更新观念：关于国际功能，残疾和健康分类的进展情况

康复医学是涉及功能障碍一残疾的医学,因此,首先要明确“功能”“残疾”的概念,本文介绍了2000年10月“国际功能,残疾和健康分类”草案对其概念的新诠释。     

对功能、残疾和健康国际分类中文版的研究

系统分析<国际功能、残疾和健康分类>(ICF)产生的历史背景、主要特点、理论模式和应用领域,并就今后ICF在中国的发展提出了有关的研究与应用设想.     

《国际功能、残疾和健康分类》研究总论

世界卫生组织 (ＷＨＯ)根据当代世界各国卫生事业发展的状况 ,从 1996开始制定了新的残疾与健康分类体系———《国际功能、残疾和健康分类》(ＩｎｔｅｒｎａｔｉｏｎａｌＣｌａｓｓｉｆｉｃａｔｉｏｎｏｆＦｕｎｃｔｉｏｎｉｎｇ ,ＤｉｓａｂｉｌｉｔｙａｎｄＨｅａｌｔｈ ,简称ＩＣＦ)。在 2 0 0 1年 5月第 5 4届世界卫生大会上 ,各成员国通过了将《国际损伤、残疾和障碍分类》(第 2版 )改名为《国际功能、残疾和健康分类》的决议 ,并鼓励各成员国考虑其具体情况 ,在研究、监测和报告中应用ＩＣＦ。ＩＣＦ已经正式由ＷＨＯ颁布 ,在世界各…     

更新观念：关于国际功能、残疾和健康分类的进展情况

康复医学是涉及功能障碍－残疾的医学,因此,首先要明确“功能”和“残疾”的概念。本文介绍了2000年10月“国际功能、残疾和健康分类”草案对其概念的新诠释。     

基于《国际功能、残疾和健康分类》的评估工具及其应用

<正>《国际功能、残疾和健康分类》(International Classification ofFunctioning, Disabilityand Health,ICF)是由世界卫生组织(World Health Organization,WHO)在2001年第54届世界卫生大会上正式命名并在国际上使用的用以描述健康及其相关状况的理论框架和分类体系^[1]。ICF为人们描述健康和残疾提供了通用语言，自发布以来，已被医疗护理人员开发出多种用途，其中基于ICF的评估工具因其可消除传统评估工具由于概念不一、语言文化背景不同造成评估结果比较困难，研究结果不利于整合的缺点，逐渐成为了医疗护理康复研究的热点。     

《国际功能、残疾和健康分类》应用指导(三)

(续第 2期 )8ＩＣＦ分类系统解说 (环境因素部分 )8.1环境因素分类性质与内容　ＩＣＦ按两个部分组织信息 :第一部分有关功能和残疾 ,第二部分是背景性因素。背景性因素是构成个体生活的全部背景 ,特别是针对在ＩＣＦ中分类的健康状况及造成功能和残疾结果的背景性因素。背景性因素代表个体生活和生存的全部背景。它们包括环境因素和个人因素 ,这些因素对具有健康问题的个体的健康和与健康有关的状况可能会产生影响。ＩＣＦ提出了两类背景性因素 :即环境因素和个人因素。环境因素是组成了ＩＣＦ的一种构成成份 ,指构成个体生活背景的外部或…     

《国际功能、残疾和健康分类》临床医生用检查表(节选)

本检查表是世界卫生组织《国际功能、残疾和健康分类》(简称ＩＣＦ)主要类目测试表 ,它是说明和记录个体功能状况和残疾的工具 ,该信息可以总结为病案记录 (例如在临床实践或是社会工作中的记录 )。检查表要与ＩＣＦ评定表或ＩＣＦ简表一起使用。Ａ .基本资料Ａ .1姓名 :＿＿＿＿＿＿＿＿＿＿＿Ａ .2性别 :(1) []女　 (2 ) []男Ａ .3出生日期 :＿＿ ＿＿ ＿＿(日 月 年 )Ａ .4地址 :Ａ .5正式教育年数 :＿＿Ａ .6现实婚姻状况 :(1)从未结婚 [](4)离婚 [](2 )已婚 [](5 )单身 [](3)分居 [](6 )同居 []Ａ .7现实职业状况 (作一最佳选择 )(1)…     

《国际功能、残疾和健康分类》应用指导(一)

