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...     

基于神经网络的ICF康复组合评定量化标准功能分级算法模型构建及其验证

摘要 目的：利用人工智能神经网络方式构建ICF康复组合（ICF-RS）评定量化标准总体及三个维度（身体功能、活动、参与）功能分级的算法模型,为应用ICF-RS评定量化标准进行数据分析及功能分级提供解决方案。 方法：本研究利用中文版ICF-RS评定量化标准,通过多中心合作,采用分层比例抽样的方法收集了6家已开展ICF-RS评定量化标准临床应用的康复医学科住院患者ICF-RS数据,以多个专家对同一患者的方式获取ICF-RS评定量化标准三个维度及整体功能状况的等级评价结果。借助于神经网络算法构建ICF-RS评定量化标准的各维度及整体功能分级模型,采用计算机k折交叉验证法选择最优模型参数,并计算模型预测受试者工作特征曲线[receiver operating characteristic(ROC) curve]下面积（area under ROC curve,AUC）、准确率（accuracy,ACC）和F1分数（F1-score）。模型构建后,再通过专家和患者一对一的方式收集100例ICF-RS数据用于对已建立的模型进行临床再测试,通过计算ROC、AUC、ACC和F1对模型性能进行评价。 结果：共收集584例住院患者的ICF-RS数据,其中484例数据用于构建及验证模型,100例数据用于测试模型的预测性能。根据k折交叉验证法结果显示,身体功能维度、活动维度、参与维度及整体ICF-RS功能分级模型的AUC分别是89.00%、92.00%、87.00%和87.00%,ACC分别达到75.19%、78.10%、72.91%和73.53%,F1分别是73.68%、77.04%%、69.28%、58.95%。在模型建立后将重新收集到的100例ICF-RS数据输入模型计算,发现各模型ROC曲线良好,AUC分别是89.04%、91.81%、86.85%、86.89%,ACC分别是64.00%、72.00%、61.00%、65.00%,F1分别是48.30%、59.95%、64.06%、49.35%。 结论：基于神经网络建立的ICF-RS整体及各维度功能分级算法模型对ICF-RS数据的功能等级预测准确率良好,预测价值较高,具有良好的临床应用价值。     

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ICF的失能评定量表的Cronbach′s α系数为0.89,评估者间信度分析显示量表总分的组内相关系数(ICC)为0.85,量表包含的20个条目的ICC在0.78～0.94(P<0.01);评估者内信度分析显示量表的总分ICC为0.95,除b230听力外,量表包含的其它条目ICC在0.72～0.97(P<0.01)。结论基于ICF的失能评定工具与数字评定量表联合在临床失能评估应用中具有良好的内在一致性及评估者间信度和评估者内信度。     

ICF康复组合功能评定工具在老年失能评估中的效度研究

目的:验证基于国际功能、残疾和健康分类(ICF)康复组合的功能评定工具在老年失能评估中的效度。方法:全国15家养老机构的1610例老人参与本研究。用基于ICF康复组合的功能评定工具对老人进行失能评估,以数字化评定量表(0～10分)评估条目失能程度,并用12项简易生活质量问卷调查(SF-12)量表对老人进行生活质量评定,...     

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。     

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。     

老年双侧全髋置换术后ICF指导下的康复对患者功能恢复的影响

全髋关节置换术(Total hip arthroplasty,THA)是治疗晚期髋关节疾病的有效手段,每年因股骨头坏死、髋关节骨关节炎等疾病行全髋关节置换术的患者越来越多[1-3]。随着现代髋关节手术的成熟和手术中麻醉水平的提高,老年患者易于接受髋关节置换术[4-5]。同期双侧全髋关节置换术与分期置换手术相比是一种行之有效的手术方案,住院时间短,住院费用少,术后并发症的发生率并无明显增多[6]。系统评价报告全髋置换术后康复干预能减轻疼痛,提高Harris得分[7],但同期双髋置换术后康复介入方面的报告很少。我科最近收治1例同时行双侧全髋置换术的患者,术后介入康复,在“国际功能、残疾和健康分类康复组合(International Classification of Functioning,Disability,and Health Rehabilitation Set,ICF-RS)”引导下调整干预方案[8],疗效较好,报告如下。     

