Research on Rehabilitation Guidelines Using World Health Organization Family International Classifications Framework and Approaches / 中国康复理论与实践

@#Objective To use World Health Organization Family International Classifications (WHO-FICs) to explore the framework and approaches of development and research of guidelines of rehabilitation at levels of policies, community and services.Methods The important documents and tools of rehabilitation at international level, including United Nations Convention on the Rights of Persons with Disabilities, WHO World Report on Disability, Community-based Rehabilitation Guideline, Rehabilitation in Health Service System, and International Classification of Diseases (ICD), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Intervention (ICHI) of WHO-FICs, had been discussed.Results The framework, classifications, diagnosis and description of diseases and functioning, coding, intervention and functioning evaluation based on ICD-11, ICF and ICHI-β-2 had been established for development and implementation of rehabilitation guidelines and Cochrane rehabilitation.Conclusion The framework and systematic approaches of ontology, classification, terminology, coding, diagnosis and description of diseases and functioning, interventions and evaluations for the development and implementation of rehabilitation guidelines had been developed.

WHO Rehabilitation in Health System: Background, Framework and Approach, Contents and Implementation / 中国康复理论与实践

This paper explored the background, framework and approach, contents and implementation of WHO Rehabilitation in Health System using approaches of ICF and WHO Handbook for Guideline Development. The actions and significances of implementations of seven recommendations and one good practice statements on assistive products had been discussed.

Unmet Needs and Services of Nursing Care for Adults with Extremely Severe and Severe Intellectual Disabilities Using Structural Equation Analysis / 中国康复理论与实践

Objective:To explore the characteristics and related factors of unmet needs of nursing care and service for adults with extremely severe and severe intellectual disabilities. Methods:A total of 127 547 adults with extremely severe and severe intellectual disabilities were sampled. Descriptive statistics and multiple response analysis were conducted, and a structural equation model of unmet needs of nursing care and received the services was developed. Results:A total of 26 038 adults with extremely severe and severe intellectual disabilities reported unmet needs of rehabilitation, including nursing care (52.50%), medicine (36.90%), assistive device (20.90%), functional training (19.70%) and surgery (0.80%) respectively. A total of 11 640 adults with extremely severe and severe intellectual disabilities reported received rehabilitation services, including nursing care (49.90%), medicine (36.80%), functional training (19.10%), assistive device (14.10%) and surgery (1.00%) respectively. The structural equation model showed that received nursing care service (main effect = 0.646) and received rehabilitation services (included nursing care) (main effect = 0.014), age (main effect = 0.031), household registration (main effect = 0.015) and educational level (main effect = -0.158) had effects on unmet needs of nursing care (P < 0.001). Conclusion:Adults with extremely severe and severe intellectual disabilities reported unmet needs mainly involved in field of nursing care, and their rehabilitation services mapped to their main needs. It proposed to develop rehabilitation services tailored to their rehabilitation experience, age, socioeconomic status, functional conditions and characteristic of unmet needs, to develop accessible services items and individualized nursing care programs, and to expand the nursing care service supply and coverage of nursing care.

Unmet Needs and Services of Rehabilitation for People with Intellectual Disabilities Using Logistic Regression Analysis / 中国康复理论与实践

Objective:To analyze the characteristics of unmet needs and services of rehabilitation for people with intellectual disability (PIDs). Methods:A total of 250 654 PIDs had been sampled and administration data of unmet needs and services of rehabilitation at provincial level had been analyzed the characteristics of unmet needs and services of rehabilitation, and the related factors of needs and services were analyzed with Logistic Regression. Results:The rate of unmet needs reported by PIDs from high to low were nursing (47.8%), medicine (37.2%), functional training (26.1%), assistive devices (19.8%) and surgery (1.3%). The PIDs reported received service of rehabilitation, including nursing care (43.5%), medicine (29.3%), functional training (27.2%), assistive devices (19.6%) and surgery (0.8%). Logistic Regression Model showed that age and severity of disabilities significantly affect the reported the unmet needs and received services (P < 0.001). Conclusion:PIDs reported unmet needs mainly involved in the fields of nursing care, medicine and rehabilitation training and therapy. The unmet needs and received services had similar structure. It proposed to develop rehabilitation services tailored to PIDs' intellectual function and adaptive behaviors to develop services items and to deliver individualized and precise services.

