中国版简明版糖尿病《国际功能、残疾和健康分类》核心要素的初步探讨

目的:初步确定中国版简明版糖尿病《国际功能、残疾和健康分类》(ICF)核心要素。方法:选取50例糖尿病患者。采用两种调查问卷记录患者信息,按ICF限定值评定患者每一分类项目的严重程度,统计每一个分类项目的频率,将频率≥30%的ICF分类项目提取形成初步临床调查结果,将这些分类项目整合成专家调查问卷发给13位康复专家和12位内分泌专家,本研究设定的专家调查取舍点为50%,即将半数以上专家认为与糖尿病患者非常相关的分类项目保留作为最终结果。结果:最终确定的中国版简明版糖尿病ICF核心要素共51项,其中2级分类43项,3级分类8项。身体功能分类28项,身体结构分类4项,活动和参与分类5项,环境因素分类14项。结论:通过本研究初步确定了中国版简明版糖尿病ICF核心要素。     

中国版脑外伤意识清醒期简明国际功能、残疾和健康分类核心要素的初步研究

目的:初步确定中国版脑外伤意识清醒期简明国际功能、残疾和健康分类(ICF)的核心要素。方法:选取100例脑外伤意识清醒期患者。1临床调查结果:采用调查问卷记录患者信息,统计每一个分类项目的频率,将频率≥30%的ICF分类项目提取形成临床调查结果;2专家调查结果:将包含139项ICF二级分类项目的调查表发给47位专家进行调查,要求专家选取认为与脑外伤患者相关性较强的100项,设定专家调查取舍点为50%,即将半数以上专家选择的,认为与脑外伤患者非常相关的分类项目保留作为专家调查结果;3取临床调查结果和专家调查结果的交集;4将该结果与通用版ICF项目进行整合,作为最终的结果。结果:最终确定的中国版脑外伤意识清醒期简明ICF核心要素共29项,其中身体功能分类10项,身体结构分类1项,活动和参与分类10项,环境因素分类8项。结论:通过本研究初步确定了中国版脑外伤意识清醒期简明ICF核心要素的组成。     

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。     

针对脑卒中的ICF核心分类模板

目的通过循证和专家讨论研究法建立第一版针对脑卒中的一套综合ICF核心分类模板和与之相应的简明ICF核心分类模板。方法来自于不同国家和地区的国际专家从初步研究中搜集证据，结合这些证据进行正式的决策并最终达成共识。初步研究包括Delphi研究方法、对ICF分类的系统评价以及实证数据的收集。结果来自12个不同日家的39位专家出席会议并达成共识。专家初步研究决定在ICF分类的第二、第三和第四级水平上针列脑卒中确定一套448个类目的ICF核心分类摸板，其中193项类目属于身体功能，26项属于身体结构，165项属于活动和参与，64项属于环境因素。综合性ICF核心分类模板包括在ICF分类第二级水平上的130个类目，其中41项属于“身体功能”，5项属于“身体结构”，51项属于“活动和参与”，33项属于“环境因素”。简明型ICF核心分类模板包括在ICF分类第二级水平上的18个类日，其中6项属于身体功能，2项属于身体结构，7项属于活动参与，以及3项属于环境因素。结论专家组通过整合研究过程中的证据，以及专家们基于ICF框架和分类的观点达成正式的共识，并确定针对“脑卒中”的ICF核心分类模板，同时界定综合型ICF核心分类模板和简要型ICF核心分类模板。     

终末期肾病血液透析《国际功能、残疾和健康分类》核心组合的初步研究

目的:初步探讨我国终末期肾病血液透析ICF核心组合及简要版的内容。方法:参考国外相关文献及WHO的ICF checklist,制成两种调查问卷。一种是由医务人员填写的专用病历记录表和个案记录表。对入组的100名患者进行调查。使用描述性统计方法确定每一ICF条目的频率,其中有功能障碍的频率之和≥30%的条目作为终末期肾病血液透析第一期ICF核心组合。另一种为医护人员调查问卷,用描述性统计方法确定医务人员认为与终末期肾病血液透析患者健康和残疾状况密切相关的ICF条目的频率,大于50%的条目作为第二期ICF核心组合。通过两期结果整合确定我国终末期肾病血液透析ICF核心组合。进一步筛选出大于50%患者存在障碍的条目作为终末期肾病血液透析ICF核心组合简要版。结果:本研究确立了52个条目组成我国终末期肾病血液透析ICF核心组合,包括28个身体功能条目、6个身体结构条目、12个活动和参与条目、6个环境因素条目。另外,确定了包含28个条目的核心组合简要版,其中身体功能部分13个、身体结构部分5个、活动和参与部分5个、环境因素部分5个。结论:初步确立了我国终末期肾病血液透析ICF核心组合及简要版,为终末期肾病血液透析患者功能和障碍的康复评估提供依据。     