在第 5 4届世界卫生大会上 ,世界卫生组织 191个成员国一致签署协议 ,认可《国际残疾分类》第 2版(ＩＣＩＤＨ 2 ) ,题为《国际功能、残疾和健康分类》(Ｉｎｔｅｒｎａ ｔｉｏｎａｌＣｌａｓｓｉｆｉｃａｔｉｏｎｏｆＦｕｎｃｔｉｏｎｉｎｇ ,Ｄｉｓａｂｉｌｉｔｙ ,ａｎｄＨｅａｌｔｈ ,ＩＣＦ) ,中文简称为《国际功能分类》 ,并敦促会员国结合本国的具体情况并特别考虑到今后可能作出的修订 ,在研究、监测和报告中酌情使用ＩＣＦ。同时 ,要求总干事根据会员国提出的要求在使用ＩＣＦ方面向它们提供支持。它标志着经过多年由多国专家共同努…     

《国际功能、残疾和健康分类》应用指导(二)

7ICF分类系统活动和参与部分应用指导活动是由个体执行一项任务或行动。活动受限是个体在进行活动时可能遇到困难。参与是投入到一种生活情景中。参与局限性是个体投入到生活情景中可能经历到不便。7.1活动和参与部分分类体系　附图显示了活动和参与部分分类体系7.2活动和参与之间的结构关系　根据领域列表 ,就活动 (A)和参与 (P)之间的联系 ,ICF提出了四种结构关系 ,可以满足不同的需求[1] 。具体如下 :7.2 .1活动领域和参与领域是不同的集合 (无交叉 )　即将一部分类目的集合仅作为活动 (即个体所执行的任务或行动 )进行编码 ,而另一…     

世界卫生组织残疾评定项目及其与《国际功能、残疾和健康分类》的关系

背景2 0 0 1年 10月 2 1- 2 7日 ,在美国马里兰州贝塞斯达召开了世界卫生组织国际分类家族 (ｔｈｅＦａｍｉｌｙｏｆＩｎ ｔｅｒｎａｔｉｏｎａｌＣｌａｓｓｉｆｉｃａｔｉｏｎｓ,ＷＨＯ ＦＩＣ)合作中心领导人会议 ,会议要求秘书处为 2 0 0 2年的中心领导人会议提交一份文件 ,说明世界卫生组织残疾评定项目 (ＤｉｓａｂｉｌｉｔｙＡｓｓｅｓｓｍｅｎｔＳｃｈｅｄｕｌｅ ,ＷＨＯＤＡＳⅡ )及其与国际功能、残疾和健康分类 (ＩＣＦ)关系。本文即是应此要求而作。导言过去 30多年来 ,我们看到一种对健康与功能的思想转变。现在已知 ,诊断及有…     

Social participation following a stroke: an assessment in accordance with the international classification of functioning,disability and health

Objective: Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation.

Methods: An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (<12?months or >12?months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation.

Results: Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F?=?2.46; 95% confidence interval (CI)?=??23.67–0.34; p?=?0.05), degree of functional independence (F?=?2.40; 95% CI?=??33.0 to ?18.93; p?<?0.001) and marital status (married or widowed) (F?=?2.6; p?=?0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F?=?99.2; r²?=?0.57; p?<0.001) and the occurrence of depressive symptoms was a moderate predictor (F?=12.78; r²?=?0.40; p?=?0.001).

Conclusions: Twenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the “social roles” domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke.

• Implications for Rehabilitation

• The Brazilian stroke individuals analyzed exhibited a moderate level of participation.

• Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation.

• Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life.

• Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health.

• This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice.

     

Work status and chronic low back pain: exploring the international classification of functioning,disability and health

Purpose.?Exploring which variables are related to work status in patients with chronic low back pain (CLBP), classified according to the International Classification of Functioning, Disability and Health (ICF).

Method.?Ninety-two patients with CLBP filled out questionnaires inquiring after health status, impairments in body functions/structures, limitations in activities of daily living (ADL), participation in work, environmental and personal factors. Additionally, patients performed tests to measure physical fitness and performance of work-related activities. Univariate analyses were performed to investigate whether differences exist between working and non-working patients. Logistic linear regression analysis was performed to explain work status from the variables of functioning.

Results.?Non-working patients had a lower self-reported physical and mental health, lower physical fitness, more self-reported limitations in ADL, lower education, more depressive symptoms and higher psycho neuroticism than working patients. Self-reported physical and mental health and educational level correctly classified 84.5% of the patients as working or non-working. Performance of work-related activities was not significantly related with work-status.

