Feng Chun, Liu Shou-Guo, Zhou Liang, Lin Feng
Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, School of Medicine, Tongji University, Shanghai, China.
Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Physiother Res Int. 2025 Jan;30(1):e70021. doi: 10.1002/pri.70021.
The International Classification of Functioning, Disability and Health (ICF) is the worldwide terminology system for measuring health and disability at both individual and population levels. However, the underlying challenges remain in achieving widespread adoption and implementation of ICF within healthcare contexts, including the unequal interval scale of the ICF Likert-type qualifier system ranging from 0 to 4, a lack of consensus on conceptualization and grading criteria of ICF items, and an excessive number of ICF items associated with each disease. The utilization of item response theory (IRT) for ICF studies demonstrated potential benefits in addressing these issues. Here, a review attempted to provide clarification of two predominant needs (sufficiency and efficiency) and two dimensions of scoring principles (stratification and assignment principles) in the ICF.
A literature search was conducted on the PubMed database, and 44 relative articles were selected. On this basis, this review was undertaken to track the research progress of the ICF based on the parameter IRT method, typically the Rasch model.
This review outlined the classification of Item response model (IRM) for ICF studies and summarized existing IRT-based ICF research paradigms. Moreover, this review identified blind spots regarding assignment principles and the difficulty parameter in current ICF-based IRT studies. The Mokken scale analysis (MSA), as a non-parametric IRT method, was introduced as a data shaping tool for parametric IRM. The pipeline of the ICF-based MSA-Rasch modeling might advance the understanding of ICF clinical application and shed light on a new paradigm of questionnaire design.
The advent of ICF-oriented IRM algorithms may advance the comprehension of ICF clinical application and pave the way for a new paradigm for IRT-derived ICF questionnaires, namely the parsimonious ICF core set. Additionally, the Wright map holds promise in facilitating insight into rehabilitation trajectories and personalizing rehabilitation goals.
《国际功能、残疾和健康分类》（ICF）是用于在个体和人群层面衡量健康与残疾的全球术语系统。然而，在医疗环境中实现ICF的广泛采用和实施仍存在潜在挑战，包括ICF李克特式限定系统从0到4的不等距量表、对ICF项目的概念化和分级标准缺乏共识，以及每种疾病相关的ICF项目数量过多。将项目反应理论（IRT）用于ICF研究显示出在解决这些问题方面的潜在益处。在此，一项综述试图阐明ICF中两个主要需求（充分性和效率）以及评分原则的两个维度（分层和赋值原则）。
在PubMed数据库上进行文献检索，选取了44篇相关文章。在此基础上，本综述基于参数IRT方法（通常是Rasch模型）追踪ICF的研究进展。
本综述概述了ICF研究的项目反应模型（IRM）分类，并总结了现有的基于IRT的ICF研究范式。此外，本综述确定了当前基于ICF的IRT研究在赋值原则和难度参数方面的盲点。作为一种非参数IRT方法的莫肯量表分析（MSA）被引入作为参数IRM的数据整理工具。基于ICF的MSA - Rasch建模流程可能会推进对ICF临床应用的理解，并为问卷设计的新范式提供思路。
面向ICF的IRM算法的出现可能会增进对ICF临床应用的理解，并为IRT衍生的ICF问卷的新范式——即简约ICF核心集铺平道路。此外，赖特图有望促进对康复轨迹的洞察并使康复目标个性化。
