Research Group Psychosomatic Rehabilitation at the Charité University Medicine Berlin, Department of Behavioral Medicine, Rehabilitation Centre Seehof, Lichterfelder Allee 55, Teltow/Berlin, Germany.
Psychopathology. 2010;43(4):262-7. doi: 10.1159/000315125. Epub 2010 May 29.
The International Classification of Functioning Disability and Health (ICF) differentiates between functions, activities/capacities, contextual factors and participation. Dysfunctions can result in impaired capacities, which in turn can lead to problems with participation depending on the context. Motivational and volitional deficits are intervening factors. The question is to what degree work performance (i.e. participation), motivational factors, and the inability to perform activities (i.e. dysfunctions) interact.
Incapacities were measured in 213 patients (70% women) admitted to the Department of Behavioral Medicine using the Mini-ICF-Rating for Mental Disorders (Mini-ICF-APP), work performance was measured with the Endicott Work Productivity Scale (EWPS), and volitional and motivational problems in regard to work were assessed with the Arbeitsbezogenes Verhaltens- und Erlebensmuster (AVEM). Sick leave prior to admission and work-related problems were assessed in a special clinical interview.
The mean global score of the Mini-ICF-APP across all patients was 0.84 +/- 0.56 (SD), corresponding to 'mild disability'. The highest disabilities in this patient population were found for 'flexibility' (item 3, 1.64 +/- 0.94); the lowest disabilities were found for 'self maintenance' (item 11, 0.19 +/- 0.44) and 'mobility' (item 12, 0.43 +/- 0.85). Partial correlations between the Mini-ICF-APP, AVEM and EWPS showed highly significant correlations between the Mini-ICF-APP and EWPS and no or weak correlations between the AVEM and the Mini-ICF-APP or EWPS.
Work performance is primarily related to the inability to perform activities and incapacities, and only due to attitudes or volitional/motivational factors to a much lesser degree. Therefore, capacity and motivation can and must be separated.
国际功能、残疾和健康分类（ICF）将功能、活动/能力、环境因素和参与区分开来。功能障碍会导致能力受损，而能力受损又会根据环境因素导致参与出现问题。动机和意志缺陷是干预因素。问题在于工作表现（即参与）、动机因素以及无法执行活动（即功能障碍）在多大程度上相互作用。
使用 Mini-ICF 精神障碍评定量表（Mini-ICF-APP）对行为医学科的 213 名患者（70%为女性）进行了能力评定，使用恩迪科特工作生产力量表（EWPS）测量了工作表现，使用 Arbeitsbezogenes Verhaltens- und Erlebensmuster（AVEM）评估了与工作相关的意志和动机问题。在专门的临床访谈中评估了入院前的病假和与工作相关的问题。
所有患者的 Mini-ICF-APP 平均总分为 0.84 +/- 0.56（SD），对应“轻度残疾”。在这个患者群体中，最高的残疾出现在“灵活性”（项目 3，1.64 +/- 0.94）；最低的残疾出现在“自我维持”（项目 11，0.19 +/- 0.44）和“移动”（项目 12，0.43 +/- 0.85）。Mini-ICF-APP、AVEM 和 EWPS 之间的偏相关分析显示，Mini-ICF-APP 与 EWPS 之间存在高度显著相关，而 AVEM 与 Mini-ICF-APP 或 EWPS 之间相关或弱相关。
工作表现主要与无法执行活动和能力障碍相关，而与态度或意志/动机因素相关的程度要小得多。因此，可以并且必须将能力和动机分开。
