Norrefalk Jan-Rickard, Svensson Elisabeth
Department of Statistics, Örebro University, Örebro, Sweden.
BMC Health Serv Res. 2014 Apr 24;14:187. doi: 10.1186/1472-6963-14-187.
The International Classification of Functioning, Disability and Health, (ICF) provides a unified, international standardized framework for describing and classifying health and health-related functioning and disability. Based on an ICF core sets the Functional Barometer, (FB), was developed for assessments of perceived pain-related problems with functions, activity and quality-of-life by patients suffering from long-term pain. The aim was to evaluate the construct validity, and to compare the assessments of a patient's problems from the perspectives of the patient and of the examining professional when using the validated FB and corresponding ICF-classification form, respectively.
Patients with long-term pain for more than 3 months that visited one of four pain clinics during specified time periods of data collections were eligible. The self-report Balanced Inventory for Spinal disorders was used for validation of the FB. Correspondingly to the validated FB an ICF-classification form for professional's assessment was developed. The data sets for these inter-scale and the patient-professional comparisons were collected adjacent to the clinical examination. By the statistical method used for evaluation of the pairs of ordinal data presence of systematic disagreement was identified and measured separately from additional individual variations.
The validation process resulted in a revised FB(2.0) that meets the requirements of good construct and content validity. The professionals' ICF-classifications of the patients' problems disagreed with the patients' assessments on the FB(2.0); the percentage agreements ranged from 18% to 51%. The main reason was that the practitioners systematically underestimated the patients' levels of problems but the different professionals contributed also to a large individual variability (noise) in assessment.
This study presents an ICF-based validated self-report questionnaire, The FB, to be used for identifying and describing pain-related problems with current functioning, activities and quality-of-life as perceived by patients suffering from long-term pain. The strong evidences of underestimation of the patients' problems and the variability in the professionals' ICF-classifications demonstrated the importance of describing the patient's problems both from the patient's and the professional's perspective beneficial for the patient's rehabilitation.
《国际功能、残疾和健康分类》（ICF）为描述和分类健康以及与健康相关的功能和残疾提供了一个统一的国际标准化框架。基于ICF核心集，开发了功能晴雨表（FB），用于评估长期疼痛患者在功能、活动和生活质量方面与疼痛相关的问题。目的是评估结构效度，并分别使用经过验证的FB和相应的ICF分类表，从患者和检查专业人员的角度比较对患者问题的评估。
在特定数据收集时间段内就诊于四家疼痛诊所之一的、患有超过3个月长期疼痛的患者符合条件。使用脊柱疾病自我报告平衡量表对FB进行验证。相应地，开发了用于专业人员评估的ICF分类表。这些量表间比较和患者-专业人员比较的数据集是在临床检查时收集的。通过用于评估有序数据对的统计方法，识别并分别测量了与其他个体差异不同的系统分歧。
验证过程产生了修订后的FB（2.0），其符合良好结构效度和内容效度的要求。专业人员对患者问题的ICF分类与患者在FB（2.0）上的评估不一致；百分比一致性范围为18%至51%。主要原因是从业者系统性地低估了患者的问题水平，但不同专业人员在评估中也造成了很大的个体差异（噪声）。
本研究提出了一种基于ICF的经过验证的自我报告问卷FB，用于识别和描述长期疼痛患者所感知的当前功能、活动和生活质量方面与疼痛相关的问题。患者问题被低估以及专业人员ICF分类存在变异性的有力证据表明，从患者和专业人员的角度描述患者问题对患者康复有益。
