文献,根据ICF的联系规则将文献中结局评价方法里的概念与ICF类目相联系,从而确定文献中与脊髓损伤护理相关的ICF类目。系统性回顾所得ICF类目和一个世界范围内的Delphi专家调查的结果合并,形成国内专家咨询问卷。然后在我国脊髓损伤护理专家中通过电子邮件的形式进行调查。获得80%以上专家认同的ICF类目将被纳入脊髓损伤护理相关ICF组合。结果:系统性回顾确定了72个ICF类目,将这些ICF类目与世界范围内的Delphi专家调查结果合并,形成了包含140个ICF类目的专家咨询表。共有29位国内脊髓损伤护理专家参与了调查,专家积极系数为96.7%,专家的权威系数范围是0.68—1(中位数0.98,四分位距0.86—0.99)。最终81个ICF类目被纳入,包括"身体功能"33个,"身体结构"8个,"活动和参与"24个,"环境因素"6个,"个人因素"10个。结论:初步确定的81个脊髓损伤护理相关ICF类目能够反映中国脊髓损伤护理实践的主要内容,为临床护士应用ICF提供了依据和范围。     

汉语失语症国际功能、残疾和健康分类核心类目初探

目的:初步确定汉语失语症国际功能、残疾和健康分类(ICF)核心类目.方法:参考国外相关文献,选取66个失语症相关ICF类目,根据每个类目设计相关问题并将所有问题制成问卷.由研究人员根据该问卷对50例脑卒中后失语症患者进行定性访谈,将超过30％失语症患者认为对自己有影响的类目制成核心类目Ⅰ.向35名康复科卫生工作人员发送...     

Reproducibility of the items on the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning,Disability and Health

Purpose: To evaluate the reproducibility of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the International Classification of Functioning, Disability and Health (ICF) and analyse the correlation between the subscore of these 26 items and the total SS-QOL score.

Methods: Seventy-five stroke survivors participated in this study. Reproducibility was evaluated using the intraclass correlation coefficient (ICC_2,1), standard error of measurement (SEM), minimum detectable change (MDC) and the Bland–Altman plot. The correlation between the subscore of the 26 items and the total SS-QOL score was analysed using Spearman’s correlation coefficients (rho) and simple linear regression. An alpha risk?≤?0.05 was considered for all analyses.

Results: The SS-QOL items that address the participation component of the ICF demonstrated excellent reliability (intra-rater ICC_2,1?=?0.96; inter-rater ICC_2,1?=?0.95). The SEM and MDC were adequate. The Bland–Altman plot demonstrated satisfactory agreement. A significant and strong correlation (rho?=?0.83) was found between the 26 SS-QOL items that address participation and the total SS-QOL score. Moreover, the evaluation of participation was found to explain 73% of the evaluation of health-related quality of life.

Conclusion: The 26 SS-QOL items that address the participation component of the ICF demonstrated adequate reproducibility. Thus, participation, which represents the social aspects of functionality, can be adequately evaluated with these items.

• Implications for Rehabilitation

• The 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke.

• The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals.

• The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke.

     

The International Classification of Functioning, Disability and Health (ICF) and nursing

Background.  Nursing conceptualizes disability from largely medical and individual perspectives that do not consider its social dimensions. Disabled people are critical of this paradigm and its impact on their health care.
Aim.  The aims of this paper are to review the International Classification of Functioning, Disability and Health (ICF), including its history and the theoretical models upon which it is based and to discuss its relevance as a conceptual framework for nursing.
Method.  The paper presents a critical overview of concepts of disability and their implications for nursing and argues that a broader view is necessary. It examines ICF and its relationship to changing paradigms of disability and presents some applications for nursing.
Conclusion.  The ICF, with its acknowledgement of the interaction between people and their environments in health and disability, is a useful conceptual framework for nursing education, practice and research. It has the potential to expand nurses' thinking and practice by increasing awareness of the social, political and cultural dimensions of disability.     

Linking of assessment scales for women with urinary incontinence and the International Classification of Functioning,Disability and Health

Purpose: This study aimed to link the content of four most used questionnaires to assess the quality of life of women with urinary incontinence (International Consultation on Incontinence Questionnaire; King's Health Questionnaire; Incontinence Quality of Life Questionnaire and Bristol Female Urinary Tract Symptoms Questionnaire) with the International Classification of Functioning, Disability and Health (ICF).

Methods: Linking the questionnaires content and the ICF was performed by two independent reviewers, with an excellent concordance level (k?=?0.941), using the method described by Cieza et al.

