基于ICF理论构建手部烧伤住院患者康复护理干预方案

目的构建手部烧伤住院患者康复护理干预方案。方法以《国际功能、残疾和健康分类》(ICF)为理论指导,初步制定包括3个维度24个条目的手部烧伤住院患者康复护理干预方案,筛选简明烧伤量表、握力、关节总活动度等7种疗效评定工具,选送13名专家进行2轮德尔菲法咨询。结果 2轮专家咨询的回收率均为100%;专家权威程度系数Cr为0.91;Kendall协调系数W分别为0.439、0.401。最终形成包括躯体功能康复领域、心理功能康复领域及社会功能康复领域的3个维度22个条目的手烧伤患者康复护理干预方案,并确定简明烧伤量表、握力、关节总活动度及Michigan手功能问卷4种康复疗效测评工具。结论本手部烧伤患者康复护理干预方案可信、可行,可初步用于临床手部烧伤患者的康复护理和效果评价。     

The benefits of an unsupervised exercise program in persons with well-healed burn injuries within the International Classification of Functioning,Disability and Health (ICF)

Vast improvements in the survival rates following burn injuries has led to a greater number of patients living with a wide range of long-term impairments, activity limitations, and participation constraints. Therefore, long-term care is critical in this clinical population and necessitates appropriate rehabilitation strategies to maximize an individual’s overall health. The purpose of this study was to test the hypothesis that the extent to which outcomes within the International Classification of Functioning, Disability, and Health (ICF) framework are improved following 6 months of unsupervised exercise training is influenced by the severity of a burn injury (i.e., percent body surface area injured). Outcome variables representing the dimensions of the ICF, body functions & structure, activity, and participation, were collected pre- and post- 6 months of exercise training in three groups of participants: non-injured control subjects (N = 11), subjects with moderate-level well-healed burn injuries (N = 13, 26 ± 6% body surface area burned), and subjects with high-level well-healed burn injuries (N = 20, 58 ± 15% body surface area burned). Exercise training improved lower extremity strength (changes in peak torque/kg body mass at 90 degrees/sec flexion: 30 ± 5% and extension: 36 ± 4%, p < 0.05) and functional activities (changes in sit to stand: -9 ± 4% and ascend stairs: -4 ± 1%; p < 0.05) in all groups. For outcome variables representing ICF levels of body functions & structure and activity, there were no differences at baseline or improvements made between the groups after training. That said, with the exception of the domain of functional activity (reported 17 ± 34% improvement in the high-level burn cohort, p < 0.05), no changes were revealed in the participation level of ICF indexed by health-related quality of life questionnaires. These findings support the utilization of a 6-month unsupervised exercise training program in the long-term rehabilitation of individuals with burn injuries; that is, improvements in body functions & structure and activity can be achieved with an exercise regimen regardless of the severity of burn injury.     

Validation of the brief International Classification of Functioning, Disability, and Health (ICF) core set for hand conditions

Study designCross-sectional multi-centre study.IntroductionThe ICF Core Sets for Hand Conditions (HC) have been developed to describe functioning of patients with HC.Purpose of the studyTo study the content validity of the Brief ICF Core Set for HC.MethodsPatients with HC were interviewed using the Comprehensive ICF Core Set for HC. ICF categories that best explained variation in patients' general health were identified using multiple regression methods.ResultsOverall, 12 of the 23 ICF categories of the Brief ICF Core Set could be validated. Our analyzes further revealed that the categories “b134 Sleep functions”, “s830 Structure of nails”, “e225 Climate” as well as categories referring to “e4 Attitudes” also deserve consideration when assessing functioning in patients with HC.ConclusionsClinicians are encouraged to complement the Brief ICF Core Set for HC by adding sleep functions, structure of nails, climate and attitudes, especially when following patients over time.Level of EvidenceLevel 3.     

住院患者护理相关《国际功能、残疾和健康分类》类目的初步研究

目的初步确定住院患者护理相关《国际功能、残疾和健康分类》(ICF)类目,以此构建住院患者护理相关ICF框架。方法从世界卫生组织ICF中初筛出护理类目,编制专家咨询问卷;对36名护理专家进行问卷咨询,按专家意见一致性>80%的标准筛选类目;按临床实用性原则对咨询结果再次筛选。结果初筛出护理类目211个,专家咨询后提取79个,再次筛选后初步确定意识功能、定向功能等74个护理类目。结论初步确定的护理类目在ICF中分布比较合理,具有系统性、有效性和方便交流的特点,可作为住院患者护理干预措施和结局评价的框架。     

Preliminary study on International Classification of Functioning, Disability and Health categories relevant to nursing of inpatients

目的 初步确定住院患者护理相关《国际功能、残疾和健康分类》(ICF)类目,以此构建住院患者护理相关ICF框架.方法 从世界卫生组织ICF中初筛出护理类目,编制专家咨询问卷;对36名护理专家进行问卷咨询,按专家意见一致性＞80％的标准筛选类目;按临床实用性原则对咨询结果再次筛选.结果 初筛出护理类目211个,专家咨询后提取79个,再次筛选后初步确定意识功能、定向功能等74个护理类目.结论 初步确定的护理类目在ICF中分布比较合理,具有系统性、有效性和方便交流的特点,可作为住院患者护理干预措施和结局评价的框架.     

