基于国际功能、残疾和健康分类的吞咽障碍评估类目的研究

关键词：国际功能、残疾和健康分类  吞咽障碍  功能评估

Keywords:international classification of functioning  disability and health  dysphagia  functional assessment

摘要：

      摘要 目的：确定吞咽障碍相关的《国际功能、残疾和健康分类（ICF）》类目集。 方法：首先采用文献综述的方法，系统性检索国内外文献中与吞咽障碍相关的ICF类目，形成初始类目集。选取12名康复科医务人员和吞咽障碍患者9名进行一对一的半结构化访谈，对类目进行本土化制定、精简及补充。最后采用德尔菲专家咨询法，邀请国内21名吞咽康复专家进行两轮专家调查，对类目的重要性、全面性和语言表述的清晰性进行评价，根据调查结果修改类目，形成最终类目集。 结果：文献回顾纳入7篇文献，汇总了得到90个吞咽障碍相关ICF类目，根据ICF编码从ICF官网获取中文版90个类目及其定义，获得中文版的初始类目集。根据个人访谈结果，删除非吞咽障碍患者所独有的9个类目，内容界定不清晰的3个类目，增加3个类目，得到81个类目。两轮德菲尔专家咨询的积极系数分别为100%和95.24%，权威系数分别为0.896和0.922，协调系数分别为0.442（P＜0.01）和0.320（P＜0.01），保留重要性均值≥4且变异系数＜0.25的50个类目。 结论：初步确定50个吞咽障碍ICF类目集，以期为评估吞咽障碍患者功能损伤水平及其环境因素的影响程度提供科学适宜的测量工具。

Abstract:

      Abstract Objective： To identify the international classification of functioning，disability and health（ICF） categories for dysphagia. Method： Initially， a literature review was conducted to search for ICF categories related to dysphagia, forming a preliminary category set. Subsequently, twelve rehabilitation medical staff and 9 patients with dysphagia were selected for in-depth interviews to refine and supplement the category pool. Finally， the Delphi expert consultation method was used，involving 21 experts who evaluated the importance， comprehensiveness， and clarity of language expression of the category content. The categories were modified based on the survey results to establish the final category pool. Result： The literature review included seven articles， identifying a total of 90 ICF categories related to dysphagia. The Chinese version of the 90 categories and their definitions were obtained from the ICF official website using ICF codes. Based on the interview results， seven categories unique to non-swallowing disorder patients and two categories with unclear content definition were removed， while three categories were added， resulting in a total of 81 categories. The two rounds of Delphi expert consultation resulted in positive coefficients of 100% and 95.24%， authoritative coefficients of 0.896 and 0.922， and coordination coefficients of 0.442 （P<0.01） and 0.320 （P<0.01）， respectively. Fifty categories were retained with an importance mean ≥4 and a coefficient of variation <0.25. Conclusion： This study preliminarily identified a set of 50 ICF categories related to dysphagia, providing a scientific measurement tool for assessing the level of functional impairment in patients with dysphagia and the degree of influence of environmental factors.