基于ICF的运动康复与健康专业课程体系构建研究①

为适应当代康复发展需求,建立现代的运动康复与健康专业课程体系,根据ICF有关功能和残疾理论与方法和当代康复学科发展的特点以及康复领域对治疗师人才的需求,结合世界物理治疗联盟(WCPT)有关物理治疗师培养课程内容要求,探讨构建运动康复与健康本科课程内容体系。     

ICF理论与方法在儿童听力语言残疾康复中的应用研究

本研究根据《国际功能、残疾和健康分类》理论与方法,对儿童语言康复进行了系统的分析研究,提出了从儿童的认知和与语言活动相关的功能与结构、儿童言语活动和日常生活与社会参与以及环境因素和个人因素四个方面进行语言康复效果评价的理论与方法。     

The ICF has made a difference to functioning and disability measurement and statistics

Aims: Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics.

Methods: In a scoping review, we investigated research published 2001–2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge.

Results: The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation.

Conclusion: The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes.

• Implications for Rehabilitation

• The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance.

• Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning.

• Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.

     

Developing an ICF core set for post-stroke disability assessment and verification in Taiwan: a preliminary study

Purpose: The purpose of this study was to develop an ICF core set for post-stroke disability assessment and verification of bio-psycho-social problems. Method: Using the Delphi method, a consensus process was conducted. In total, 24 multidisciplinary experts from different institutions completed the consensus process. The questionnaire for the study comprised 144 ICF second-level, stroke-relevant categories. A 5-point Likert-type scale was used by participants to weight the impact of each category on activities of daily life after a stroke. Consensus of ratings was assessed with Spearman’s rho and semi-interquartile range indices. The core set for post-stroke disability assessment and verification was developed from those categories with a mean score ≥4.0 found in the third round of the Delphi exercise. Results: The core set for post-stroke disability assessment and verification contained 51 categories. Of these, 18 categories were from the component body functions, one from body structures, 22 from activities and participation, and 10 from environmental factors. The mean (standard deviation) Spearman’s rho was 0.72 (0.14), and Cronbach’s α was 0.98. Conclusions: The preliminary core set for post-stroke disability assessment and verification can offer comprehensive information on the performance of daily-life activities of chronic stroke survivors. Further validation is required.

Implications for Rehabilitation

• To identify stroke patients with permanent difficulties in Taiwan, the ICF core set for post-stroke disability assessment and verification (PSDV) focused on chronic stroke survivors in the community.

• The PSDV core set which is closely linked to the Barthel Index and Functional Independence Measure can offer comprehensive information on activities of daily living in stroke patients in Taiwan.

• With the PSDV core set, stroke patients with hemineglect or dysphagia can be assessed.

     

Inter-rater reliability in disability assessment based on a semi-structured interview report

Purpose. To investigate whether physicians are able to perform a disability assessment based on a written report and to assess the inter-rater reliability between physicians in the assessment of work limitations.

Method. In total, 12 insurance physicians used written reports to assess work limitations in 12 patients. The reports involved a semi-structured interview executed by a nurse practitioner. The insurance physicians were asked whether they could make reliable assessments based on these reports. In addition, inter-rater reliability was measured by computing their percentage agreement with respect to the mental and physical items of two Dutch disability lists (the Functional Information System and the Mental Ability List).

Results. The quality of the reports was evaluated as reasonable to good. Half the physicians found the assessment based on the reports to be reasonably reliable, 25% found the opposite and 25% was indecisive. The overall agreement between the insurance physicians was reasonable to good, with a mean agreement of 76% (range 64 – 88%). Agreement between the physicians concerning the number of hours a patient could function daily was low.

Conclusions. Half the physicians thought that a reliable assessment based on the written information was possible. The quality of written patient reports made by nurse practitioners trained in conducting a semi-structured interview was considered reasonable to good by insurance physicians. The inter-rater reliability between insurance physicians of physical-disability and mental-disability assessment based on the written reports was reasonable to good. The assessment of the number hours patients could function daily had low inter-rater reliability.     

