《中国康复理论与实践》

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (4): 373-381.doi: 10.3969/j.issn.1006-9771.2025.04.001

• 专题 ICF应用研究 • 上一篇    下一篇

主要残疾类别的定义、分类、分级以及评估研究：基于ICF和ICD-11的方法

杨亚茹1,2, 邱卓英1(), 陈迪1,3(), 吕军4,5,6, 田益凡1,3, 张爱民3   

  1. 1.世界卫生组织国际分类家族中国合作中心，北京市 100068
    2.华东师范大学体育与健康学院，上海市 200241
    3.中国康复科学所康复信息研究部，北京市 100068
    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
  • 收稿日期:2025-04-04 出版日期:2025-04-25 发布日期:2025-04-25
  • 通讯作者: 邱卓英(1962-)，男，汉族，湖北武汉市人，博士，研究员、教授、世界卫生组织国际分类家族中国合作中心联席主任，主要研究方向：ICF、康复心理学、残疾与康复政策、康复科学、基于ICF残疾评估、调查与统计，E-mail: qiutiger@hotmail.com；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
  • 作者简介:杨亚茹(1997-)，女，汉族，北京市人，博士研究生，世界卫生组织国际分类家族中国合作中心成员，中国心理学会康复心理学专委会委员，主要研究方向：ICF、康复心理学、特殊教育、康复科学、健康心理学、残疾研究、基于ICF残疾评估、调查与统计。
  • 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(2022CZ-1);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)

Disability definition, classification, grading and assessment in disability eligibility: an ICF and ICD -11 framework perspective

YANG Yaru1,2, QIU Zhuoying1(), CHEN Di1,3(), LÜ Jun4,5,6, TIAN Yifan1,3, ZHANG Aimin3   

  1. 1. WHO-FIC Collaborating Center in China, Beijing 100068, China
    2. College of Physical Education and Health, East China Normal University, Shanghai 200241, China
    3. Department of Rehabilitation Information Research, China Rehabilitation Science Institute, Beijing 100068, China
    4. School of Public Health, Fudan University, Shanghai 200032, China
    5. China Research Center on Disability, Fudan University, Shanghai 200032, China
    6. National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai 200032, China
  • Received:2025-04-04 Published:2025-04-25 Online:2025-04-25
  • Contact: QIU Zhuoying, E-mail: qiutiger@hotmail.com; CHEN Di, E-mail: cindino80@126.com
  • Supported by:
    The Fundamental Research Funds for Central Public Welfare Research Institutes, conducted by China Rehabilitation Science Institute(2022CZ-1);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 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)理论架构和分类系统，结合世界卫生组织(WHO)相关世界报告以及有关国家的行业技术报告中的证据，系统分析视力、听力、言语、肢体、智力和精神残疾的定义、分类、分级和评估方法。
方法 基于ICF的生物-心理-社会的功能和残疾模式、分类体系以及编码系统和ICD-11，对标WHO相关世界报告和有关国家行业技术报告的证据，系统探讨视力、听力、言语、肢体、智力和精神6类常见残疾标准的定义、分类、分级和评估的方法。
结果 ICF的残疾模式和ICD-11的分类系统为各类残疾的定义、分类、分级以及评估提供了理论和方法。残疾定义应该从身体功能损害、活动受限和参与局限以及环境因素3个层面进行。视力、听力、言语、肢体、智力和精神残疾的定义、分类与分级均遵循ICF有关的身体功能和结构以及活动和参与的分类方法以及ICD-11相关疾病分类的方法。标准化的活动和参与评估工具如世界卫生组织残疾评定量表(WHODAS 2.0)可以用于测量个体整体活动和参与状况。
结论 基于ICF功能分类体系和ICD-11疾病分类，从身体功能和结构、活动和参与以及环境因素3个层面，对残疾进行定义、分类、分级并且运用基于ICF的功能评估工具对功能和残疾状况进行评估。WHODAS 2.0作为活动和参与评估的通用工具，不仅可以用于整体功能评估，还可以作为工具，转换其他活动和参与评估工具的结果。基于ICF功能和残疾分类的理论和分类架构以及ICD-11相关疾病分类的方法，系统分析WHO发布的世界报告和有关国家行业技术报告中残疾定义、分类、分级以及评估方法，分析讨论国际上针对各类的残疾定义、分类、分级方法以及评估的研究进展。各类残疾统计会因采用不同的残疾定义、诊断标准与评估方法的不同而有差异性。需要根据服务对象的需求以及服务能力建立残疾服务纳入标准。

关键词: 国际功能、残疾和健康分类, 国际疾病分类第十一次修订版, 残疾, 分级, 评估

Abstract:

Objective Utilizing the International Classification of Functioning, Disability and Health (ICF) framework and International Classification of Diseases, the 11th Revision (ICD-11) system, alongside evidence from World Health Organization (WHO) global reports and technical reports from relevant countries, this study systematically examines the definitions, classifications, grading, and assessment methods for visual, hearing, speech, physical, intellectual, and mental (psychiatric) disabilities.
Methods Employing the ICF's biopsychosocial model, classification, and coding system and ICD-11, and referencing WHO global reports and national technical reports, this study systematically investigated the definitions, classifications, grading and assessment approaches for six prevalent disabilities: visual, hearing, speech, physical, intellectual and mental.
Results The ICF and ICD-11model and classification system offered a robust framework for defining, classifying, grading and assessing disabilities. Disability definitions should address body function impairments, activity limitations, participation restrictions and environmental factors. The definitions, classifications and grading of visual, hearing, speech, physical, intellectual and mental disabilities aligned with ICF categories for body functions and structures, activities and participation and categories of ICD-11. Standardized tools like the WHO Disability Assessment Schedule (WHODAS 2.0) effectively measured overall activity and participation levels.
Conclusion Anchored in the ICF and ICD-11 framework, disabilities are defined, classified, graded and assessed across body functions and structure, activities and participation, and environmental factors. WHODAS 2.0 serves as a universal tool for assessing activities and participation, enabling both comprehensive functional evaluations and the conversion of results from other assessment tools. By analyzing WHO global reports and technical documents in some countries within the ICF and ICD-11 classifications framework, this study highlights global advancements in disability definitions, classifications, grading and assessments. Variations in disability statistics stem from differing definitions, diagnostic criteria and assessments. Disability service eligibility criteria should be tailored to the needs of recipients and the capacity of providers.

Key words: International Classification of Functioning, Disability and Health, International Classification of Diseases, the 11th Revision, disability, grading, assessment

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