Unmet Needs and Services Development of Rehabilitation for People with Hearing Disability Using Logistic Regression Analysis / 中国康复理论与实践

Objective:To explore the characteristics of unmet needs and services of rehabilitation for people with hearing disability (PHD). Methods:A total of 219 473 PHDs administration data of unmet needs and services of rehabilitation at provincial level were sampled (2019) and analyzed the characteristics of needs and services of rehabilitation with multiple response analysis, and the related factors of needs and services with Logistic regression. Results:There were 47 657 (21.7%) PHDs reported their unmet needs of rehabilitation, from high to low were assistive devices (65.5%), medicine (22.7%), nursing care (19.1%), functional training (16.2%) and surgery (2.2%). There were 34 684 (18.8%) PHDs reported their received services, from high to low were assistive devices (59.8%), medicine (22.5%), functional training (19.7%), nursing care (19.4%) and surgery (1.8%). The logistic regression model showed that age, types of household registration and severities of disabilities related with the reported unmet needs and received services (P < 0.001). Conclusion:PHDs mainly reported unmet needs in the fields of assistive devices, medicine, and rehabilitation training. The reported unmet needs for PHDs had matched the received services structurally. It proposed to use modern science and technology to develop services delivery and to improve accessibility and quality of rehabilitation services.

Unmet Needs and Services of Rehabilitation for People with Physical Disabilities Using Logistic Regression Analysis / 中国康复理论与实践

Objective:To explore the characteristics of unmet needs and services of rehabilitation for people with physical disabilities (PWPs). Methods:A total of 1 512 438 PWPs administration data of unmet needs and services of rehabilitation at provincial level were sampled and analyzed the characteristics of needs and services of rehabilitation, and the related factors of needs and services. Results:The reported unmet needs of PWPs from high to low were assistive devices assistive devices (55.9%), nursing care (27.0%), medicine (26.3%), functional training (23.9%) and surgery (2.3%). Received service of rehabilitation. The services of rehabilitation for PWPs arranged as assistive devices (48.2%), nursing caring (26.4%), functional training (24.3%), medicine (19.5%) and surgery (1.4%). The logistic regression model showed that age and severity of disabilities had significant effect on the reported unmet needs of rehabilitation and received services for PWPs (P < 0.001). Conclusion:PWPs reported unmet needs mainly in the fields of assistive devices, nursing care, medicine and rehabilitation training. They received primary services included assistive devices, nursing care and rehabilitation training and therapies. The services development will emphasize the accessibility and coverage. According to ICF model, it proposed to take measures to implement individualized and precise rehabilitation services to improve the quality of services.

Unmet Needs and Service of Rehabilitation for Children with Disabilities / 中国康复理论与实践

Objective:To explore the status of disability, and characteristics of unmet needs and services of rehabilitation for children with disabilities (CWDs). Methods:A total of 130 290 CWDs administration data of unmet needs and services of rehabilitation at provincial level had been sampled and analyzed. Results:CWDs accounted for 5.33% of the total population with disabilities, in which, 60.4% were boys and 39.6% were girls; 16.3% aged 0 to nine years and 83.7% were seven to 18 years old; 88.4% with agricultural household and 11.6% with non-agricultural household. The distribution of disability severity from severe to mild were 28.3%, 39.5%, 17.7% and 14.6%. The reported unmet needs included assistive devices (40.3%), functional training (37.4%), nursing care (32.2%), medicine (24.9%) and surgery (5.7%). The received services involved in assistive devices (37.9%), functional training (33.7%), nursing care (31.0%), medicine (19.7%) and surgery (2.9%). Logistic Regression model showed that severities of disabilities had significant effects on reported unmet needs and received services (P < 0.001). Conclusion:Implement rehabilitation programs would be tailored to the unmet needs of rehabilitation as CWDs had functioning oriented unmet needs. It proposed to develop individualized and structured rehabilitation services to improve the accessibility and quality of rehabilitation for CWDs.

Systematic Implementation of World Health Organization Family International Classifications in Rehabilitation: Protocol and Roadmap / 中国康复理论与实践