Results: A total of 94 items were analyzed, in which 154 meaningful concepts were identified and linked to 48 ICF categories, of which 49% were from activities and participation component (d) and 36.8% from body functions (b).

Conclusions: The scales are linked with the classification at different levels. The International Consultation on Incontinence Questionnaire was the most limited instrument. Bristol Female Urinary Tract Symptoms Questionnaire and Incontinence Quality of Life Questionnaire presented greater agreement with the ICF, but the concepts in their items are mostly linked to body functions, denoting a biomedical vision. King’s Health Questionnaire demonstrated greater affinity with the ICF, and most concepts were related to the activities and participation categories, approaching more effectively the biopsychosocial model.

• Implications for Rehabilitation

• Choosing the right instrument to assess the quality of life of women with urinary incontinence can be a difficult task, since the instruments have different approaches.

• The use of International Classification of Functioning, Disability and Health as a reference among health professionals involved in rehabilitation of women with urinary incontinence will promote unification of the language about this group functioning.

• The comparison among instruments presented here will help the professional to choose the one that provides the greatest amount of information in a consistent way, aiding the clinical decision-making process.

     

脊髓损伤护理相关ICF组合的信度与效度研究

目的:检验《脊髓损伤护理相关ICF组合》的信度和效度。方法:2013年12月~2014年3月,4个研究中心的140例脊髓损伤患者参与研究,采用《脊髓损伤护理相关ICF组合》和《脊髓独立测量量表》第3版(SCIMⅢ)评定患者,以检验《脊髓损伤护理相关ICF组合》的内在一致性信度、评定者间信度、重测信度和校标关联效度。结果:《脊髓损伤护理相关ICF组合》的身体功能、身体结构、活动和参与以及背景性因素这四个成份的Cronbach'sα系数分别为0.85、0.54、0.97和0.85;两个评定者之间平均kappa系数为0.51;重测信度检验显示两次评定之间平均kappa系数为0.78;身体功能、活动和参与成份与SCIMⅢ的各分量表和总分呈中度至高度负相关(r=-0.528~-0.896,P0.01),身体结构成份和背景性因素成份与其呈低度负相关(r=-0.204~-0.396,P0.05)。结论:《脊髓损伤护理相关ICF组合》作为脊髓损伤患者的临床护理评估工具是稳定和可靠的。     

《国际功能、残疾和健康分类·康复组合》在非急性期患者中使用的信度与效度分析

目的:检验《国际功能、残疾和健康分类?康复组合》(the International Classification of Functioning, Disability and Health Rehabilitation Set)在非急性期患者中使用的信度与效度。方法:广东、福建、湖北省13个研究中心有515例非急性期患者参与研究,采用ICF康复组合、Barthel指数(Barthel Index)、SF-36(Short Form-36)进行评定。分析ICF康复组合的内在一致性、评定者间信度、评定者内信度和效标关联效度。结果:ICF康复组合的身体功能、活动和参与成分的Cronbachα系数分别是0.69和0.87;评定者间一致率和加权Kappa系数均值为68.5%和0.73;评定者内信度结果显示一致率和加权Kappa系数均值分别是81.7%和0.82;身体功能、活动、参与三个成分与Barthel指数呈中度至高度负相关(r=-0.498—-0.887,P0.01),与SF-36中生理功能成分的相关性尚可(r=-0.524—-0.900,P0.01),与躯体疼痛成分没有相关性或相关性较差,与SF-36的生理职能、总体健康、活力、社会功能、情感职能和精神健康成分呈现中到低度的相关性(r=-0.254—-0.547,P0.01)。结论:ICF康复组合具有较好的信度与效度,适合作为评定工具在临床实践中使用。     

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。     

Functioning and subjective health among stroke survivors after discharge from hospital

