《中国康复理论与实践》

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (7): 772-780.doi: 10.3969/j.issn.1006-9771.2025.07.004

• 专题 残疾标准研究 • 上一篇    下一篇

基于ICF和ICD-11的中国5种肢体残疾相关标准比较研究

叶海燕1,2, 杨亚茹2,3,4, 邱卓英2,4, 王忠彦2,4, 陈迪1,2(), 宋桂芸5,6a(), 王方永6b, 田益凡1,2, 刘叶1,2   

  1. 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.康复大学社会发展学院/国际康复政策和ICF研究中心，山东青岛市 266113
    5.首都医科大学康复医学院，北京市 100068
    6.中国康复研究中心北京博爱医院，a. 康复评定科；b. 脊柱脊髓外科，北京市 100068
  • 收稿日期:2025-03-27 修回日期:2025-06-09 出版日期:2025-07-25 发布日期:2025-07-30
  • 通讯作者: 陈迪(1982-)，男，汉族，北京市人，博士，副研究员，世界卫生组织国际分类家族中国合作中心成员，主要研究方向：ICF、残疾研究、康复科学、康复大数据、康复信息。E-mail：cindino80@126.com； 宋桂芸(1972-)，女，汉族，北京市人，学士，主任技师，主要研究方向：康复评定与康复治疗，康复科学。E-mail：yangguixuns@sina.com
  • 作者简介:叶海燕(1997-)，女，汉族，江西赣州市人，硕士，研究实习员，主要研究方向：康复信息、残疾评定与分类、文献计量。
  • 基金资助:
    1.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(CRSI2024CZ-22);2.国家社会科学基金重大项目(17ZDA078);3.国家重点研发计划项目(2021YFC2701004);4.国家自然科学基金面上项目(72274038)

Comparative study of five physical disability-related standards in China based on ICF and ICD-11

YE Haiyan1,2, YANG Yaru2,3,4, QIU Zhuoying2,4, WANG Zhongyan2,4, CHEN Di1,2(), SONG Guiyun5,6a(), WANG Fangyong6b, TIAN Yifan1,2, LIU Ye1,2   

  1. 1. Department of Rehabilitation Information Research, China Rehabilitation Science Institute, Beijing 100068, China
    2. WHO-FIC Collaborating Center in China, Beijing 100068, China
    3. College of Physical Education and Health, East China Normal University, Shanghai 200241, China
    4. School of Social Development/International Center for Rehabilitation Policy and ICF Research, University of Health and Rehabilitation Sciences, Qingdao, Shandong 266113, China
    5. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
    6a. Department of Rehabilitation Evaluation; b. Department of Spinal Cord Surgery, Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China
  • Received:2025-03-27 Revised:2025-06-09 Published:2025-07-25 Online:2025-07-30
  • Contact: CHEN Di, E-mail：cindino80@126.com; SONG Guiyun, E-mail: yangguixuns@sina.com
  • Supported by:
    The Fundamental Research Funds for Central Public Welfare Research Institutes, conducted by China Rehabilitation Science Institute(CRSI2024CZ-22);National Social Science Fund of China (Major)(17ZDA078);National Key Research and Development Program of China(2021YFC2701004);National Natural Science Foundation of China (General)(72274038)

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摘要：

目的 系统比较5种在保险、工伤、司法鉴定和残疾评定等领域广泛应用的肢体残疾相关标准，从定义、编码、分类、分级和评估等方面进行分析以揭示各标准的架构和方法，为肢体残疾标准的整合与优化提供循证证据。

方法 基于《国际功能、残疾和健康分类》(ICF)和《国际疾病分类第十一次修订版》(ICD-11)，分析《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)、《军人残疾等级评定标准》(军残标准)和《残疾人残疾分类和分级》(残疾分类分级标准)，对比5种标准中肢体残疾方面的定义、编码方式、分类体系、分级标准和评估方法。