Objective:To explore systematic implementation of World Health Organization Family International Classifications (WHO-FICs) in the field of rehabilitation: the theoretical and policy framework at macro level, governance and management mechanism at meso level, and implementation modules at micro levels, respectively. Methods:The policy and theoretical framework of rehabilitation development was discussed based on the international rehabilitation policy documents of WHO, mainly as World Report on Disability, Global Action Plan on Disability and Rehabilitation in Health Service System. Protocol and roadmap of systematic implementation of WHO-FICs, including International Classification of Diseases (ICD-11), International Classification of Functioning, Disability and Health (ICF), and International Classification of Health Intervention (ICHIβ-2) was proposed. Results:With the use of WHO-FICs, the theoretical and policy framework of rehabilitation was constructed, and the contents and principles of modern rehabilitation services were clarified at macro-level. Rehabilitation is an important part of health service, there are six building blocks: i.e. leadership and governance, financing, human resources for health, service providing, medical technology and health information system. It proposed to use knowledge management system of WHO-FICs, including the classification, nomenclature, definitions, descriptions, terminology and coding systems, to standardize rehabilitation evaluation and statistics. The management and governance system of rehabilitation should be implemented using WHO-FICs. Rehabilitation services are based on the bio-psycho-social model and implemented the principles of people-centered and functioning-oriented. The systematic implementation of WHO-FICs in rehabilitation abide by the model of "Evaluation (ICHI)－Evaluation, Description, Classification and Coding of Functioning (ICF)－Disease Classification, Diagnosis and Coding (ICD)－Rehabilitation Intervention (ICHI)", and with the standardized process of "Evaluation (Functioning and unmet needs)－Diagnose (Disease and Functioning)－Planning of Rehabilitation－Intervention－Evaluation of Outcome". The mic-modules of implementation of WHO-FICs in rehabilitation had been constructed. There were 28 categories of diseases, 7 categories of functioning and 6 categories of rehabilitation interventions in rehabilitation proposed by International Society of Physical and Rehabilitation Medicine. According to ICD-11 and ICF, it proposed to use WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), Brief Model Disability Survey (MDS-B) and VB40 Generic Functioning Domains (VB40), and the ICF core-sets in evaluation of functioning and rehabilitation outcome. The implementation of WHO-FICs in management of medical records and reporting realized the standardized management of medical record, encoding of diseases, functioning and intervention, reporting of performance, and provided tools for billing, reimbursement and payment management of rehabilitation. It proposed to develop WHO-FICs based clinical data sets and big data to implement functioning-related Diagnosis Related Groups and case-mix statistics. Conclusion:With the systematic implementation of WHO-FICs in rehabilitation, the policy and theoretical framework at macro level had been developed. The mechanism of management and governance at meso level had been explored. The application modules and approaches at micro level had been established. A scientific and effective overall solution had been proposed to enhance the scientific, standardized, refined and informatization level, strengthen the level and governance capacity, and improve the quality, safety and the coverage of rehabilitation services.

Effects of Physical Activities on Functioning and Health for Aging People Using ICF / 中国康复理论与实践

Objective:To explore the developmental model of physical activities and function of older adults in the perspective of ICF to research the influence of physical activities on their body function, activity and participation, including related environmental factors and personal health behavior. Methods:Theory and methods of ICF had been implemented. Results:A framework of physical activities and overall function for aging people was developed based on ICF. Physical activities positively affected on the overall function, activities of daily living and participation for aging people. Different exercises played different roles on fitness, motor function and cognitive function. Conclusion:The theoretical framework of physical activities and functional health for aging people has been established based on the bio-psycho-social model of ICF. For aging people, physical activities contribute to improvement of functioning and health, such as overall function, functional independence and activities of daily living, as well as physical fitness, and cognitive function. There are different effects of different types of sports on the body function for aging people. Moderate to moderate-vigorous aerobic (endurance) exercise could reduce 30% or more the risks of morbidity and mortality. Exercise and sports may delay or prevent the impairment of cognitive function. Long-term resistance exercise and aerobic exercise can reduce the risk of dementia.

Framework and Approach of Service and Guidance of Community-based Physical Activities Using ICF / 中国康复理论与实践

Objective:To explore the community-based physical activities using ICF and the WHO Guideline of Community-based Rehabilitation (WHO CBR guideline) to develop framework and guidance service at community level to promote community health. Methods:The ICF theory and approach of functioning, disability and health, and the matrix of WHO CBR guideline was adopted as a framework of community-based physical activities and inclusive development. Results:Participants can improve their physical functioning and exercise ability, also promote the development of healthy behaviors, mental health and wellbeing through community-based physical activities. There are benefits of community-based physical activities for the participants for their health, rehabilitation, education, career development and empowerment. Health service system in modern community will be established with the integration of community-based physical activities, health care and rehabilitation. Family-based physical activities for people with disabilities include kinds of community-based exercises in the form of Community-Family-Individual. It is important to provide activity guidance for people with disabilities at community and family. With the approach of individualized guidance, the specialized services, such as counseling, skill training, modification of sport environment and psychological counseling, and guidance, will be provided to promote the people with disabilities to develop healthy behaviors. Conclusion:A framework of community-based physical activities has been established model tailored to functioning and wellbeing using ICF. WHO CBR guideline has been adopted to promote inclusive development of community-based physical activities, health, rehabilitation, education, career development and empowerment to achieve community inclusive development and overall health. Family or dwelling based physical activities are kinds of community-based physical activities, which are proposed to provide individualized guidance for people with disabilities.