中国（武汉）地区应用慢性缺血性心脏病的ICF核心功能组合的研究

目的：研究适应中国（武汉）地区慢性缺血性心脏病（CHID）患者的简明国际功能、残疾与健康分类（ICF）的核心功能组合类目,使其能广泛应用于临床医疗实践、为CIHD患者健康状况的测量提供可靠的依据。方法：使用CIHD的ICF调查表同时对58例CIHD患者和32名心血管以及康复专家做面访或电邮调查,统计CIHD患者出现明显问题的频率和专家一致认为有显著意义的类目的频率。结果：得到患者阳性率≥30％的ICF类目30个,专家组意见显著性≥50％的ICF类目22个,合计得到具有显著性意义的ICF核心功能组合类目共有37个,其中身体功能13个,身体结构2个,活动与参与8个,环境因素14个。结论：本次研究所得的简明核心功能组合类目与已报道的简明ICF核心功能组合类目相比一致性较好,地域、调查对象等因素的影响也能对少数有差别的类目进行很好的解释,尚有部分类目确定有待更大样本的再次检验。     

脊髓损伤患者神经源性膀胱的国际功能、残疾和健康分类核心类目研究

摘要 目的：筛选出脊髓损伤患者神经源性膀胱的国际功能、残疾、健康分类核心类目。 方法：通过ISCOS提供的开放脊髓损伤数据库（international SCI data sets）筛选出和神经源性膀胱相关的基础数据库，整理出这些数据库的每个变量。利用WHO-FIC合作中心ICF研究组开发的ICF与结局测量工具间联系和匹配的原则，采用专业人员对内容定性联系和匹配的方法，将针对筛选出的变量与ICF综合版测量项目进行联系和匹配。整理匹配的ICF项目生成神经源性膀胱ICF核心要素。 结果：通过对比2名研究者筛选相同变量，合并相近的变量，剔除与神经源性膀胱不相关的变量，最终纳入85项。共提取有明确意义的概念60个，可与ICF联系、匹配的概念46个。与ICF联系、匹配后共得出神经源性膀胱ICF核心类目40项，其中身体功能16项、身体结构8项、活动和参与9项、环境因素与个人因素7项。 结论：系统回顾研究法初步筛选出脊髓损伤患者神经源性膀胱ICF核心类目，为神经源性膀胱评估、治疗提供了更全面的框架。     

脑卒中ICF核心分类量表综合版的效标关联效度研究①

目的分析研究脑卒中ICF核心分类量表(ICF Core Sets)综合版的效标关联效度。方法根据联系规则将健康调查简表(SF-36量表)、Barthel指数、简易精神状态检查(MMSE)、世界卫生组织生存质量测量简表(WHOQOL-BREF)、世界卫生组织《残疾评定量表》(WHO-DASⅡ)中项目的概念与脑卒中ICF核心分类量表综合版中项目的概念作定性研究,确定测量项目内容的关联性。在此基础上选择上述6个量表对93例脑卒中患者进行临床测量研究和相关分析。结果脑卒中ICF核心分类量表综合版中16个身体功能项目及27个活动和参与项目与本研究所选择的测试量表中的项目内容相关(0.4相似文献   

脊髓损伤护理相关《国际功能、残疾和健康分类》类目的初步研究

目的:确定与脊髓损伤患者护理相关的《国际功能、残疾和健康分类》(ICF)类目。方法:首先在数据库中检索与脊髓损伤患者护理相关的文献,根据ICF的联系规则将文献中结局评价方法里的概念与ICF类目相联系,从而确定文献中与脊髓损伤护理相关的ICF类目。系统性回顾所得ICF类目和一个世界范围内的Delphi专家调查的结果合并,形成国内专家咨询问卷。然后在我国脊髓损伤护理专家中通过电子邮件的形式进行调查。获得80%以上专家认同的ICF类目将被纳入脊髓损伤护理相关ICF组合。结果:系统性回顾确定了72个ICF类目,将这些ICF类目与世界范围内的Delphi专家调查结果合并,形成了包含140个ICF类目的专家咨询表。共有29位国内脊髓损伤护理专家参与了调查,专家积极系数为96.7%,专家的权威系数范围是0.68—1(中位数0.98,四分位距0.86—0.99)。最终81个ICF类目被纳入,包括"身体功能"33个,"身体结构"8个,"活动和参与"24个,"环境因素"6个,"个人因素"10个。结论:初步确定的81个脊髓损伤护理相关ICF类目能够反映中国脊髓损伤护理实践的主要内容,为临床护士应用ICF提供了依据和范围。     