Development of ICF core set for disability evaluation in social security

PURPOSE: The purpose of this paper is to report on the development of an ICF core set for functional assessment in disability claims in European social security systems. METHOD: A formal decision-making process was applied. First, national meetings suggested categories to be included in the core set. Thereafter, the members of EUMASS working group for ICF selected a core set based on these suggestions, in a formal voting procedure. RESULTS: From 191 different suggestions for ICF categories given by the national meetings, 20 were selected for the core set. Five were from body functions and 15 from activities and participation. No category from environmental factors was included. CONCLUSION: The EUMASS working group successfully reached consensus on a core set for functional assessments in disability benefit claims. The core set is generic, and should be used by medical doctors. It is intended for evaluation of rights to long term benefits. For the assessment in short term sickness absence, return to work, and vocational rehabilitation, other core sets need to be developed. The usefulness of the ICF qualifiers for the level of functioning in disability assessment has yet to be established.     

Development of ICF core set for disability evaluation in social security

Purpose. The purpose of this paper is to report on the development of an ICF core set for functional assessment in disability claims in European social security systems.

Method. A formal decision-making process was applied. First, national meetings suggested categories to be included in the core set. Thereafter, the members of EUMASS working group for ICF selected a core set based on these suggestions, in a formal voting procedure.

Results. From 191 different suggestions for ICF categories given by the national meetings, 20 were selected for the core set. Five were from body functions and 15 from activities and participation. No category from environmental factors was included.

Conclusion. The EUMASS working group successfully reached consensus on a core set for functional assessments in disability benefit claims. The core set is generic, and should be used by medical doctors. It is intended for evaluation of rights to long term benefits. For the assessment in short term sickness absence, return to work, and vocational rehabilitation, other core sets need to be developed. The usefulness of the ICF qualifiers for the level of functioning in disability assessment has yet to be established.     

Simplified bipartite concepts of functioning and disability recommended for interdisciplinary use of the ICF

Abstract

Purpose: To argue for and propose bipartite concepts of functioning and disability, to tally with the structure of the ICF classification list, concepts of social models and clinical needs. Method: The ICF concepts are discussed in relation to the history of ideas regarding disability concepts and the needs for such concepts in interdisciplinary rehabilitation. Results: Bipartite concepts are presented; they refer to actual functioning, simply body functions/structures and participation, including functioning in standardized environments. Participation refers to actually performed “activities”, with “activities” simply denoting things that people may do. Bipartite concepts are congruent with the ICF classification and the structure of social models of disability, suitable for clinical and interdisciplinary use and easy to understand. The issue of standardized environments represents a methodological issue rather than the conceptual issue of defining functioning and disability. An individual perspective on activity and activity limitations, i.e. the middle part of the tripartite ICF concept, is somewhat similar to concepts of traditional language that were regarded as too generalizing already in 1912, when the interactional concept of “disability in a social sense” was introduced in rehabilitation practices. Conclusion: Bipartite concepts of functioning and disability are recommended for interdisciplinary use of the ICF.

• Implications for Rehabilitation

• The ICF classification is useful, but the ICF concept of activities in an individual perspective is confusing.

• We suggest a use of the term “activities” simply to denote things that people may do and “participation” to denote actually performed activities.

• Estimations of ability should be explicit about how they are related to environmental factors.

     

国际功能、残疾和健康分类康复组合（ICF-RS）用于老年非特异性下腰痛患者水中太极效果评价的研究

摘要目的：采用ICF康复组合（ICF-RS）评价非特异性下腰痛（nonspecific low back pain, NLBP）患者的功能状况,初步分析水中太极治疗NLBP的康复疗效。方法：74例NLBP患者随机分配入治疗组（水中太极）和对照组（核心肌力训练）,每组各37例。按照预定的治疗方案进行为期8周的集中康复训练,通过ICF-RS评估NLBP患者的功能改善情况。结果：NLBP患者存在明显身体功能障碍的类目依次为：b152情感功能、b280痛觉、b455运动和耐受能力、b710关节活动能力、b730肌肉力量;存在明显活动与参与功能障碍依次为：d230进行日常事务、d410改变身体基本姿势、d415保持一种身体姿势、d640做家务、d660帮助别人、d710基本的人际交往、d770亲密关系、d850有报酬的就业、d920娱乐与休闲。2组NLBP患者治疗前后通过ICF-RS进行疗效评估,2组患者治疗后30条类目中14条明显改善（b152、b280、b455、b710、b730、d230、d410、d415、d640、d660、d710、d770、d850、d920）,治疗组改善类目评分均较对照组改善明显,具有显著性差异（P＜0.05）。结论：水中太极对NLBP痛患者有明显的临床疗效。ICF-RS可以用于评估NLBP患者的功能状况,指导康复治疗和进行疗效评价。