ICF核心组合的开发研究概述

国际功能、健康和残疾分类（ICF）是由世界卫生组织（WHO）为不同健康领域的应用而建立的国际分类之一。WHO于1980年出版的用于测试目的的《国际损伤、残疾和障碍分类》（ICIDH）的修订版本,     

慢性阻塞性肺疾病ICF核心功能组合信度与效度的初步研究

目的探讨中国慢性阻塞性肺疾病（COPD）患者国际功能、残疾和健康分类（ICF）核心功能组合的信度与效度。 方法选择52例COPD患者,采用COPD ICF核心功能组合、SF-36健康调查量表进行评定。信度分析采用内部一致性分析方法;内部一致性信度采用Cronbach α系数和折半信度分析。效度分析采用内容效度和校标效度方法;内容效度采用Spearman相关分析,判断分量表每个类目与该分量表的相关性;校标效度采用Spearman相关分析,判断COPD ICF核心功能各个分量表及总量表与医学结局研究简明调查表（SF-36）平均分、FEV1/FVC、COPD分级、自评健康分数的相关性。 结果COPD ICF核心功能组合的4个分量表中,身体功能、身体结构、活动和参与具有很好的内容一致性,Cronbach α系数在0.698~0.957之间,总量表Cronbach α系数为0.921,折半信度相对较低（0.384~0.916）;环境因素的Cronbach α系数和折半信度不存在。COPD ICF核心功能组合的内容效度分析结果显示：身体功能、活动和参与、身体结构分量表有较好的内容效度;环境因素内容效度差。校标效度分析结果显示：身体功能、身体结构、活动和参与及总量表与作为检测标准的4个指标相关性良好;环境因素的校标效度差。 结论采用COPD ICF核心功能组合对COPD患者的评定功能可靠、有效,但其普适性尚需进一步检验;环境因素分量表尚需调整。     

基于循证和《国际功能、残疾和健康分类（ICF）》确定慢性心力衰竭功能评估类目的研究

目的:初步确定慢性心力衰竭(CHF)患者功能评估的《国际功能、残疾和健康分类(ICF)》类目。方法:检索Cochrane Library、PubMed、Embase、CNKI、WanFang、CBM数据库近5年有关CHF的临床研究,由两名研究员按照标准链接规则独立进行指标的概念提取、ICF类目链接。结果:最终纳入116篇文献,去重后得177个功能评价指标,链接到116条ICF二级类目,其中66条出现在5%以上的文献中(25个身体功能,2个身体结构,31个活动与参与,8个环境因素)。频数最高的6个ICF类目分别为b410心脏功能(n=90)、s410心血管系统结构(n=49)、b415血管功能(n=43)、b440呼吸功能(n=41)、b455运动耐受功能(n=40)、d450步行(n=40)。结论:链接到较多的ICF类目反应CHF患者功能损伤的异质性,同时确定了ICF可以作为对该类患者全面功能评估的框架,进一步的临床调查与Delphi专家咨询可以为构建CHF-ICF核心组合提供科学依据,有利于后续开展基于综合评估的CHF患者个体化、详尽化、动态化的治疗与护理措施。     

ICF的历史及发展研究

1从ＩＣＩＤＨ到ＩＣＩＤＨ - 2发展过程回顾ＩＣＦ的前身是《国际损伤、残疾和障碍分类》(ＩＣＩＤＨ)。早在 1972年 ,世界卫生组织对疾病结果分类描述提出了初步的方案 ,并于数月之后提出了一个比较综合的方法。这些建议确立了两条重要的原则 :区分损伤及其重要性 ,即功能和社会性结果。这些不同方面或维度根据不同领域独立进行分类。从本质上讲 ,这种方法包括有一系列平行而有区别的分类。ＩＣＤ中多轴心 (病因、解剖、病理等 )是整合在仅占一位数的等级系统中 ,而ＩＣＩＤＨ则探讨了建立一种与ＩＣＤ深层结构相一致的原则方案的可能性。…     

