运用ICF构建残疾标准的理论架构与方法体系

doi:10.3969/j.issn.1006-9771.2025.00.001

Abstract

Abstract:

Objective To construct a conceptual framework and methodology for developing disability eligibility/standard using the bio-psycho-social model of disability, and classification theory and methods of the International Classification of Functioning, Disability and Health (ICF).

Methods Based on the ICF's bio-psycho-social model, and aliged with the United Nations Convention on the Rights of Persons with Disabilities and the World Health Organization technical documents in the fields of disability statistics and services, this study explored the systematic implementation of ICF to construct a conceptual framework and methodology for disability eligibility/standards, including core concepts and terminology of functioning and disability, methods and system of classification and grading, coding system, standardization of disability survey questionnaires and protocols, and assessment/evaluation tools, as well as standard system of disability data.

Results The establishment of disability standards should be based on specific application contexts and functions. Standards for surveys and statistics emphasized data collection and analysis, applied to the design of survey questionnaires and methodologies. Standards for service eligibility focused on determining service qualification through structured assessments/evaluation of functioning and disability. Comprehensive standards served both purposes. A well-rounded disability standard integrated a clear theoretical framework, scientific classification, grading and coding systems, and standardized disability reporting and evaluation/assessment methods/tools. The conceptual framework and methodological system for disability standards based on ICF comprised five core aspects: a core conceptual and terminological system for disability; disability classification and grading methods and systems; a scientifically structured classification, grading, and coding system; standardized disability reporting and assessment/evaluation methods and procedures; and standardized disability data systems. Applying ICF in practice involved systematically integrating the theoretical framework into the development of disability classification and grading systems, constructing coding systems using ICF, implementing standardized disability reporting and assessment/evaluation tools derived from the ICF, designing and standardizing disability survey instruments, questionnaires/protocols, and assessment/evaluation tools and protocols, and establishing ICF-based disability data standards.

Conclusion ICF provides a robust conceptual framework and methodology for the development of disability eligibility/standards. The bio-psycho-social model, conceptual framework and methodological approaches of classification, grading and coding of functioning and disability, and ICF-based standardized survey and assessment/evaluation tools, enable the establishment of core disability concepts and terminology, disability classification and grading systems, disability coding systems, disability survey questionnaires and protocols and assessment/evaluation tools and programs, and disability data standards. The systematic application of the ICF framework and methodology enhances the scientific rigor, inclusivity and applicability of disability eligibility/standards.

Key words: disability eligibility/standards, concepts and terminology, coding of disability, survey questionnaire, evaluation, assessment, data, International Classification of Functioning, Disability and Health

CLC Number:

R197

YANG Yaru, QIU Zhuoying, CHEN Di, WANG Zhongyan, ZHANG Meng, SONG Guiyun. Constructing disability eligibility standards using ICF: conceptual framework, approaches and methodological systems[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(7): 745-754.

Figures/Tables 4

Table 1

Conceptual framework and approaches system of ICF-based disability eligibility/certification"

领域	ICF分类理论与方法	运用ICF构建残疾标准
残疾概念架构、残疾概括性定义和各类残疾的具体定义	ICF生物-心理-社会模式。提供全面的残疾定义架构。强调残疾的多维性和动态性残疾的概括性定义。残疾是人类的功能状态。ICF的术语体系明确区分了“功能”(积极方面)和“残疾”(消极方面)，为健康和残疾的描述提供了通用语言功能涵盖身体功能和结构、活动和参与。残疾是身体功能和身体结构损伤或障碍，活动受限以及参与局限功能和残疾概念构成：残疾是身体功能和结构的损伤或障碍；残疾表现为活动受限或参与局限；残疾受环境因素影响；残疾与个人因素有关 ICF建立了3个领域的分类方法和分类体系：身体功能和结构、活动和参与以及环境因素	概括性定义：残疾是人类的功能状态，将残疾视为身体功能与结构、活动和参与，以及环境和个人因素相互作用的结果残疾的构成要素：残疾涉及身体层面(身体功能和结构损伤)、个体层面(活动受限和参与局限)和环境层面(辅助技术、无障碍环境等) 基于ICF分类定义各类残疾：根据ICF身体功能和结构分类定义各类残疾(如感觉障碍、肢体障碍等)，根据ICF活动和参与分类定义各类残疾(活动参与障碍等)，根据环境因素和个人因素定义各类残疾
功能和残疾的核心概念和术语体系	ICF提供了有关功能和残疾的通用语言 ICF构建了标准化的功能和残疾概念和术语体系，核心术语包括功能状态、残疾、身体功能与结构(损害/障碍)、活动(受限)和参与(局限)、环境因素、个人因素等	基于ICF的功能和残疾概念，构建残疾标准的核心概念和术语体系，描述功能和残疾状况。功能是描述人类健康状况的中性术语。残疾是人类功能状态的消极方面，包括功能障碍、活动受限或参与局限残疾标准的核心概念和术语体系对标ICF的分类逻辑架构、功能和残疾定义命名方法以及功能和残疾的语义体系
残疾分类系统	身体功能与结构分类(8大系统) 活动和参与分类(9大领域) 环境因素分类(5大领域)	运用ICF分类系统建立残疾标准的分类体系根据目的(残疾调查统计或残疾资格标准)和应用场景，选择ICF的分类方法对残疾标准进行分类，如根据身体功能和活动，残疾标准可以分为感觉功能残疾，活动残疾等运用ICF环境因素分类可以建立残疾相关服务资格标准，如使用辅助技术的残疾分类
残疾分级系统	ICF设定了限定值，用于量化残疾严重程度在ICF的3个领域，ICF设定了不同的限定值 ICF限定值根据功能障碍严重程度的百分等级分数，设置了0~4共5个等级	残疾分级是衡量残疾严重程度的方法。分级依据一般根据残疾评估的指标和服务的纳入指标进行。ICF限定值方法可以用于残疾严重程度的定性和定量描述，即残疾分级不同的功能、残疾和障碍领域，运用不同的分级方法根据ICF限定值，残疾严重程度分为4个等级：轻度(1)、中度(2)、重度(3)和极重度(4)
编码系统	ICF编码系统：身体功能(b)、身体结构(s)、活动和参与(d)、环境因素(e) ICF限定值编码附加于类目后，用于量化残疾严重程度 ICF的编码体系是ICF分类系统数字化应用的基础	ICF编码方法的系统应用可以提升残疾标准的标准化，对残疾定义、分类和分级进行编码，对标ICF分类体系，提升残疾标准的标准化水平运用ICF分类编码对残疾标准的残疾分类分级内容进行编码，建立残疾标准的编码系统基于ICF编码系统的残疾标准数字化工具，提升残疾数据的可交换性和互操作性
残疾调查问卷和方案或评估工具和方案	WG-SS、WG-SS Enhanced、WG-ES WHO-MDS WHODAS 2.0 ICD-11 V功能评估部分的通用功能评估工具	运用基于ICF的残疾调查工具，设计标准化残疾调查问卷，覆盖所有的残疾类别、残疾等级，调查问卷的编码系统也采用ICF的编码体系运用基于ICF的残疾评估工具，设计和标定标准化残疾评估工具，并将评估结果转换成残疾类别、残疾等级，并对评估结果采用ICF编码基于ICF的调查和评估工具设计标准化残疾调查问卷和调查方案，开发标准化残疾服务资格鉴定和评估标准
残疾标准数据标准	基于ICF分类标准，建立残疾数据标准，包括残疾数据结构、数据编码、数据交换与融合等基于ICF结构化残疾数据包括身体功能与结构、活动和参与、环境因素、个人因素等 ICF为残疾数据融合和数据应用提供了工具	运用ICF的残疾概念、术语体系和编码系统，构建残疾标准的数据标准运用ICF的分类体系，建立多维度、结构化的残疾数据标准，涉及残疾分类分级和残疾相关服务运用ICF的分类标准，建立残疾标准相关的数据标准，以实现残疾数据交换和互操作，也为残疾相关服务提供数据支持

