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。     

Validation of the Comprehensive ICF Core Set for obstructive pulmonary diseases from the perspective of physiotherapists

Background and Purpose. The ‘Comprehensive ICF Core Set for obstructive pulmonary diseases’ (OPD) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with OPD. To optimize a multidisciplinary and patient‐oriented approach in pulmonary rehabilitation, in which physiotherapy plays an important role, the ICF offers a standardized language and understanding of functioning. For it to be a useful tool for physiotherapists in rehabilitation of patients with OPD, the objective of this study was to validate this Comprehensive ICF Core Set for OPD from the perspective of physiotherapists. Method. A three‐round survey based on the Delphi technique of physiotherapists who are experienced in the treatment of OPD asked about the problems, resources and aspects of environment of patients with OPD that physiotherapists treat in clinical practice (physiotherapy intervention categories). Responses were linked to the ICF and compared with the existing Comprehensive ICF Core Set for OPD. Results. Fifty‐one physiotherapists from 18 countries named 904 single terms that were linked to 124 ICF categories, 9 personal factors and 16 ‘not classified’ concepts. The identified ICF categories were mainly third‐level categories compared with mainly second‐level categories of the Comprehensive ICF Core Set for OPD. Seventy of the ICF categories, all personal factors and 15 ‘not classified’ concepts gained more than 75% agreement among the physiotherapists. Of these ICF categories, 55 (78.5%) were covered by the Comprehensive ICF Core Set for OPD. Conclusion. The validity of the Comprehensive ICF Core Set for OPD was largely supported by the physiotherapists. Nevertheless, ICF categories that were not covered, personal factors and not classified terms offer opportunities towards the final ICF Core Set for OPD and further research to strengthen physiotherapists' perspective in pulmonary rehabilitation. Copyright © 2009 John Wiley & Sons, Ltd.     

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。     

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。     

Three model curricula for teaching clinicians to use the ICF

PURPOSE: Three systematic programmes to train health professionals to use the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) are described, along with efforts to evaluate their effectiveness. METHODS: The first programme was a randomized study comparing the effects of a 2-hour instructor-led programme and a self-directed learning module on ICF-related knowledge, attitudes, and coding skills among occupational therapy graduate students. The second programme was a series of intensive 3.5-day workshops for public sector rehabilitation professionals in South Africa. The third programme involved a series of internet-based teaching modules regarding the ICF for graduate students in rehabilitation counselling. RESULTS: The first project found that both instructor-led and self-guided training formats were effective in improving basic ICF-related knowledge, but only instructor-led training led to a significant improvement in coding skill. It also had more positive effects on ICF-related attitudes. This approach to learning assessment was generalizable to multidisciplinary health professionals in South Africa, who achieved a relatively high degree of coding accuracy after the 3.5-day workshop. Participant evaluations supported the structure, content, and length of the training. Students in the third programme also reported a very positive learning experience and positive views of the ICF. CONCLUSIONS: An empirical basis is important for identifying the best and most efficient training methods for particular audiences and specific purposes. The length and format of training can be differentially related to specific training goals (i.e., knowledge, attitudes, and coding skills). Interactive distance learning methods may help to overcome the weaknesses of self-directed training in comparison to face-to-face training.     

基于ICF和ICHI声带息肉患者术后发声功能康复训练的效果

目的 探讨基于《国际功能、残疾和健康分类》(ICF)和《国际健康干预分类》(ICHI)构建发声功能康复训练对改善声带息肉术后发声功能的效果。 方法 基于ICF和ICHI设计言语嗓音功能整体康复干预方案。2017年1月至2018年12月,声带息肉伴有发声功能障碍手术治疗患者30例,分别于术前、术后、康复训练1个月后,采用嗓音嘶哑分级评估(GRBAS)进行评估,采用嗓音疾病评估仪检测声学参数。 结果康复训练1个月后,患者GRBAS评分较术前和术后均降低(F > 6.214, P< 0.05);患者基频、基频微扰、振幅微扰和标准化噪声能量较术前和术后均降低(F > 9.655, P< 0.05)。 结论 基于ICF和ICHI的发声功能康复训练能有效改善声带息肉术后患者的发声功能。     