从ICIDH到ICF的变革

20 0 1年 5月 ,世界卫生组织 (ＷＨＯ)正式把国际残疾分类 (ＩｎｔｅｒｎａｔｉｏｎａｌＣｌａｓｓｉｆｉｃａｔｉｏｎｏｆＩｍｐａｉｒｍｅｎｔ,Ｄｉｓａｂｉｌ ｉｔｉｅｓａｎｄＨａｎｄｉｃａｐｓ,ＩＣＩＤＨ) [1 ] 修改为国际功能、残疾和健康分类 (ＩｎｔｅｒｎａｔｉｏｎａｌＣｌａｓｓｉｆｉｃａｔｉｏｎｏｆＦｕｎｃｔｉｏｎｉｎｇ ,Ｄｉｓ ａｂｉｌｉｔｙ,ａｎｄＨｅａｌｔｈ ,ＩＣＦ) [2、3] ,具体包括功能、残疾、健康。所谓功能 (ｆｕｎｃｔｉｏｎｉｎｇ)包括“身体功能和结构”、“活动”、“参与”3个水平 ,是人为了生存所具…     

CIHD简明ICF核心要素量表的信度与效度的研究

目的：对慢性缺血性心脏病（CIHD）的国际功能、残疾与健康分类（ICF）核心要素表进行信度、效度评价,为中国冠心病患者的全面的功能评价提供特异性测量工具。方法：100例经冠状动脉造影检查证实为冠心病的患者,按照中国CIHD简明ICF核心要素量表、MacNew心脏病特异性问卷和医学结局研究简明调查表（SF-36）的评分规则进行评定。结果：中国CIHD简明ICF核心要素量表的4个成份中,Cronbachα系数在身体功能和活动与参与两方面的结果为0.834～0.839,具有较高的内部一致性;Kendall’sW值达到0.818,且P=0.000,评测者间结果具有很好的一致性。CIHD简明ICF核心要素表与SF-36和MacNew表之间的spearson系数为0.567与0.552（P〈0.01）;表示有较好相关性。结论：采用中国CIHD简明ICF核心要素量表评定CIHD患者的功能是可靠和有效的,建议进一步推广使用。     

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。     

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。     

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。     

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.     

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...     

An international survey of Psychiatric‐Mental‐Health Nurses on the content validity of the International Classification of Functioning,Disability and Health Core Sets for Schizophrenia

The International Classification of Functioning, Disability and Health (ICF) Core Sets for schizophrenia describe the key problems in functioning that are experienced by individuals with this disorder. This study examines the content validity of these Core Sets and aims to identify the most frequent problems faced by people with schizophrenia, considering for this analysis the perspective of Psychiatric‐Mental‐Health Nurses. The study complied with the COREQ checklist for qualitative studies. A total of 101 nurses from 30 countries covering all six World Health Organization regions participated in a Delphi study. Their responses in Round 1 were linked to ICF categories, retaining those reported by at least 5% of participants. In Round 2, they were asked to rate the relevance of each of these categories to the nursing care of patients with schizophrenia. This process was repeated in Round 3. A total of 2327 concepts were extracted in Round 1 and linked to ICF categories. Following the analysis, 125 categories and 31 personal factors were presented to the experts in rounds 2 and 3. Consensus (defined as agreement ≥75%) was reached for 97 of these categories and 29 personal factors. These categories corresponded to all those (N = 25) in the Brief Core Set and 87 of the 97 categories of the Comprehensive Core Set for schizophrenia. Ten new categories emerged. The Delphi process identified the problems in functioning that nurses encounter when treating individuals with schizophrenia, and the results supported the content validity of the Core Sets. We conclude that these Core Sets offer a comprehensive framework for structuring clinical information and guiding the treatment process.     