国际功能、残疾和健康分类核心要素在器官移植患者术后早期应用中的效度研究

目的评估国际功能、残疾和健康分类(ICF)核心要素在器官移植患者术后早期应用中的效度。 方法采用ICF核心要素问卷、功能独立性评测(FIM)以及Barthel指数(BI)评估肾、肝、肺和心脏移植患者,用ICF核心要素的每个目录报告问题的频率评估其内容效度,而用ICF核心要素的目录与FIM和BI的相关性评估其结构效度。 结果共102例器官移植术后早期患者完成研究。在身体功能方面,ICF核心要素中有10个目录作为一个问题被30%以上的患者报告,22个目录与FIM或BI相关。在身体结构中,仅s810(皮肤结构)作为一个问题被30%的患者报告,3个目录与FIM或BI相关。在活动与参与方面,3个目录被30%的患者报告存在问题,15个目录与FIM和BI相关。在环境因素方面,８个目录作为促进因素被30%的患者报告,8个目录与ＦIM或BI相关。 结论ICF核心要素用于器官移植术后早期患者显示良好的内容效度和结构效度。     

Use of the International Classification of Functioning, Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis

PURPOSE: To identify the preliminary comprehensive and brief core sets for multiple sclerosis (MS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF). METHOD: Focus groups and a consensus process were used to identify ICF core sets for MS. This included: preliminary ICF studies; empirical patient data collection for 101 MS participants; review of the evidence base and treatment in MS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia. RESULTS: One hundred and forty-four (40%) second level ICF categories were selected by 23 participants in three rounds. The comprehensive MS ICF core set includes 34 (24%) categories from the component 'body function', six (4%) categories from 'body structures', 68 (47%) from 'activities and participation' and 36 (25%) from the component 'environmental' factors. Ten categories in 'personal factors' in MS were also suggested by the participants after intensive discussions. The brief set comprises 30 categories, 21% of categories in the comprehensive core set. CONCLUSION: Consensus expert opinion can use ICF categories to identify the core set for MS which reflects disease complexity and care burden for persons' with MS. Further research is needed to identify ICF categories of relevant personal factors to improve our understanding of the large social and cultural variance associated with them.     

Linking the Bournemouth Questionnaire for low back pain to the International Classification of Functioning,Disability and Health

Purpose: Understanding the content of health-related quality of life (HRQOL) questionnaires can facilitate comparison and selection of the most appropriate tool in the assessment of patients with low back pain. The International Classification of Functioning, Disability and Health (ICF), as part of the WHO-FIC, can be used as a standardised method for mapping and comparing HRQOL questionnaire content. The purpose of this study was to link the Bournemouth Questionnaire (BQ) to the ICF in order to assess and compare the content of the BQ to the brief ICF core sets for low back pain. Methods: The BQ was linked to the ICF following the rules described by Cieza and Stuki. Following the linking process, the results were further linked to the brief ICF core sets for low back pain. Results: The BQ covered 21 ICF categories within the domains of body functions and activities and participation. Only five meaningful concepts could not be linked to the ICF. The brief core sets for low back pain contain 35 categories, identified as important concepts in back pain patients. The BQ covered 10 of the categories of the brief core sets. Conclusion: HRQOL tools provide valuable information about the health status of patients. Content comparison based on ICF provides relevant information about the concepts covered and enables selection of the appropriate clinical tools. The BQ is easy to administer and is linked to a number of important concepts contained within the ICF and to concepts considered to be important in the assessment of patients with LBP.

• Implications for Rehabilitation

• Selecting appropriate health-related quality of life (HRQOL) tools can prove difficult, with such a variety of them available, and each with varying content.

• ICF provides a standardised framework for the content assessment of HRQOL tools.

• Understanding the content of HRQOL tools can facilitate better tool selection and assist in the accurate assessment of patients with low back pain.

     

Use of the International Classification of Functioning,Disability and Health (ICF) to identify preliminary comprehensive and brief core sets for multiple sclerosis

Purpose. To identify the preliminary comprehensive and brief core sets for multiple sclerosis (MS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF).

Method. Focus groups and a consensus process were used to identify ICF core sets for MS. This included: preliminary ICF studies; empirical patient data collection for 101 MS participants; review of the evidence base and treatment in MS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia.

Results. One hundred and forty-four (40%) second level ICF categories were selected by 23 participants in three rounds. The comprehensive MS ICF core set includes 34 (24%) categories from the component ‘body function’, six (4%) categories from ‘body structures’, 68 (47%) from ‘activities and participation’ and 36 (25%) from the component ‘environmental’ factors. Ten categories in ‘personal factors’ in MS were also suggested by the participants after intensive discussions. The brief set comprises 30 categories, 21% of categories in the comprehensive core set.