Conclusions.?The relation between work status and CLBP is multidimensional, as was illustrated by using the bio-psychosocial model of the ICF. Patients with a low educational level, a low self-reported physical or mental health were more likely to be non-working. Self-reported limitations and physical and mental health are more important in explaining work status than objective measurements of performance.     

国际功能、残疾和健康分类认识一种新的国际分类系统

目的:国际、残疾和健康分类是一种新的国际分类系统,是在国际障碍分类的基础上发展而来的,是为了记录健康状况及与健康相关的状况,而提供统一的、标准化的语言,使全世界不同学科和领域能够对有关健康和保健情况进行广泛交流。并提供了一种框架,可以对健康及与健康相关的信息进行编码(如诊断、残疾等)。方法:从基本特征,分类项目,应用领域等几个方面对国际、残疾和健康分类进行分析。结果:①国际、残疾和健康分类的基本特征明确了环境因素及个人因素的重要性,在国际、残疾和健康分类中均用肯定的形式表示,且各个项目间的关系是双向、关联、相互作用、相互制约的立体式模式。②涉及的范围较前更加广泛,涉列的项目内涵扩大,且各个项目的分类详细。③国际、残疾和健康分类所有的人均可以使用,是世界上惟一被承认的一种分类工具。结论:国际、残疾和健康分类系统表明医务工作者面对的不仅是疾病、残疾,也不只是针对身心功能障碍水平的简单处置,而是要全面把握对象的活动能力、参与水平、环境因素及主观意识状况,使其充分发挥主观能动性。     

Using the international classification of functioning to examine the impact of trigger finger

Purpose: To evaluate the impact of trigger finger (TF) on hand motor function, activity and participation (A&P) and quality of life (QOL), and to evaluate the association between personal factors (age and gender, disease severity) and body functions (dexterity and strength) with A&P and QOL in patients with TF.

Methods: Sixty-six patients with TF (study group) and 66 healthy volunteers (control group) participated in the study. TF symptoms were graded using the Quinnell classification. A&P was evaluated using the Disabilities of Arm Shoulder and Hand questionnaire and the QOL using the World Health Organization Quality of Life questionnaire. Dexterity was evaluated using the Functional Dexterity Test and the Purdue Pegboard Test; hand strength was evaluated using the Jamar Dynamometer and Pinch Gauge.

Results: The comparisons between the study and control groups revealed significant differences in all measures. The study group reported lower perceived QOL, A&P and reduced hand strength and dexterity. Hierarchical regression analyses revealed that (a) the severity of TF contributed significantly to the explained variance of QOL, while demographics and hand functioning did not; (b) demographics, TF severity and hand function all contributed significantly to the explained variance of A&P.

Conclusion: The findings of the study point to the importance of addressing the functional implications and QOL of individuals with TF.

• Implications for Rehabilitation

• Although trigger finger is considered to be a mild hand pathology, it has a wide-ranging impact on hand functioning, daily activities and quality of life.

• Clinicians should include assessments of these outcomes in the treatment of individuals with trigger finger.

• Treatment efficacy should be evaluated with International Classification of Functioning outcomes, and not limited to symptomatology.

     

Measuring deterioration in international classification of functioning domains of people with multiple sclerosis who are ambulatory

BACKGROUND AND PURPOSE: Measures to detect important effects related to physical therapy interventions must be able to detect an important change. The purpose of this study was to select the most responsive physical functioning measures for multiple sclerosis (MS) using the International Classification of Functioning, Disability and Health (ICF) as a framework. SUBJECTS: The participants were 120 people with MS who were ambulatory from a population-based sample. METHODS: Physical functioning was assessed by quantitative clinical measures of activities (n=5) and body functions (n=7) and by self-reported performance in self-care, mobility, and domestic life domains in the activities and participation component of the ICF at baseline and 2 years later. A participant's perception of change and a change in Expanded Disability Status Scale (EDSS) scores were used as external criteria in the analysis of the receiver operating characteristic curve and the minimally important change score. The minimal detectable change was calculated as distribution-based responsiveness. RESULTS: According to the external criteria, 51% of the participants showed deterioration as measured by their own perceptions compared with the 26% of the participants who showed deterioration as rated by the clinician. Regardless of the external criterion applied, the measures most responsive to deterioration were self-reported scores in self-care, mobility, and domestic life; distance walked and change in heart rate during a 6-minute walk test; 10-m walk test speeds, stride length, and cadence; repetitive squatting; and Box and Block Test scores. DISCUSSION AND CONCLUSION: The results show the relative responsiveness of different measures in the subsample who deteriorated and provide data that can facilitate the interpretation of score changes in people with MS who are ambulatory for future studies and in clinical practice.     