AIM: This paper reports a study exploring functioning (functions, activities and participation) and subjective health among stroke survivors 6 months after discharge from hospital. A further aim was to investigate patterns of functions and activities, and associations between functioning and subjective health. BACKGROUND: Nurses tend to emphasize functional and activity outcomes and rarely look to people's participation in their social world. By integrating individual and social contextual factors in their assessments, nurses will have a powerful tool to broaden their outlook. The International Classification of Functioning, Disability and Health can be used as a framework for understanding the consequences of stroke. Studies are needed, however to make the International Classification of Functioning operational for practical use. METHODS: A cross-sectional and explorative design was used using structured interviews and assessments with a number of scales with 89 stroke survivors 6 months after their hospital stay. The measures used were Personal Activities of Daily Living, including cognitive ability, transfer, dressing, bathing, energy to eat, ingestion, swallowing, going to the toilet, faecal continence, and urinary continence; and Instrumental Activities of Daily Living, including washing clothes, cooking, cleaning, transport and shopping. Factor analysis was performed for functions and activities and the final solution had an explained variance of 70%. The data were collected during autumn 2003 and spring 2004. FINDINGS: Close associations (r(s) > 0.5) were found between Activities of Daily Living in relation to participation and subjective physical health. CONCLUSION: Existing Activities of Daily Living scales were expanded and found to relate to a participation scale and a subjective health scale. Using these scales in nursing care has the potential to correct current bias towards functions and activities by broadening the focus to include the social as well as the physical.     

Evaluation of cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning,Disability, and Health: a large-scale,multi-institutional observational study

Purpose: We comprehensively evaluated cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health.

Method: We surveyed 1967 patients receiving long-term inpatient psychiatric care. Patients were further categorized into an old long-stay group (n?=?892, >5 years in hospitals) and a new long-stay group (n?=?1075, 1–5 years in hospitals). We obtained responses for all the International Classification of Functioning, Disability, and Health items in domain b (Body Functions) and domain d (Activities and Participation). We estimated weighted means for each item using the propensity score to adjust for confounding factors.

Results: Responses were received from 307 hospitals (response rate of hospitals: 25.5%). Cognitive and social functioning in the old long-stay group was more severely impaired than in the new long-stay group. No statistically significant differences were observed regarding the International Classification of Functioning, Disability, and Health items associated with basic activities of daily living between the two groups.

Conclusion: Combined therapy consisting of cognitive remediation and rehabilitation on social functioning for this patient population should be started from the early stage of hospitalization. Non-restrictive, independent environments may also be optimal for this patient population.

• Implications for rehabilitation

• Rehabilitation of cognitive and social functioning for patients requiring long-term inpatient psychiatric care should be started in the early stages of hospitalization.

• In psychiatric fields, the International Classification of Functioning, Disability, and Health checklist could facilitate individualized rehabilitation planning by allowing healthcare professionals to visually assess the comprehensive functioning of each patient using graphics such as radar charts.

     

中国版简明版脑血管病急性期国际功能、残疾和健康分类核心要素的初步研究

摘要 目的：初步确定中国版简明版脑血管病急性期国际功能、残疾和健康分类（ICF）的核心要素。 方法：选取30例脑血管病患者。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,将包含166项ICF二级分类项目的调查表发给15位专家进行专家调查,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脑血管病患者非常相关的分类项目保留作为专家调查结果,取临床调查结果和专家调查结果的交集作为最终的结果。 结果：最终确定的中国版简明版脑血管病急性期ICF核心要素共44项,其中身体功能分类21项,身体结构分类2项,活动和参与分类11项,环境因素分类10项。 结论：通过本研究初步确定了中国版简明版脑血管病急性期ICF核心要素。     

Leisure participation for school-aged children with Down syndrome

Purpose.?To describe leisure participation for school-aged children with Down syndrome and to investigate how factors, classified by the World Health Organisation's International Classification of Functioning, Disability and Health, influence their leisure participation.

Method.?Families in Western Australia with a child aged 5–18 years with Down syndrome were surveyed in a population-based study (n == 208) in 2004.

Results.?One-third of parents reported that their child with Down syndrome had no friends although half reported two or more friends. Factors affecting number of friendships included the child's functional ability, behavioural issues and parent's availability of time. Those children with higher functional independence scores in daily tasks were more likely to have two or more friends than those with lower functional independence scores (OR: 1.02, 95%% CI 1.01–1.04 for a single point increase in WeeFIM score). All children participated in predominantly solitary and sedentary leisure activities.

Conclusions.?Leisure participation was affected by complex factors both within and external to the child with Down syndrome. Further investigation of the relevance of these factors to leisure may enable more satisfying and meaningful participation in leisure for school-aged children with Down syndrome.     

基于ICF的康复评定工具开发与标准化研究

目的探讨运用ICF开发标准化康复评定工具的理论与方法。方法运用ICF关于功能、残疾和健康的理论和心理测量的理论与方法。结果分析ICF关于功能、残疾和健康的理论,提出基于ICF的功能、残疾和健康评定方法体系,研究基于ICF测量工具开发和标准化的方法,分析ICF核心分类集(ICF Core sets)发展的案例。结论基于ICF可建立标准化的康复临床评定工具。