Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Faculty of Applied Health and Social Sciences, Technical University of Applied Sciences, Rosenheim, Germany.
BMC Health Serv Res. 2020 Jan 30;20(1):66. doi: 10.1186/s12913-020-4911-6.
The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) in 2001 and has been in the process of implementing it in clinics since then. Current international efforts to implement ICF in rehabilitation clinics include the implementation of ICF Core Sets and the development of simple, intuitive descriptions for the ICF Generic-30 Set (also called Rehabilitation Set). The present study was designed to operationalize these ICF tools for clinical practice in Japan. This work included 1) the development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, 2) the development of a rating reference guide for Activity and Participation categories, and 3) the examination of the interrater reliability of rating Activity and Participation categories.
The Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set was developed following the process employed to develop the Chinese and Italian versions. For further operationalization of this ICF Set in practice, a rating reference guide was developed. The development of the rating reference guide involved the following steps: 1) a trial of rating patients by several raters, 2) cognitive interviewing of the raters to analyse the thinking process involved in rating, 3) drafting of the rating reference guide, and 4) review by ICF specialists to confirm consistency with the original ICF concepts. After the rating reference guide was developed, interrater reliability of the rating with the reference guide was determined. Interrater reliability was examined using weighted kappa statistics with linear weight.
Through the pre-defined process, the Japanese version of the simple, intuitive descriptions for 30 categories of the ICF Generic-30 Set and the rating reference guides for 21 Activity and Participation categories were successfully developed. The weighted kappa statistics ranged from 0.61 to 0.85, showing substantial to excellent agreement of the ratings between raters.
The present study demonstrates that ICF categories can be translated into clinical practice. Collaboration between clinicians and researchers would further enhance the implementation of the ICF in Japan.
世界卫生组织于 2001 年制定了《国际功能、残疾和健康分类》（ICF），并一直在临床中推行。目前，国际上在康复诊所推行 ICF 的努力包括推行 ICF 核心分类组合和为 ICF 通用-30 分类组合（也称为康复分类组合）制定简单直观的描述。本研究旨在为日本的临床实践操作这些 ICF 工具。这项工作包括：1）制定 ICF 通用-30 分类组合简单直观描述的日文版；2）为活动和参与分类制定评定参考指南；3）检验评定活动和参与分类的组内信度。
ICF 通用-30 分类组合简单直观描述的日文版是按照中文和意大利文版本的制定过程制定的。为了进一步将这个 ICF 组合在实践中操作化，制定了一个评定参考指南。制定评定参考指南涉及以下步骤：1）让几位评定者对患者进行评定尝试；2）对评定者进行认知访谈，以分析评定过程中的思维过程；3）起草评定参考指南；4）请 ICF 专家进行评审，以确认与原始 ICF 概念的一致性。在制定了评定参考指南后，确定了使用参考指南进行评定的组内信度。使用线性权重的加权 Kappa 统计检验了组内信度。
通过预先设定的过程，成功制定了 ICF 通用-30 分类组合的 30 个类别的简单直观描述的日文版和 21 个活动和参与分类的评定参考指南。加权 Kappa 统计值范围为 0.61 至 0.85，表明评定者之间的评分具有实质性到极好的一致性。
本研究表明，ICF 类别可以转化为临床实践。临床医生和研究人员之间的合作将进一步加强 ICF 在日本的实施。