Table 1

Box 1

Core concepts and terms of functioning and disabilities in ICF"

功能(functioning)：功能是有关身体功能、身体结构，以及活动和参与的通用术语。功能被视为个体(相关的健康状况)与个体所处的情境因素(环境因素和个人因素)之间交互作用的积极方面^[21]。
残疾(disability)：残疾是身体功能与结构损伤(障碍)、活动受限和参与局限的概括性术语。残疾被视为个体(相关的健康状况)与个体所处情境因素(环境因素和个人因素)之间交互作用的消极方面^[26]。
身体功能与结构(body function and structure)：反映个体生理、解剖结构及其组成成分的功能状态。身体层面，残疾涉及身体功能和结构的损伤或障碍(impairment)。如视力残疾定义为视觉障碍(身体功能)；听力残疾定义为听觉障碍等。ICF根据人体8大系统对身体功能和结构进行分类，是残疾标准的分类依据之一。
活动和参与(activity and participation)：分别描述个体执行一项任务或行动和投入到一种生活情景中。活动和参与状况可以使用能力和表现衡量。在个体层面，残疾是指个体的活动受限(activity limitation)或参与局限(participation restriction)。活动和参与涉及9大领域，是残疾标准分类依据之一。
环境因素(environmental factor)：构成人们生活和指导人们生活的自然、社会和态度环境。在环境层面，外部环境条件和服务直接影响个体的功能和残疾状况，包括产品和技术(如辅助技术)、无障碍环境设施、社会支持、态度以及服务体系和政策等。在构建残疾标准时，环境因素常常是建立残疾相关服务需求与服务评价标准应该考虑的因素。
个人因素(personal factor)：是个体生活与生存的特殊背景，由不属于健康状况或健康状态的个人特征所构成，包括性别、种族、年龄、其他健康情况、生活方式、习惯、教养、应对方式、社会背景等。在制定残疾标准时，常常要确定残疾标准所针对人群的年龄、特定的残疾经历，如残疾发生的时间、持续时间等因素。

Box 1

Figure 1

Table 2

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领域	内容	示例
多维度残疾数据的标准化	标准化残疾数据涉及身体功能与结构、活动和参与、环境因素及个人因素等数据的标准化。ICF将残疾数据组织为4个核心维度，每个维度采用ICF编码系统进行标准化记录	b210.2 (中度视功能损伤) d450.1 (轻度行走受限) e1151.0 (无辅助器具)
残疾评估与鉴定的标准化	通过标准化的评估工具量化个体在活动和参与方面的功能状态，并生成ICF编码数据	采用WHODAS 2.0评估个体沟通能力，得到d310.2 (中度沟通困难)
残疾注册登记的标准化	在残疾注册登记中，用ICF编码残疾人的基本信息、残疾类型和严重程度，确保数据的准确性和可追溯性	残疾人注册登记信息：s730.3 (重度上肢损伤)、e1151.1 (轻度辅助器具支持)，结合个人因素(如年龄、职业)形成完整数据档案
残疾服务的标准化实施	标准化数据直接支持残疾服务的个性化设计和实施。通过分析基于ICF的残疾数据，服务机构可为个体提供精准服务，并评估服务效果	基于评估结果d450.4 (极重度行走困难)，提供电动轮椅和家庭无障碍改造比较干预前后d820 学校教育参与的变化(如从d820.2提升至d820.0)，衡量教育支持的有效性

Constructing disability eligibility standards using ICF: conceptual framework, approaches and methodological systems

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