失语症第三方残疾功能变量的网络图分析

目的:构建失语症第三方残疾功能变量间相关关系的图模型,分析其网络特征,为失语症及其第三方残疾康复提供新的研究思路。方法:参考国外相关文献及综述,选取失语症第三方残疾功能变量的64个ICF条目,采用访谈法评估30例受试者的功能变量。构建图模型时,以每个条目作为节点,各条目间的风险相关性作为连线。建模采用R软件(3.6.2版),网络分析可视化采用Pajek软件(5.08版),用马赛克图表示各条目在各级限定值上的频数分布。结果:64个条目中,有14对两两相连的双条目组元,有18个相互联系的条目构成的功能地形图中最大的独立结构,为主组元结构。其中d855(无报酬的就业)占据了重要位置,分别与d920(娱乐与休闲)、b1263(精神稳定性)和e5750(全社会的支持服务)相连。双条目组元及主组元网络结合条目在马赛克图上的频数分布,既可以提供功能变量间的网络关系,又可以提供自身的属性特征,二者相互参照,以提供更多元的康复思路。结论:采用ICF功能变量构建的图模型,可反映失语第三方残疾功能变量间的复杂关系网络。各功能变量的频数分布,可反映属性特征。从这两个不同的角度进行相关分析,可以为疾病的康复提供多视角的策略。     

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中的分布。通过与卒中风险相关关系图谱比较,对其中的关键条目进行分析。结果:ICF的功能鉴别谱含有137个条目,其主组元由73个身体功能条目构成。最致密的4-核结构含有22个身体功能条目,属于脑高级功能和心肺功能相关条目。4-核条目广泛分布于现有的疾病综合核心组合中。功能鉴别谱与风险相关谱之间有条目交叉,但网络关系有差异。结论:使用ICF体系固有的排除项信息,可以建立功能鉴别谱,作为分析和应用ICF知识的新工具。     

孤独症谱系障碍儿童《国际功能、残疾和健康分类》功能变量关系图模型探析

目的:在世界卫生组织(WHO)发布的孤独症谱系障碍(ASD)核心组合基础上,建立反映功能变量关系图模型,探索ASD治疗的ICF靶条目。方法:ASD便利样本77例,0-5岁和6-16岁患儿共有ICF组合条目67条。根据条目的频数计算障碍率。通过图建模建立条目间风险相关关系网络,继而进行主岛屿提取、k-核解析和网络参数(点度、介数、接近度和拉普拉斯度)计算。分析障碍率与网络参数之间的相关关系,并对k-核结构进行可视化分析。结果:障碍率在10%-90%的34个ICF条目借助风险相关关系处于主岛屿结构中。条目的障碍率与各个网络参数之间无明显相关关系。从核心网络中提取的关键条目具有中等程度的障碍率(0.4-0.8),以其作为可干预的ICF靶条目符合已有的ASD治疗认识。结论:基于频数分析的ICF条目障碍率和基于图建模的网络参数之间无明显相关关系,在核心组合基础上建立功能图谱,并从中提取核心网络和关键条目,有可能为发掘可干预ICF靶条目提供新思路。     

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。     

超重和肥胖多囊卵巢综合征功能变量关系结构解析

目的:构建反映多囊卵巢综合征(PCOS)功能变量间关系结构的图模型,分析其结构特征,为PCOS康复的临床和科研提供新依据。方法:肥胖或超重PCOS患者57例,以肥胖的国际功能、残疾和健康分类(ICF)综合核心组套的109个分类项目为变量。采用"最小的绝对缩减和变量选择算子"发掘变量之间的条件依存关系,采用自举法重采样技术和置信区间检验法来加强模型的稳定性,以R软件和Pajek2.04建模。采用Ucinet6.360和Pajek2.04对建成的模型进行组元分析、聚类分析和k核解析。结果:在最终构建的图模型中,有17对两两相连的双项目结构。有31个项目相互联系构成了图模型中最大的独立组元,其中b650(月经功能)与b555(内分泌腺功能)和e580(卫生的服务、体制和政策)相连,而b555还与s580(内分泌腺结构)、s630(生殖系统的结构)、e455(与卫生有关专业人员的个人态度)和e465(社会准则、实践和观念)相关。对该主组元的马可夫聚类分析可得到10个聚类。b126(气质和人格功能)是图模型中最具影响力的ICF项目,其所属聚类也是影响力最大的聚类。结论:PCOS功能变量间存在复杂的关系结构。图建模可以揭示其中的结构特征,从中可以找到符合已有临床知识的结构特征,并且可以为应用ICF指导PCOS康复的临床实践和科学研究提供新的线索。     

运用ICF核心分类组合脑卒中(综合版)评价脑卒中患者功能状况的多中心研究

目的运用ICF核心分类组合脑卒中(综合版)评价脑卒中康复患者的功能、结构、活动和参与、环境因素,并探讨其相互关系。方法 2012年7月至2014年6月,来自全国57个医疗中心的首发脑卒中住院患者2822例,采用ICF核心分类组合脑卒中(综合版)进行评定。对各类目以及不同类目之间的关系进行分析。结果步态、肌肉力量、随意运动控制、驾驶、做家务、就业是患者困难较大的前几位类目;环境因素中,建筑物相关的用品和技术、个人室内外移动和运输用的用品和技术、劳动和就业的服务、体制和政策等是影响患者的前几位障碍因素。功能与活动和参与正相关(r=0.712, r=0.694, P 0.001);活动和参与的活动表现与能力表现高度正相关(r=0.877, P 0.001);环境因素中的障碍因素与活动和参与的活动表现正相关(r=0.308, P 0.001)。结论 ICF核心分类组合脑卒中(综合版)可以作为一个新的康复评价体系应用于脑卒中患者,有助于开展更实用、更有效的康复。     