基于ICF模式的康复心理学:学科范式与内容北大核心CSCD

目的应用ICF的生物-心理-社会的功能与残疾模式,探讨基于ICF的康复心理学的研究内容与范式。方法采用ICF的功能与残疾理论,从康复科学和心理科学的学科架构出发,应现代康复科学发展的要求,在ICF功能架构下构建现代康复心理学的研究内容与范式。结果ICF构建了一个涉及到身心和环境的整体康复模式。基于ICF的功能模式,现代康复心理学研究的主要内容不仅涉及身体层面的功能和结构,更要研究活动和参与,强调个体与环境的交互作用。现代康复心理学涉及的领域不仅包括身体功能障碍的心理康复,还包括活动干预和环境干预。基于ICF的架构可以采用共同的术语和编码方法,使康复心理学工作者能够与相关学科专业人员进行多学科和跨学科交流。结论基于ICF构建现代康复心理学的研究理论架构与研究范式,可以形成融入心理科学和康复科学的康复心理学体系。     

基于ICF构建药物依赖人群功能分析与社区居家运动康复方案研究

目的 应用《国际功能、残疾和健康分类》(ICF)理论与方法对药物依赖人群的心理健康和功能状态进行分析,构建居家运动康复的理论架构、康复方案和实施方案。     

Communication attitude and speech in 10-year-old children with cleft (lip and) palate: An ICF perspective

Many children born with cleft palate have impaired speech during their pre-school years, but usually the speech difficulties are transient and resolved by later childhood. This study investigated communication attitude with the Swedish version of the Communication Attitude Test (CAT-S) in 54 10-year-olds with cleft (lip and) palate. In addition, environmental factors were assessed via parent questionnaire. These data were compared to speech assessments by experienced listeners, who rated the children's velopharyngeal function, articulation, intelligibility, and general impression of speech at ages 5, 7, and 10 years. The children with clefts scored significantly higher on the CAT-S compared to reference data, indicating a more negative communication attitude on group level but with large individual variation. All speech variables, except velopharyngeal function at earlier ages, as well as the parent questionnaire scores, correlated significantly with the CAT-S scores. Although there was a relationship between speech and communication attitude, not all children with impaired speech developed negative communication attitudes. The assessment of communication attitude can make an important contribution to our understanding of the communicative situation for children with cleft (lip and) palate and give important indications for intervention.     

基于ICF的作业治疗：理论架构与方法体系

目的 研究《国际功能、残疾和健康分类》(ICF)在作业治疗中的理论架构、方法体系及其在临床实践中的系统应用。方法 基于ICF理论,结合世界作业治疗师联合会的相关政策文件,分析作业治疗发展的理论架构,探讨基于ICF框架下临床情境下系统化的作业治疗。结果 基于ICF构建作业治疗的理论架构与方法体系,明确现代康复服务中综合作业治疗干预的目标、原则与应用方法。作业治疗干预目标是通过多学科、跨领域地应用综合作业治疗方案,提高个体的活动和参与,使功能最佳化。作业治疗基于生物-心理-社会模式,坚持以人为本和功能定向的原则,在不同情景下实施个性化的干预方案。在临床实践中,建议系统应用世界卫生组织国际健康分类家族,构建系统化的作业治疗服务体系,即功能与需求分析(ICHI)-功能分类、评估及编码(ICF)-疾病分类、诊断及编码(ICD)-作业治疗干预(ICHI)。结论 构建了基于ICF的作业治疗理论架构与方法体系,建立了综合性的临床作业治疗应用模式,明确了以活动和参与为导向的作业治疗干预目标,提高了作业治疗的系统化、结构化、标准化及精细化水平。     

Validation of the comprehensive ICF core set for osteoarthritis: the perspective of physical therapists

Background and purpose

Osteoarthritis is a common chronic disease associated with functional impairments and activity limitations, as well as participation restrictions. The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Osteoarthritis is an application of the ICF and represents the typical spectrum of problems in functioning of patients with osteoarthritis.

