《中国康复理论与实践》

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (4): 382-390.doi: 10.3969/j.issn.1006-9771.2025.04.002

• 专题 ICF应用研究 • 上一篇    下一篇

基于ICF架构比较4种残疾标准分类分级方法

田益凡1,2, 陈迪1,2(), 邱卓英2(), 杨亚茹2,3, 吕军4,5,6, 董向兵7   

  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.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
  • 收稿日期:2025-03-27 出版日期:2025-04-25 发布日期:2025-04-25
  • 通讯作者: 陈迪(1982-)，男，汉族，北京市人，博士，副研究员，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；邱卓英(1962-)，男，汉族，湖北武汉市人，博士，研究员、教授，WHO国际家族分类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、康复信息与康复数据科学。E-mail: qiutiger@hotmail.com
  • 作者简介:田益凡(1999-)，女，汉，北京市人，硕士，研究实习员，主要研究方向：康复信息、康复大数据、康复科学。
  • 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-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)

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

TIAN Yifan1,2, CHEN Di1,2(), QIU Zhuoying2(), YANG Yaru2,3, LÜ Jun4,5,6, DONG Xiangbing7   

  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. School of Physical Education and Health, East China Normal University, Shanghai 200241, 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
    7. China Life Reinsurance Company Ltd., Beijing 100033, China
  • Received:2025-03-27 Published:2025-04-25 Online:2025-04-25
  • Contact: CHEN Di, E-mail: cindino80@126.com; QIU Zhuoying, E-mail: qiutiger@hotmail.com
  • Supported by:
    The Fundamental Research Funds for Central Public Welfare Research Institutes, conducted by China Rehabilitation Science Institute(CRSI2024CZ-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)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较和分析。从残疾的定义上看，《人身保险伤残评定及代码》《人体损伤致残程度分级》和《残疾人残疾分类和分级》3种标准均于2011年后颁布，采用了ICF的理念和方法定义残疾并且对残疾进行分类。考虑到残疾涉及的身体功能和结构、活动和参与以及环境因素。但由于用途不同，分级的方法和级别不同，除《残疾人残疾分类和分级》外，其他3类标准均采用10级的分级方法。分级的依据主要涉及身体功能和结构。在残疾评估方面，各标准推荐了不同评估工具，有的依据日常生活能力，有的依据身体的功能，表现出差异性。由于4类残疾标准的分类分级方法不同，残疾数据用于不同的目的，残疾数据之间缺乏可比性。国际发展趋势倡导基于ICF和ICD-11建立统一的残疾标准架构，以实现不同残疾数据的可比性和数据之间交换。

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

Abstract:

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 Work-Related 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 first graded disabilities into ten levels and then classified as injury site; the work-related injury standard divided disabilities into five categories based on clinical disciplines, grading from one to ten; the disability eligibility standard divided disabilities into seven categories, each with four grades. For coding systems and assessment tools, the insurance standard used ICF coding system, while the disability standard for persons with disabilities used a numerical coding system other from ICF, and the other standards did not use coding systems. Assessment tools varied significantly. The use of World Health Organization Disability Assessment Schedule (WHODAS 2.0) was proposed but not applying it in grading.
Conclusion This study has systematically compared and analyzed four typical disability-related standards in China using the ICF framework. Personal Insurance Disability Assessment and Coding, Grading of Disability Caused by Bodily Injury, and Classification and Grading of Disabilities for Persons with Disabilities are all promulgated after 2011, and adopt ICF concepts and methods to define and classify disabilities, considering body function and structure, activity and participation, and environmental factors. However, due to different purposes, their grading methods and levels vary: except for Classification and Grading of Disabilities for Persons with Disabilities, which uses a four-level grading system, the other standards use a ten-level system, primarily based on body function and structure. In disability assessment, the recommended methods differ by category, showing significant variability. Due to differing classification and grading methods, disability data from various standards are lack in comparability. The international trend advocates for a unified disability standard framework based on ICF and ICD-11 to enhance the comparability and exchangeability of disability data.

Key words: International Classification of Functioning, Disability and Health, disability, Disability Assessment and Code for Life Insurance, Classification of Disability Degrees for Human Body Injury, Standard for Identify Work Ability-Grading of Disability for Work-Related Injuries and Occupational Diseases, Classification and Grading Criteria of Disability

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