基于ICF的慢性阻塞性肺疾病综合评估指标体系的构建研究  

Development of a Comprehensive Assessment System for Chronic Obstructive Pulmonary Disease Based on ICF

作　　者：王岚[1] 郑金萍 沈悦好[2] 禹玺[3] WANG Lan;ZHENG Jinping;SHEN Yuehao;YU Xi(School of Nursing,Tianjin Medical University,Tianjin 300070,China;Tianjin Medical University General Hospital,Tianjin 300052,China;Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津医科大学护理学院,天津市300070 [2]天津医科大学总医院,天津市300052 [3]天津市第一中心医院,300192

出　　处：《中国全科医学》2021年第10期1289-1293,共5页Chinese General Practice

基　　金：国家自然科学基金青年科学基金项目(71804125)。

摘　　要：背景慢性阻塞性肺疾病(COPD)的健康管理需要基于患者全面的评估后再给予综合性与个体化治疗方案,从而改善患者的生理和心理状态,提高健康行为的长期依从性。目的构建基于《国际功能、残疾和健康分类》(ICF)的COPD(ICF-COPD)综合评估指标体系,为患者制定完整的涵盖生理、心理、功能和社会参与状态的干预方案提供依据。方法于2019年4—8月,以国际阻塞性肺疾病ICF核心要素(综合版)为参考内容,采用德尔菲专家函询法,对从事COPD临床诊疗、临床护理、护理管理、护理教育、肺康复与心理治疗工作的专家进行两轮专家函询,结合专家建议最终确立ICF-COPD综合评估指标体系。结果两轮专家函询应答率分别为100.0%(21/21)、95.2%(20/21),专家权威系数(Cr)分别为0.836和0.845,一、二级指标的肯德尔协调系数分别为0.209和0.271,各级指标的重要性赋值均数为3.55~4.90分,变异系数为0.061~0.297,满分率为15%~90%。最终确定的ICF-COPD综合评估指标体系包括4项一级指标(身心功能、身体结构、活动与参与、环境因素)、53项二级指标。结论ICFCOPD综合评估指标体系的构建过程科学合理,能保证患者制定康复干预方案前评估内容的全面性。Background The health management of chronic obstructive pulmonary disease(COPD)requires comprehensive and individualized treatment based on the whole person assessment,so as to improve the patients’physiological and psychological status and long-term compliance to healthy behaviors.Objective To establish a comprehensive assessment system for COPD based on the International Classification of Functioning,Disability and Health(ICF),to offer a reference for the development of integrated intervention options involving physiology,psychology,functioning and social participation for such patients.Methods From April to August,2019,we constructed a questionnaire based on the comprehensive ICF core set for COPD,and used it to carry out a two-round email-based survey with experts(in fields of clinical diagnosis and treatment,clinical nursing,nursing management,nursing education,pulmonary rehabilitation and psychological therapy related to COPD)using the Delphi technique,then in accordance with the survey results,we improved it and developed the final version.Results The response rate and Cr were 100.0%(21/21)and 0.836,respectively,for the first round of survey,and were 95.2%(20/21)and 0.845,respectively,for the second round of survey.The Kendall’s coefficient of concordance were 0.209 and 0.271 for indices and subindices.The average importance value of indices ranged from 3.55-4.90.The variation coefficients of indices ranged from 0.061-0.297,and full mark rate was 15%-90%.The Comprehensive ICF-COPD Assessment System consists of 4 indices,including physical and mental functions,body structure,activities and participation,and environmental factors,and 53 subindices.Conclusion The development of Comprehensive ICF-COPD Assessment System is scientific and rational,which could ensure the comprehensiveness of the assessment content before the formulation of rehabilitation intervention plan.

关 键 词：肺疾病 慢性阻塞性 国际功能、残疾和健康分类 综合评估 德尔菲技术 

分 类 号：R563[医药卫生—呼吸系统]