Objective

To validate the Comprehensive ICF Core Set for Osteoarthritis from the perspective of physical therapists.

Methods

Physical therapists experienced in the treatment of patients with osteoarthritis were asked about patients’ problems, resources and aspects of the environmental factors treated by physical therapists in patients with osteoarthritis in a three-round, electronic-mail survey using the Delphi technique. Responses were linked to the ICF.

Results

Seventy-two experts from 22 countries named 744 meaningful concepts that covered all ICF components. One hundred and fifty-two ICF categories were linked to these answers, 32 concepts were linked to the not-yet-developed personal factors component, and 14 issues were not covered by a single ICF category. Twelve ICF categories were not represented in the Comprehensive ICF Core Set for Osteoarthritis, although at least 75% of the participants rated them as important.

Discussion and conclusion

The content validity of the ICF was widely supported by the physical therapists. However, several issues were raised that were not covered and need to be investigated further.     

学习应用ICF和《社区康复指南》促进中国社区康复发展

本研究讨论国际残疾康复政策架构与方法,并就如何运用这些文件和工具促进社区康复发展进行阐述,强调能力建设的重要性和方法的科学性。     

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.

     

Using the ICF within speech-language pathology: Application to developmental language impairment

The conceptual framework proposed by the World Health Organization (WHO), the International Classification of Functioning, Disability, and Health, (ICF), provides a multidimensional approach to the investigation of various communication disorders, including developmental language impairments. The comprehensive view of health and common language offered by the ICF framework is useful for guiding clinical and research practices within speech-language pathology. Some sub-specialities (e.g., aphasia and traumatic brain injury (TBI)) have already begun to use the ICF framework to guide assessment and treatment practices. However, its application for children with specific language impairment (SLI), a type of developmental language impairment and one of the most common communication disorders in preschool and school-age children, is somewhat limited. The purpose of this paper is two-fold: (1) to emphasize the usefulness of the ICF framework as a tool for describing SLI and (2) to illustrate how consideration of the ICF framework may be helpful in the management and evaluation of outcomes for children with SLI.     

颅脑损伤ICF评定量表信效度的初步研究

目的：研究颅脑损伤（TBI）国际功能、残疾和健康分类（ICF）评定量表的信度与效度。方法：TBI患者100例,均采用TBI的ICF评定量表、Fugl-Meyer肢体运动功能评定表和改良Barthel指数（MBI）进行评定。效度研究采用结构效度和效标效度的方法,信度研究采用评定员问信度和内部一致性的分析方法。评定员间的信度检验用Kendall＇sW值相关;内容一致性检验用Cronbach＇sAlpha值分析;效标效度用Pearson相关,判断3个量表间的相关性。结果：ICF评定量表4个维度中,活动与参与方面Cronbach’SAlpha系数为0．927,身体功能方面Cronbach’SAlpha系数为0．739,Kendall＇sW值为0．700（均P〈O．05）。ICF评定量表身体功能方面与Fugl—Meyer肢体运动功能评定表间的Pearson系数为0．754,呈现负相关性（P〈0．05）;ICF评定量表活动与参与方面与MBI评定表间Pearson系数为0．785,呈现负相关性（P-〈0．05）。结论：TBI的ICF评定量表具有一定的可靠性和有效性,能更好地反映肢体运动功能和日常生活活动能力。     