Needs and Framework of Information Platform for Quality Control of Rehabilitation Medicine Using Internet with ICF Framework / 中国康复理论与实践

Objective:To analyse the needs and framework development of an information platform on quality control of rehabilitation medicine based on ICF. Methods:According to the demanding of the information on quality control of rehabilitation medicine and the principle of the Internet Plus, this study discussed how to collect standardized data based on the classification and coding system of ICF, and how to implement the clinic standardized procedure and the clinical rehabilitation pathway on the information platform. Meanwhile, the index system on the information platform was also discussed to make data comparable among regions and countries. Results:This information platform should implement standardized procedure of diagnosis and treatment of rehabilitation medicine, based on the concept of ICF and ICD-11. The index system of the information platform should be compatible and open exchange. The structure of the information platform should use the framework, data standard, categories and coding of ICF. Conclusion:An information platform based on the ICF framework, terminology system and coding system can meet the needs of rehabilitation medical quality control, data collection and analysis.

Comparison of Standards of Intellectual Impairment in China Using ICF / 中国康复理论与实践

Objective:To compare the standards of intellectual impairment in China based on ICF to provide evidences for standardization of identification and services of intellectual impairment. Methods:The national standards of intellectual impairment or injury from Standard of Identification of Work Capacity: Identification Classification of DisabilityCaused by Work-related Injuries, Occupational Diseases and Classification of Impairment Related to Injury and China Insurance Disability Standard and Code were compared under the framework, terminology, coding and evaluation of ICF. Results:These three standards covered ICF three components, including body structure, body function, activity and participation, but not contextual factors. The terminology and coding system of China Insurance Disability Standard and Code came from ICF. However, there was no standardized terminology and coding system among sectors. The classification and evaluation for intellectual impairment were different among these three standards, that made it difficult to compare the outcome directly. Conclusion:It is proposed to adopt the ICF framework and approach to standardize the definition, terms, coding, and evaluation of intellectual impairment in disability standards in China to promote data exchange of evaluation and service among sectors.

Construction of System of Specialty and Development of Curricula of Physical Therapy for Undergraduate Based on ICF / 中国康复理论与实践

Objective:This paper reviewed the current development of education of physical therapy and discussed the growing demand for physical therapists and gaps of their professional education. It is crucial to reconstruct a framework and system of sciences and specialty in physical therapy at the undergraduate level using WHO International Classification of Functioning, Disability and Health (ICF) to meet the requirement of core competency of physiotherapist developed by World Confederation of Physical Therapy. The core curricula should be integrated into the conceptual framework and approaches of functioning and rehabilitation. Methods:Using ICF, the construction framework, system of specialty and development of curricula of physical therapy at undergraduate education had been proposed and reconstructed. Results:With the theories and approaches of modern pedology and curriculum theory and ICF, referenced by competency requirements for physical therapists from World Confederation of Physical Therapy, three core courses had been proposed and their content had been reconstructed, involving the theories, methods and practical skills in the fields of physical therapy. These courses include functional diagnosis, intervention and evaluation based on ICF. Conclusion:It is implicated from the theory and approaches of ICF that the education and professional training of physical therapy should be tailored to the needs of health-related services.

Evaluation of Functioning for Aging Patients with Stroke Using World Health Organization Disability Assessment Schedule 2.0 / 中国康复理论与实践

Objective:To apply World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a tool to assess the functioning of the old patients after stroke. Methods:From August, 2018 to February, 2019, 107 old inpatients with stroke were divided into four groups according to the course of disease: ≤ 6 months, 7-12 months, 13-18 months and 19-24 months. They were assessed with WHODAS 2.0 and modified Barthel Index (MBI) at admission and discharge. Results:The scores of both MBI and total WHODAS 2.0 improved at discharge (t > 2.481, P < 0.001). WHODAS 2.0 total scores decreased with the course of disease (F = 3.444, P < 0.05), but no significant decrease was found in the domains of Getting Along, Life Activities and Participation (F < 2.410, P > 0.05). WHODAS 2.0 total scores negatively correlated with MBI score (r = -0.540, P < 0.001), except the scores of domains of Life Activities and Participation (r = 0.184, P > 0.05). Conclusion:WHODAS 2.0 can be used as a tool to assess and follow up the function and disability of old stroke patients.