The international classification of functioning,disability and health and its application to cognitive disorders

Purpose:?This paper describes the conceptual foundation and systematic framework of the International Classification of Functioning, Disability, and Health (ICF) as a mechanism for understanding the course and consequences of various health related states. The specific application of the ICF with persons with cognitive dysfunction is also presented.

Method:?A comprehensive literature review related to the conceptualization of the ICF, its classification scheme and coding process is presented. Information on cognitive disorders including prevalence, functional manifestations and the assessment of a person's cognitive functioning and the applicability of the ICF's holistic classification and coding of cognitive dysfunction within the components of body structure and function, activity and participation, and environmental attributes is also reviewed.

Conclusion:?The ICF has the potential to classify and interpret cognitive deficits on a global level and thereby reflects upon the overall health and functioning of the individual in major life activities. The coding system systematically organizes measures related to the person's cognitive status and the resulting functional outcomes. The ICF focuses on individuals' performance of activities in all aspects of life and validates the independence and well-being of persons with disabilities making it an important instrument to be used by rehabilitation professionals.     

The international classification of functioning, disability and health and its application to cognitive disorders

PURPOSE: This paper describes the conceptual foundation and systematic framework of the International Classification of Functioning, Disability, and Health (ICF) as a mechanism for understanding the course and consequences of various health related states. The specific application of the ICF with persons with cognitive dysfunction is also presented. METHOD: A comprehensive literature review related to the conceptualization of the ICF, its classification scheme and coding process is presented. Information on cognitive disorders including prevalence, functional manifestations and the assessment of a person's cognitive functioning and the applicability of the ICF's holistic classification and coding of cognitive dysfunction within the components of body structure and function, activity and participation, and environmental attributes is also reviewed. CONCLUSION: The ICF has the potential to classify and interpret cognitive deficits on a global level and thereby reflects upon the overall health and functioning of the individual in major life activities. The coding system systematically organizes measures related to the person's cognitive status and the resulting functional outcomes. The ICF focuses on individuals' performance of activities in all aspects of life and validates the independence and well-being of persons with disabilities making it an important instrument to be used by rehabilitation professionals.     

Identification of international classification of functioning,disability and health relevant categories to describe functioning and disability of patients with myasthenia gravis

Purpose.?To describe functioning and health of patients with myasthenia gravis (MG) and to identify which are the most common problems patients encounter, by using the international classification of functioning, disability and health (ICF).

Method.?Adult patients with MG were recruited at C. Besta Neurological Institute. The ICF checklist was administered in individual sessions. Categories were identified as relevant if they were reported as a problem by more than 30% of patients (within activities and participation, the threshold was counted on capacity qualifier).

Results.?One hundred two patients were enrolled (mean age 47.2; inpatients were 29.4%, females 68.6%) and 54 ICF categories were selected: 14 body functions categories (26% out of total selected categories), 2 body structures (4%), 22 activities and participation categories (41%) and 16 environmental factors (29%). Environmental factors were essentially reported as facilitators.

Conclusions.?Twelve ICF categories, not contained in ICF core-sets for neurological condition, related to mobility, household and labour activities were identified. The ICF categories identified in this study are an useful guideline for clinicians and researchers, for monitoring interventions and follow-up of clinical conditions on a broad set of functional areas, and for developing ICF-based assessment tools for patients with MG.     

ICF-based classification and measurement of functioning

If we aim towards a comprehensive understanding of human functioning and the development of comprehensive programs to optimize functioning of individuals and populations we need to develop suitable measures. The approval of the International Classification, Disability and Health (ICF) in 2001 by the 54th World Health Assembly as the first universally shared model and classification of functioning, disability and health marks, therefore an important step in the development of measurement instruments and ultimately for our understanding of functioning, disability and health. The acceptance and use of the ICF as a reference framework and classification has been facilitated by its development in a worldwide, comprehensive consensus process and the increasing evidence regarding its validity. However, the broad acceptance and use of the ICF as a reference framework and classification will also depend on the resolution of conceptual and methodological challenges relevant for the classification and measurement of functioning. This paper therefore describes first how the ICF categories can serve as building blocks for the measurement of functioning and then the current state of the development of ICF based practical tools and international standards such as the ICF Core Sets. Finally it illustrates how to map the world of measures to the ICF and vice versa and the methodological principles relevant for the transformation of information obtained with a clinical test or a patient-oriented instrument to the ICF as well as the development of ICF-based clinical and self-reported measurement instruments.