中国版脑卒中简明ICF核心要素量表在康复中的应用

目的探讨国际中文版脑卒中简明《国际功能、残疾和健康分类》(ICF)核心要素量表在脑卒中康复评定中的应用。方法180 例脑卒中患者接受规范康复2 个月。于治疗前、治疗结束时及治疗后6 个月,采用中国版脑卒中简明ICF 核心要素量表、Barthel 指数(BI)、功能综合评定量表(FCA)、世界卫生组织残疾评定量表(WHODASⅡ)进行评定。结果BI、FCA、WHODASⅡ评分与ICF核心量表总分及各成份分相关(P<0.05)。结论ICF核心量表是一种有效的脑卒中患者功能评定工具。     

中国版脑卒中简明ICF核心要素的初步研究

目的: 确定中国版脑卒中简明ICF核心要素量表的内容。方法: 采用两种调查问卷同时记录脑卒中患者的信息，一种为由临床医生和卫生专业人员填写的病例记录表（主要为脑卒中的综合ICF核心要素），一种为由脑卒中患者本人填写的个案记录表。使用描述性统计方法确定综合ICF核心要素中每一类目的频率，大于30%的类目集合作为中国脑卒中患者的第一期简明ICF核心要素。根据脑卒中的综合ICF核心要素制订专家调查问卷并通过电子邮件向国内的55位专家发送，使用描述性统计方法确定专家调查问卷中综合ICF核心要素每一类目的频率，大于50%的类目集合作为中国脑卒中患者的第二期简明ICF核心要素。通过整合两期的结果确定中国版脑卒中患者的简明ICF核心要素。结果:本研究产生了74个二级水平的ICF类目，其中“身体功能”20个，“身体结构”1个，“活动和参与”34个，还有 19个“环境因素”。 结论:整合临床调查研究的结果和专家的意见初步确定了中国版脑卒中患者的简明ICF核心要素,但这一结果尚待完善。     

WASSP: An international review of its clinical application

WASSP: The Wright and Ayre Stuttering Self-Rating Profile was originally designed and standardised as an outcome measure to be used with adults who stutter in the UK. It reflects the increasingly influential World Health Organization's International Classification of Functioning, Disability, and Health (ICF) framework. Recent publications have demonstrated that WASSP is now in mainstream use, both clinically and as a research tool, and appears to measure change effectively with a variety of therapy approaches both within and outside the UK. WASSP is reviewed with regard to its psychometric properties and in the context of the recent focus on health related quality of life (HRQL) instruments. Evidence of the clinical application of WASSP is reported through the findings of a UK survey, an international survey and further sources of evidence. The conclusion considers the implications for a revised edition of WASSP and the development of an adolescent version (A-WASSP).     

Reflective action assessment with a prospective clinical problem solving tool in the context of rehabilitation medicine: an illustrative case study

Purpose: This study describes a case formulation approach applying a prospective ICF derived clinical tool to assess rehabilitation needs for a community dwelling stroke survivor with care from an outpatient rehabilitation medicine clinic. Method: Case history data on the person were assessed for rehabilitation management planning using a prospective tool to interlink current with projected future functional status in everyday settings. Implicit assessment with reflective action informed decision points at each stage of the rehabilitation process. Results: As a result of reflective action using the prospective tool, rehabilitation management led to significant changes in client participation after limitations to mobility and self care were mapped to the living conditions of the stroke survivor. The context sensitive rehabilitative plan resulted in higher subjective health-related quality of life in the stroke survivor and significant other and enhanced their capacity for participation. Conclusions: Reflective action informed assessment applying ICF concepts to clinical problem solving resulted in positive gains in health-related quality of life in a stroke survivor.

Implications for Rehabilitation

• Reflective inquiry about the use of The International Classification of Disability, Functioning and Health (ICF) enables extension of its applicability in clinical practice settings.

• An ICF-based tool is proposed to interlink the ICF and ICD in rehabilitation case management.

• A case study is used to highlight the use of an ICF-based tool in the context of rehabilitation medicine.