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。     

Assessing the impact of musculoskeletal health conditions using the International Classification of Functioning,Disability and Health

Purpose.?To propose the joint use of the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) and to illustrate this proposal using musculoskeletal (MSK) conditions.

Method.?In light of the MSK conditions as classified in the ICD, categories from existing ICF core sets for MSK conditions were pooled to specify functioning. Another approach was to consider other categories from measures or instruments already linked in the literature.

Results.?ICF Categories have been pooled from six core sets for MSK conditions, two specific care settings, one MSK clinical trial setting and eight instrument linkage papers.

Conclusions.?The ICD–ICF joint use would be able to capture the impact of a health condition by taking into account the disease and functioning status which would facilitate clinical care. Therefore, there is reasonable ground to demonstrate the operational linkage and complementary role of the ICD and the ICF in the context of the ICD revision.     

The International Classification of Functioning,Disability and Health (ICF) in vocational rehabilitation and disability assessment in Slovenia: state of law and users' perspective

Objective. This study illustrates the use of the ICF in vocational rehabilitation and disability assessment in Slovenia.

Method.?A review of the Slovenian law about vocational rehabilitation was performed. A survey was developed and group and individual interviews were conducted with professionals involved in vocational rehabilitation who use the ICF.

Results.?The vast majority of the respondents believe that ICF helps to create a common language for multidisciplinary communication. The main advantages of the ICF identified by the respondents are that it provides a holistic view of the person, assesses complexities of functioning, provides a unified language and offers a quick and easy insight into functioning. The disadvantages of ICF are complicated terminology and subjectivity of the assessor. A difficulty encountered by the users is that by law, only body functions of the ICF are assessed. Additional qualitative analysis of the users' understanding of ICF and its purpose revealed heterogeneity. Significant differences between public and private organisations were found.

Conclusion.?ICF is a promising tool for use in vocational rehabilitation and disability assessment in Slovenia. A major challenge is the lack of interface between ICF and policies on vocational rehabilitation in Slovenia.     

Application of the International Classification of Functioning,Disability and Health system to symptoms of the Duchenne and Becker muscular dystrophies

Purpose: Duchenne and Becker muscular dystrophies, collectively referred to as dystrophinopathies, are X-linked recessive diseases that affect dystrophin production resulting in compromised muscle function across multiple systems. The International Classification of Functioning, Disability and Health provides a systematic classification scheme from which body functions affected by a dystrophinopathy can be identified and used to examine functional health.

Materials and methods: The infrastructure of the Muscular Dystrophy Surveillance, Tracking, and Research Network was used to identify commonly affected body functions and link selected functions to clinical surveillance data collected through medical record abstraction.

Results: Seventy-one (24?second-, 41 third- and 7 fourth-level) body function categories were selected via clinician review and consensus. Of these, 15 of 24 retained second-level categories were linked to data elements from the Muscular Dystrophy Surveillance, Tracking, and Research Network surveillance database.

Conclusions: Our findings support continued development of a core set of body functions from the International Classification of Functioning, Disability and Health system that are representative of disease progression in dystrophinopathies and the incorporation of these functions in standardized evaluations of functional health and implementation of individualized rehabilitation care plans.

• Implications for Rehabilitation

• Duchenne and Becker muscular dystrophies, collectively referred to as dystrophinopathies, are X-linked recessive disorders that affect the production of dystrophin resulting in compromised muscle function across multiple systems.

• The severity and progressive nature of dystrophinopathies can have considerable impact on a patient's participation in activities across multiple life domains.

• Our findings support continued development of an International Classification of Functioning, Disability and Health core set for childhood-onset dystrophinopathies.

• A standardized dystrophinopathy International Classification of Functioning, Disability and Health documentation form can be used as a screening tool by rehabilitation professionals and for patient goal setting when developing rehabilitation plans.

• Patient reports of perceived functional health should be incorporated into the rehabilitation plan and therapeutic progress monitored by a standardized form.