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。     

糖尿病国际功能、残疾和健康分类综合核心组套的图建模

目的:绘制基于国际功能、残疾和健康分类(ICF)的糖尿病功能地形图,为糖尿病的功能研究提供新的依据。方法:收集200例糖尿病患者的便利样本,以糖尿病ICF综合核心组套中的99个分类项目为变量进行图建模。缺失值以多重填补法进行填补,采用"最小的绝对缩减和变量选择算子"发掘变量之间的条件依存关系,采用自举法重采样技术和置信区间检验法强化模型的信度和效度,以R软件和Pajek2.04进行建模和分析。结果:在99个分类项目中,有61个相互联系构成了功能地形图中的最大的独立结构,并且可以解析出一个由44个分类项目组成的2-核。"s220"(眼球的结构)、"s6100"(肾)、"d760"(家庭人际关系)、"d455"(到处移动)和"d450"(步行)因连接范围较大而居于地形图的中心地位。结论:图建模所绘制的糖尿病功能地形图可以揭示功能类别之间的复杂的关系结构。这些关系结构既可以从临床知识中寻找到依据,也可以为应用ICF指导糖尿病康复的临床实践和科学研究提供线索。     

应用肥胖国际功能、失能和健康分类综合核心组合描述肥胖型多囊卵巢综合征的疾病特征

目的使用肥胖ICF综合核心组合对肥胖型多囊卵巢综合征（PCOS）的疾病特征进行描述,揭示和探讨符合肥胖型PCOS疾病特征功能障碍的相关领域。 方法使用肥胖ICF综合核心组合对60例肥胖型PCOS患者进行评估,大于30%的患者报告作为障碍的条目才被考虑与PCOS患者的功能相关。 结果参与研究的60例肥胖型PCOS患者中,肥胖ICF综合核心组合条目的109条中有20个条目被选择与PCOS疾病特征相关。其中,身体功能领域有6条（占全部被选择条目的30%）,身体结构领域有1条（占全部被选择条目的5%）,环境因素领域有13条（占全部被选择条目的65%）。 结论肥胖ICF综合核心组合可用于描述肥胖型PCOS的疾病特征和功能障碍,为临床应用ICF核心组合评估PCOS患者的功能障碍提供了可能。     

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。     

Validation of the extended ICF core set for stroke from the patient perspective using focus groups

Purpose: The extended international classification of functioning, disability and health (ICF) core set for stroke is an application of the ICF of the World Health Organisation (WHO) with the purpose to represent the typical spectrum of functioning of persons with stroke. The objective of the study was to add evidence to the validation of the extended ICF core set for stroke from the perspective of patients using focus groups to explore the aspects of functioning and health important to persons with stroke. Method: The sampling of patients followed the maximum variation strategy. Sample size was determined by saturation. The focus groups were digitally recorded and transcribed verbatim. After qualitative data analysis, the resulting concepts were linked to ICF categories and compared to the categories included in the extended ICF core set for stroke. Results: Sixty patients participated in 15 focus groups. The content of 131 out of 166 ICF categories contained in the extended ICF core set for stroke was reported by the persons with stroke. The content of 31 additional categories that are not covered in the extended ICF core set for stroke was raised. Conclusions: The existing version of the extended ICF core set for stroke could be confirmed almost entirely from patient perspective.

Implications for Rehabilitation:

• The extended ICF Core Set for stroke can be used to create a functioning profile for persons after stroke to identify problems and resources considering a client-centred approach.

• This study shows which aspects of the environment of persons after stroke are relevant from the clients’ perspective and should be integrated in the rehabilitation process.

• This study provides a basis for the further development of the ICF, especially with regard to its update in relevant aspects from clients’ perspective after stroke.

     

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.     

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.     

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.     

Investigating the International Classification of Functioning,Disability, and Health (ICF) Framework to Capture User Needs in the Concept Stage of Rehabilitation Technology Development

This study evaluates whether the International Classification of Functioning, Disability, and Health (ICF) framework provides a useful basis to ensure that key user needs are identified in the development of a home-based arm rehabilitation system for stroke patients. Using a qualitative approach, nine people with residual arm weakness after stroke and six healthcare professionals with expertise in stroke rehabilitation were enrolled in the user-centered design process. They were asked, through semi-structured interviews, to define the needs and specification for a potential home-based rehabilitation device to facilitate self-managed arm exercise. The topic list for the interviews was derived by brainstorming ideas within the clinical and engineering multidisciplinary research team based on previous experience and existing literature in user-centered design. Meaningful concepts were extracted from questions and responses of these interviews. These concepts obtained were matched to the categories within the ICF comprehensive core set for stroke using ICF linking rules. Most of the concepts extracted from the interviews matched to the existing ICF Core Set categories. Person factors like gender, age, interest, compliance, motivation, choice, and convenience that might determine device usability are yet to be categorized within the ICF comprehensive core set. The results suggest that the categories of the comprehensive ICF Core Set for stroke provide a useful basis for structuring interviews to identify most users needs. However some personal factors (related to end users and healthcare professionals) need to be considered in addition to the ICF categories.     

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。     

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。