Linking osteoarthritis-specific health-status measures to the International Classification of Functioning,Disability, and Health (ICF)

OBJECTIVES: The objective of this study was to link the Western Ontario and McMaster Universities (WOMAC) and Lequesne-Algofunctional indices to the ICF on the basis of linking rules developed specifically to accomplish this aim. The linking process enables the understanding of the relationship between health-status measures and the ICF. METHODS: Since the fifth World Health Organisation/International Liege Against Rheumatism (WHO/ILAR) Task Force and the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group recommend the use of WOMAC and the Lequesne-Algofunctional indices in patients with osteoarthritis of the hip and knee in clinical trials, these two health-status measures have been used in this study.Both health-status measures were linked to the ICF separately by two trained health professionals. Consensus between health professionals was used to decide which ICF category should be linked to each item/concept of the two questionnaires. To resolve disagreements between the two health professionals, a third person trained in the linking rules was consulted. RESULTS: Except for the concept of 'morning stiffness', both health professionals agreed on the ICF category chosen to link all the items/concepts of both questionnaires. Altogether, 29 different ICF categories have been linked. Five ICF categories belong to the ICF component 'body functions', 23 categories to the component 'activities and participation', and one category to 'environmental factors'. Both questionnaires have 10 ICF categories in common. CONCLUSIONS: The results of the linking process reflect both the structure of the two questionnaires studied and the relationship between them, showing that the ICF classification can become the cardinal reference for existing health-status measures.     

Outcome evaluation of the hand and wrist according to the International Classification of Functioning,Disability, and Health

This article is a brief review of the outcome evaluation of the hand and wrist according to the International Classification of Functioning, Disability, and Health. Several tools currently exist to quantify outcome in hand surgery at the impairment level (eg, mobility, hand strength, cutaneous sensation, dexterity). According to the World Health Organization's paradigm, however, activity limitations and participation restrictions are also clinically relevant. The authors have recently built a measure of an upper limb-impaired individual's ability to manage manual activities in daily life. Participation and quality of life are difficult outcomes to measure because they are multidimensional and depend on such factors as functional abilities, general physical health, financial security, and stability of the social and familial environment.     

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

Assessment of the impact of the rheumatic disease on the individual patient is necessary to evaluate the outcome of an intervention targeted at the disease process as well as at the restoration of the patient's functioning. The International Classification of Functioning, Disability and Health (ICF) is a comprehensive tool designed to record and organise a wide range of information about health and health related states, based on bio-psycho-social perspective. The ICF components, namely, body functions, body structures, and activities and participation are complemented by the contextual components, environmental factors and personal factors. All of them are in mutual interactions. The ICF contains lists of so-called ICF categories that describe the components of the integrative World Health Organisation model. It uses an alphanumerical model where categories are 'nested' so that broader categories are defined to include more detailed subcategories of the parent categories. Organized in such a way and with more than 1400 categories ICF covers virtually all the spectrum of problems encountered in patients with musculoskeletal conditions. The main practical tools of the ICF include ICF check lists, ICF core sets, ICF categorical profile and ICF assessment sheet. The ICF is likely to become the generally accepted conceptual framework and will be increasingly used in clinical practice to structure patient problems, particularly in multidisciplinary care and for rehabilitation purposes.     

基于国际功能残疾健康分类的参与测评工具的研究现状

介绍了《国际功能残疾健康分类》中参与概念及测评意义,并对参与测评工具进行综述,旨在为社区康复工作者及研究者选择和使用相关工具提供参考。提出尝试引进及修订国外成熟的参与测评量表,以满足我国康复护理领域的科研及实践需求。     

Review of participation measuring instruments according to the International Classification of Functioning, Disability and Health (ICF)

介绍了《国际功能残疾健康分类》中参与概念及测评意义,并对参与测评工具进行综述,旨在为社区康复工作者及研究者选择和使用相关工具提供参考.提出尝试引进及修订国外成熟的参与测评量表,以满足我国康复护理领域的科研及实践需求.     

Linking the Disabilities of Arm, Shoulder, and Hand to the International Classification of Functioning, Disability, and Health.

The objective of this study was to explore whether the items from a specific outcome measure, that is, Disabilities of the Arm, Shoulder, and Hand (DASH), for quantifying limb symptoms and functions in musculoskeletal disorders fit into the framework of the International Classification of Functioning, Disability and Health (ICF). All DASH items were compared to the ICF according to eight linking rules. Two groups of researchers performed the linking independently, and the results were compared by correlation. The 30 DASH items and four items from the optional modules were linked to 63 ICF categories and 11 chapters: 15 categories belong to the ICF body functions component and 48 to the activities and participation component. There were no items coded under the components body structure or environmental factors. Kappa index showed an agreement of 0.73 (p<0.001). The results showed that the content of the DASH does link well with the ICF framework. Clinicians and researchers must attend to the fact that certain domains and categories from the ICF are not covered by the DASH. Limitations of the instrument may be overcome by simultaneously using other instruments that address the intended content.     

Identifying content gaps in health status measures for intermittent claudication using the International Classification of Functioning,Disability and Health

Objective

The Walking Impairment Questionnaire (WIQ) and Intermittent Claudication Questionnaire (ICQ) are commonly used patient-reported functional outcome measures for intermittent claudication, but their functional representation has not been characterized. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework comprehensively describes health-related function and has been used to evaluate health status and quality of life (QOL) measures. We applied a content analysis technique commonly used in functional rehabilitation research to evaluate ICF domains represented by WIQ and ICQ to characterize their health status and functional representation.