基于ICF职业康复核心分类组合的职业康复个案管理  

Case management based on the ICF vocational rehabilitation core set

作　　者：胡志活 吴孟杰 陈芷莹 杨亚茹 WOO Chi Wood;NG Mang Kit;CHAN Tsz Ying;YANG Yaru(Fu Hong Society,Hong Kong 999077,China;WHO-FIC Collaborating Center in China,Beijing 100068,China;College of Physical Education and Health,East China Normal University,Shanghai 200241,China)

机构地区：[1]扶康会,中国香港999077 [2]世界卫生组织国际分类家族中国合作中心,北京市100068 [3]华东师范大学体育与健康学院,上海市200241

出　　处：《中国康复理论与实践》2025年第2期209-217,共9页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的基于《国际功能、残疾和健康分类》(ICF)职业康复核心分类(VR-CS)构建系统性的个案管理模式,探索其在职业康复中的应用路径和成效,将VR-CS的13个核心类目运用于职业康复的个案管理实践中,基于全面的功能评估,设计并且实施系统化和个性化的个案管理方案,从而提升个体的职业独立性、社会参与度以及整体生活质量。方法采用理论研究与实证个案分析相结合的方法,基于VR-CS的13个核心类目,从身体功能与结构、活动与参与以及环境因素3个层面,对全面职业评估、制定并实施整体化和个性化职业康复计划以及动态监测进行理论分析。通过3类典型职业康复个案,即重性抑郁症、高功能孤独症和轻度认知障碍个体的职业康复说明基于VR-CS的个案管理相关证据和效果。结果基于VR-CS的个案管理方法,采用ICF的生物-心理-社会的功能模式,构建了整体性与个性化的个案管理系统,融合了评估与分析职业康复需求、设定目标与制定计划、实施多学科团队协作干预和个性化干预、过程监测与动态调整、重返职业活动与长期跟踪服务等环节。基于VR-CS构建的个案管理模式在促进个案职业独立性与社会参与度方面表现出显著且系统性的成效。本研究围绕VR-CS的13个核心类目,设计并实施个案管理的主要方法和步骤进行了详细的分析,并在3个案例中阐释了该模式在实际职业康复中的方法。在身体功能与结构层面,个案管理涵盖精力和驱力功能评估(b130)、高水平认知功能训练(b164)和运动耐受性提升(b455)。自初始评估阶段起,个案管理即围绕功能限制与需求设定短期和长期目标,并在干预过程中持续动态监测,适时调整干预措施。提升了个体的身体耐受力与认知功能,改善了在复杂职业环境中的持续工作能力。在活动与参与层面,聚焦于职业技能掌握(d155)、应激管理与心�Objective To develop a systematic case management model based on the International Classification of Functioning,Disability and Health(ICF)Vocational Rehabilitation Core Set(VR-CS)and explore its application pathways and efficacy in vocational rehabilitation.The 13 core categories of VR-CS are applied in vocational rehabilitation case management practices,utilizing comprehensive functional assessments to design and implement structured and individualized case management plans.This,in turn,seeks to enhance individuals'vocational independence,social participation and overall quality of life.Methods This study adopted a combined approach of theoretical research and empirical case analysis.Based on the 13 core categories of VR-CS,a comprehensive vocational assessment was conducted across three dimensions:body function and structure,activities and participation,and environmental factors.The study theoretically analyzed how to develop and implement holistic and individualized vocational rehabilitation plans,along with dynamic monitoring processes.Three types of typical vocational rehabilitation cases were examined,including individuals with major depressive disorder,high-functioning autism and mild cognitive impairment,to illustrate the evidence and effectiveness of VR-CS-based case management.Results The VR-CS-based case management method,grounded in the ICF bio-psycho-social model,constructed an integrated and individualized case management system.This system combined the assessment and analysis of vocational rehabilitation needs,goal setting and planning,multidisciplinary team intervention,individualized interventions,process monitoring and dynamic adjustments,return-to-work activities,and long-term follow-up services.The case management model developed through VR-CS demonstrated significant and systematic efficacy in promoting vocational independence and social participation.This study provided a detailed analysis of the primary methods and steps involved in designing and implementing case management and elaborates

关 键 词：职业康复 核心分类组合 个案管理 

分 类 号：R492[医药卫生—康复医学]