Conclusion. Consensus expert opinion can use ICF categories to identify the core set for MS which reflects disease complexity and care burden for persons' with MS. Further research is needed to identify ICF categories of relevant personal factors to improve our understanding of the large social and cultural variance associated with them.     

基于图模型的脑卒中功能变量关系结构探析

目的:为国际功能、残疾和健康分类(ICF)在脑卒中康复中的应用提供新思路和新依据。方法:选取100例脑卒中患者组成的便利样本,访谈法评定国际版脑卒中ICF综合核心组合的166个条目。以条目为节点,条目间的风险相关性为连线,构建图模型。采用R软件(3.2.2版)建模,用Pajek64(5.02版)进行网络分析和可视化。结果:在图模型总体内,存在主组元结构,并且可以从中提取具有稳定路径结构的3-核结构。主组元中还可以提取具有牢固连接关系的主岛屿结构。其中"d450步行"既属于通用组合,又属于简要核心组合,并且占据了重要位置。简要核心组合条目在总图中的子网络,以及这些条目在各级限定值上的频数分布,可以提供相互参照和相互补充的功能变量知识。结论:ICF综合核心组合的图模型,可反映脑卒中功能变量间的复杂关系结构。该组合的频数分布,可反映卒中功能变量的属性特征。从关系结构和属性特征两个不同视角进行分析,可以为ICF的康复应用提供综合策略。     

Use of the International Classification of Functioning,Disability and Health to identify preliminary comprehensive and brief core sets for Guillain Barre syndrome

Purpose.?To identify the preliminary comprehensive and brief core sets for Guillain Barre syndrome (GBS), in a Delphi process using the International Classification of Functioning, Disability and Health (ICF).

Method.?Focus groups and a consensus process were used to identify ICF core sets for GBS. This included: preliminary ICF studies; empirical patient data collection for 77 GBS participants; review of the evidence base and treatment in GBS literature followed by a Delphi exercise with 23 physicians and allied health professionals in Melbourne, Australia.

Results.?The expert consensus selected 99 second level ICF categories (in three rounds) which identify health domains relevant to GBS for multidisciplinary assessment. These domains were consistent with current practice and existing GBS literature. The comprehensive core set includes: 27 (23%%) categories from the component ‘body function’, 7 (12%%) categories from ‘body structures’, 43 (36%%) from ‘activities and participation’ and 22 (29%%) from the component ‘environmental’ factors. The brief set comprised 20 categories, 20%% of categories in the comprehensive core set.

Conclusion.?The core set categories for GBS-related health need to be addressed in multidisciplinary care programs. Future clinical ‘rating’ of this set may facilitate scale development using the ICF in GBS. Further research is needed to confirm the generalisability of this set in clinical settings.     

脑卒中国际功能残疾和健康分类简要核心组合的信度与效度研究

目的:分析研究脑卒中国际功能、残疾和健康分类(ICF)简要核心组合的信度和效度。方法:选择50例脑卒中患者,采用国际脑卒中ICF简要核心组合、美国国立卫生研究院卒中量表(NIHSS)、Fugl-Meyer运动功能量表(FM)、Barthel指数(BI)进行评定。评定者间信度采用Kappa一致性分析方法;同步效度采用Spearman相关分析。结果:身体功能中的四个类目意识功能、定向功能、语言精神功能和肌肉力量功能的kappa值为0.664—1.000,信度中度到优;身体结构的类目脑的结构kappa值为0.976,信度优;活动和参与的四个类目的kappa值为0.696—0.846,信度中度到优;环境因素的类目直系亲属家庭kappa值为0.450,信度中度。ICF除"e310直系亲属家庭"外的其他项目的总分与NIHSS、Fugl-Meyer、BI评分的Spearman相关系数分别为0.795、-0.866、-0.795(P<0.01)。结论:采用国际脑卒中ICF简要核心组合对脑卒中患者进行综合评定可靠有效。     

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.     

ICF Core Set for patients with musculoskeletal conditions in the acute hospital

PURPOSE: The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with musculoskeletal conditions in the acute hospital. METHODS: The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients. RESULTS: Twenty-one experts selected a total of 47 second-level ICF categories. The largest number of categories was selected from the ICF component Body Functions (17 categories or 36%). Nine (19%) of the categories were selected from the component Body Structures, 11 (23%) from the component Activities and Participation, and 10 (21%) from the component Environmental Factors. CONCLUSION: The Acute ICF Core Set for patients with musculoskeletal conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.