使用《国际功能、残疾和健康分类》(ICF)来描述受创伤难民的功能状况。

Using the International Classification of Functioning, Disability and Health (ICF) to describe the functioning of traumatised refugees.

作者信息

Jørgensen Ulrik, Melchiorsen Hanne, Gottlieb Annemarie Graae, Hallas Vibeke, Nielsen Claus Vinther

机构信息

Marselisborg Centre, Denmark.

出版信息

Torture. 2010;20(2):57-75.

DOI:
Abstract

The aim of this project was to use the International Classification of Functioning, Disability and Health (ICF) to develop an interdisciplinary instrument consisting of a Core Set, a number of codes selected from ICF, to describe the overall health condition of traumatised refugees. We intended to test 1) whether this tool could prove suitable for an overall description of the functional abilities of traumatised refugees before, during and after the intervention, and 2) whether the Core Set could be used to trace a significant change in the functional abilities of the traumatised refugees by comparing measurements before and after the intervention. In 2007, eight rehabilitation centres for traumatised refugees in Denmark agreed on a joint project to develop a tool for interdisciplinary documentation and monitoring, including physical, mental and social aspects of the person's health condition. ICF, developed and approved by WHO in 2001, was found suitable because it offers a common and standardised language and a corresponding frame of reference to describe health and associated conditions in terms of functioning rather than symptoms and diagnosis. Traumatised refugees are in most cases severely affected mentally by the traumas they have been subjected to, physically by injuries suffered during torture and war, psycho-somatically with pain, and socially by cultural uprooting, as well as by social difficulties in the exile community. The rehabilitation perspective thus seems to be more meaningful than the traditional treatment perspective because it takes into account the very complex situation of this group. The aim of the project was to find out whether any functional changes could be monitored using the instrument. The aim was neither to study nor to describe the effect of rehabilitation approaches, such as conditions related to traumatised refugees' networks or environments that might affect the refugees' living conditions. It was also not the intention to discuss the cause of the potential changes of the functional abilities. The project selected a Comprehensive Core Set of 106 codes among 1,464 possible codes (1) used by an interdisciplinary group of international and national experts in rehabilitation of traumatised refugees. The Comprehensive Core Set was furthermore reduced to a Brief Core Set of 32 codes by the interdisciplinary team (key persons) at the centres included in the project. From each centre six clients were randomly selected from those who fulfilled the inclusion criteria. All were scored within a four week period after the start, before any intervention was initiated, and up to a month after the first scoring. The results from this project led us to the conclusion that it is possible to develop an instrument based on the ICF classification. The instrument is useful for a general description of the total health condition (physical and mental functional ability as well as the environmental impact) of traumatized refugees. The tool helps describe changes in the functional abilities used in connection with the preparation of the plan of action. It can also be used to describe the refugees included in the study and their general condition. The ICF Core Set for traumatised refugees has not yet been validated, but the results of the project provide a basis for further development.

摘要

本项目的目的是运用《国际功能、残疾和健康分类》(ICF)开发一种跨学科工具,即一套核心集,从ICF中选取若干编码,用于描述受过创伤的难民的整体健康状况。我们旨在测试:1)该工具是否适用于全面描述受过创伤的难民在干预前、干预期间和干预后的功能能力;2)通过比较干预前后的测量结果,核心集是否可用于追踪受过创伤的难民功能能力的显著变化。2007年,丹麦八家为受过创伤的难民设立的康复中心商定开展一个联合项目,开发一种用于跨学科记录和监测的工具,涵盖个人健康状况的身体、心理和社会方面。人们发现2001年由世界卫生组织制定并批准的ICF是合适的,因为它提供了一种通用的标准化语言以及相应的参照框架,用以从功能而非症状和诊断的角度描述健康及相关状况。在大多数情况下,受过创伤的难民在精神上受到其所遭受创伤的严重影响,身体上受到酷刑和战争期间受伤的影响,身心上承受着疼痛,社会方面则受到文化根源丧失以及流亡社区社会困境的影响。因此,康复视角似乎比传统治疗视角更有意义,因为它考虑到了这一群体非常复杂的情况。该项目的目的是查明是否可以使用该工具监测任何功能变化。其目的既不是研究也不是描述康复方法的效果,比如与受过创伤的难民网络或环境相关的可能影响难民生活条件的状况。也无意讨论功能能力潜在变化的原因。该项目在1464个可能的编码中,由国际和国家跨学科专家小组为受过创伤的难民康复选取了一套包含106个编码的综合核心集(1)。此外,该跨学科团队(项目所涉各中心的关键人员)将综合核心集缩减为一套包含32个编码的简要核心集。从每个中心符合纳入标准的人员中随机选取六名客户。在开始后的四周内,即在任何干预措施启动之前,以及首次评分后的一个月内,对所有人员进行评分。该项目的结果使我们得出结论,基于ICF分类开发一种工具是可行的。该工具对于全面描述受过创伤的难民的整体健康状况(身体和心理功能能力以及环境影响)很有用。该工具有助于描述与制定行动计划相关的功能能力变化。它还可用于描述研究中所纳入的难民及其总体状况。用于受过创伤的难民的ICF核心集尚未经过验证,但该项目的结果为进一步开发提供了基础。

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