基于ICF架构比较4种残疾标准分类分级方法  

Comparison of classification and grading approach in four selected disability standards using ICF framework

作　　者：田益凡 陈迪 邱卓英[2] 杨亚茹 吕军[4,5,6] 董向兵 TIAN Yifan;CHEN Di;QIU Zhuoying;YANG Yaru;LÜJun;DONG Xiangbing(Department of Rehabilitation Information Research,China Rehabilitation Science Institute,Beijing 100068,China;WHO-FIC Collaborating Center in China,Beijing 100068,China;School of Physical Education and Health,East China Normal University,Shanghai 200241,China;School of Public Health,Fudan University,Shanghai 200032,China;China Research Center on Disability,Fudan University,Shanghai 200032,China;National Health Commission Key Laboratory of Health Technology Assessment(Fudan University),Shanghai 200032,China;China Life Reinsurance Company Ltd.,Beijing 100033,China)

机构地区：[1]中国康复科学所康复信息研究部,北京市100068 [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 [4]复旦大学公共卫生学院,上海市200032 [5]复旦大学中国残疾问题研究中心,上海市200032 [6]国家卫生健康委员会卫生技术评估重点实验室(复旦大学),上海市200032 [7]中国人寿再保险有限责任公司,北京市100033

出　　处：《中国康复理论与实践》2025年第4期382-390,共9页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中国康复科学所中央级公益性科研院所基本科研业务费项目(No.CRSI2024CZ-1);国家社会科学基金重大项目(No.17ZDA078);国家重点研发计划项目(No.2021YFC2701004);国家自然科学基金面上项目(No.72274038)。

摘　　要：目的基于《国际功能、残疾和健康分类》(ICF)的理论框架,对我国现行残疾标准中4个领域残疾标准的分类分级方法进行比较。研究重点聚焦于定义方法、分类依据、分级标准、编码系统及评估工具等核心维度。方法以《人身保险伤残评定及代码》(保险标准)、《人体损伤致残程度分级》(司法标准)、《劳动能力鉴定职工工伤与职业病致残等级》(工伤标准)和《残疾人残疾分类和分级》(残疾分类分级标准)为研究对象,对各标准的文本进行文献回顾,梳理残疾定义、分类和分级方法的核心要素;采用内容分析法,提取并比较各标准在定义、分类、分级、编码系统及评估工具等方面的异同;结合ICF的理论框架,分析各标准的优缺点及其在实际应用中的局限性。结果各标准在残疾定义、分类分级、编码系统及评估工具等方面存在差异。在定义方面,保险标准侧重ICF的身体结构和功能损伤;司法标准将残疾定义为身体损伤导致的生活和工作能力受限,涵盖ICF的身体结构、功能、活动和参与;工伤标准关注因工伤导致的劳动能力丧失,涉及身体功能和结构、活动和参与;残疾人残疾分类分级标准参照ICF模式,定义残疾为身体结构、功能损害及活动和参与的局限性。在分类分级上,保险标准依据身体结构与功能分为8大类,伤残程度分为10级;司法标准先分级再分类,分为10级,同级内按损伤部位分类;工伤标准按临床分科原则分为5门类,级别1~10级;残疾人标准分为7大类,每类分4级。在编码系统及评估工具上,保险标准采用ICF编码体系,残疾人标准使用数字编码但非ICF编码,其他标准未使用编码系统;评估工具差异显著,残疾人标准提出使用世界卫生组织残疾评定量表(WHODAS 2.0),但未实际应用于分级。结论本研究基于ICF的分类架构,对国内4种典型的与残疾相关的标准进行了系统的比�Objective Based on the theoretical framework of International Classification of Functioning,Disability and Health(ICF),this paper compared the classification and grading methods of disability standards in four areas in China,focusing on definition,classification,grading,coding systems and assessment tools.Methods Four disability standards including Disability Assessment and Code for Life Insurance(insurance standard),Classification of Disability Degrees for Human Body Injury(judicial standard),Grading of Disability for WorkRelated Injuries and Occupational Diseases(work-related injury standard),and Classification and Grading of Disabilities for Persons with Disabilities(disability eligibility standard)were systematically analyzed.Each standard was reviewed to identify core elements of disability definitions,classification,and grading methods.Content analysis was used to extract and compare the definitions,classification,grading,coding systems,and assessment tools.The strengths,weaknesses,and practical limitations of each standard were analyzed using the ICF framework.Results There were different in disability definitions,classification and grading,coding systems,and assessment tools across the standards.In terms of definitions,the insurance standard emphasized ICF's body structure and function impairments;the judicial standard defined disability as limitations in life and work capacity due to bodily injury,covering ICF's body structure and function,activity and participation;the work-related injury standard focused on loss of labor capacity due to work-related injuries,involving body structure and function,activity and participation;the disability eligibility standard refered to the ICF model,defining disability as impairments in body function and structure,and activity limitations and participation restriction.Regarding classification and grading,the insurance standard divided disabilities into eight categories based on body structure and function,with ten grades of disability severity;the judicial standard firs

关 键 词：国际功能、残疾和健康分类 残疾 人身保险伤残评定及代码 人体损伤致残程度分级 劳动能力鉴定职工工伤与职业病致残等级 残疾人残疾分类和分级 

分 类 号：R49[医药卫生—康复医学]