结果 依据ICF分类架构与分类方法，在身体功能和结构层面，肢体残疾主要涉及神经肌肉骨骼和运动相关功能(b7)，包括关节和骨骼功能(b710-b729)、肌肉功能(b730-b749)和运动功能(b750-b789)；在活动与参与层面，主要涉及活动(d410-d499)与自理能力(d510-d599)。相关疾病多见于某些感染性疾病或寄生虫病(01)，神经系统疾病(08)，肌肉骨骼系统损伤或结缔组织疾病(15)，发育异常(20)和损伤、中毒或外因的某些其他后果(22)等。对5种肢体残疾相关标准的分析发现，仅残疾分类分级标准对肢体残疾进行明确界定，但术语系统仍与ICF存在一定差距。在编码体系上，仅保险标准采用ICF编码，其余4种残疾标准采用自拟的编码方法。肢体残疾标准中细分项目并没有完全覆盖ICF中与肢体残疾相关的所有类目。在分级方式方面，残疾分类分级标准采用4级制，其余4种标准均分为10级。在评估方法方面，5种标准均侧重于对身体结构、功能的评估，并且注意到日常活动能力的评定，但没有采用世界卫生组织残疾评定量表(WHODAS 2.0)的综合功能评估方法。

结论 中国针对不同的需求，制定了不同的肢体残疾标准，标准的定义和结构与内容存在着很大的差异性。应该根据ICF和ICD-11与肢体残疾相关的内容，修订完善肢体残疾的相关内容，涉及定义、分类、分级、编码及评估等问题，并强调引入WHODAS 2.0作为综合功能评估。

关键词: 肢体残疾, 分类, 分级, 评定, 国际功能、残疾和健康分类

Abstract:

Objective To systematically compare five physical disability-related standards widely used in the fields of insurance, work related injury, forensic appraisal, and disability evaluation. The comparison covers definition, coding, classification, grading, and assessment methods to reveal each standard's framework and methodology, and to provide evidence for integrating and optimizing physical disability standards.

Methods Based on International Classification of Functioning, Disability and Health (ICF) and International Classification of Diseases, 11th Revision (ICD-11), we analyzed and compared five physical disability-related standards, including Disability Assessment and Code for Life Insurance (Insurance Standard), Grading of Disability due to Human Body Injury (Judicial Standard), Standard for Identify Work Ability—Gradation of Disability Caused by Work-related Injuries and Occupational Diseases (Work Injury Standard), Standard for Assessment of Disability Grades of Military Personnel(Military Standard), and Classification and Grading Criteria of Disability (Disability Classification Standard). We examined definition, coding systems, classification, grading scales and assessment.

Results According to the ICF framework, at the level of body functions and structures, physical disability mainly involved neuromusculoskeletal and movement related functions (b7), including joint and bone functions (b710-b729), muscle functions (b730-b749), and movement functions (b750-b789). At the activities and participation level, it primarily concerned mobility (d410-d499) and self care (d510-d599). Related conditions were commonly found in Certain infectious or parasitic diseases (01), Diseases of the nervous system (08), Diseases of the musculoskeletal system or connective tissue (15), Developmental anomalies (20), and Injury, poisoning or certain other consequences of external causes (22), etc. Among the five standards, only Disability Classification Standard explicitly defined physical disability, yet its terminology did not followed ICF categories. Regarding coding, only the Insurance Standard adopted ICF codes; and the other four used self devised coding systems. The sub categories in these physical disability standards did not fully cover all ICF categories relevant to physical disability. In terms of grading, Disability Classification Standard used a four level grading, whereas the other four standards employed ten level grading. Concerning assessment, all five emphasized evaluation of body structures and functions and involved daily activity capacity; however, WHO Disability Assessment Schedule (WHODAS 2.0) for comprehensive functional assessment, had not been proposed for evaluation of general functioning.

Conclusion China has developed different physical disability standards to meet diverse needs. There are differences in definition, structure and content. It is necessary to revise and refine the relevant components of physical disability, including definition, classification, grading, coding and assessment, based on ICF and ICD-11, and to introduce WHODAS 2.0 as a comprehensive functional assessment tool.

Key words: physical disability, classification, grading, assessment, International Classification of Functioning, Disability and Health

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