实用老年医学

实用老年医学 ›› 2026, Vol. 40 ›› Issue (1): 32-37.doi: 10.3969/j.issn.1003-9198.2026.01.007

• 临床研究 • 上一篇    下一篇

融合难度与干预获益度的老年脑卒中慢性期病人ICF社区康复决策工具

路悦, 陈瑾瑾, 朱承媛, 周亮, 冯纯, 林枫   

  1. 211166 江苏省南京市,南京医科大学康复医学院(路悦,陈瑾瑾,林枫);
    210024 江苏省南京市,南京医科大学附属老年医院康复医学科(朱承媛);
    310014 浙江省杭州市,浙江人民医院康复中心(周亮);
    200090 上海市,上海市第一康复医院(冯纯)
  • 收稿日期:2025-06-19 发布日期:2026-01-16
  • 通讯作者: 林枫,Email:peterduus@njmu.edu.com
  • 基金资助:
    国家重点研发计划项目(2020YFC2008500,2020YFC2008501)

A decision-making tool for ICF-based community rehabilitation in elderly patients with chronic stroke incorporating difficulty and intervention benefit scales

LU Yue, CHEN Jinjin, ZHU Chengyuan, ZHOU Liang, FENG Chun, LIN Feng   

  1. School of Rehabilitation Medicine, Nanjing Medical University, Nanjing 211166, China(LU Yue, CHEN Jinjin, LIN Feng);
    Department of Rehabilitation,Geriatric Hospital of Nanjing Medical University, Nanjing 210024, China(ZHU Chengyuan);
    Rehabilitation Centre of Zhejiang Provincial People’s Hospital, Hangzhou 310014, China(ZHOU Liang);
    Shanghai First Rehabilitation Hospital, Shanghai 200090,China(FENG Chun)
  • Received:2025-06-19 Published:2026-01-16
  • Contact: LIN Feng, Email:peterduus@njmu.edu.com

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摘要： 目的 构建适用于社区康复的老年脑卒中病人国际功能、残疾和健康分类(ICF)参数化评估工具。 方法 采用便利抽样法,基于最大变异原则纳入江浙沪地区207例老年脑卒中慢性期病人。根据社区长者ICF类目库和ICF脑卒中综合核心组合国际扩展版的交集,制定包含136个类目的ICF问卷。所有条目均纳入建模:一方面构建项目反应理论(Item Response Theory,IRT)模型获取难度参数,另一方面基于贝叶斯图建模技术建立图模型(Graphical Model,GM)计算干预获益度参数。 结果 最终建立的Rasch模型具有良好的信度(Cronbach’s α=0.966)和效度。模型可视化工具列出了与病人能力匹配且获益度适宜的类目,发现共有37个类目存在显著干预获益。 结论 在现有ICF组合基础上,构建含类目难度和干预获益度的参数化评估工具,可为社区慢性期老年脑卒中病人筛选出与其能力匹配的康复目标,助力社区康复。

关键词: 老年人, 慢性期卒中, 国际功能、残疾和健康分类, 项目反应理论, 贝叶斯离散图模型, 康复

Abstract: Objective To construct a parametric assessment tool based on the International Classification of Functioning, Disability, and Health (ICF) for community rehabilitation in elderly patients with chronic stroke. Methods Using convenience sampling and maximum variation sampling principles, 207 elderly patients with chronic stroke were recruited from the Jiangsu-Zhejiang-Shanghai region. An ICF questionnaire with 136 categories was developed based on the intersection of the ICF category set for community-dwelling older adults and the extended comprehensive ICF core set for stroke. All items were included in subsequent modeling:an Item Response Theory (IRT) model was constructed to estimate difficulty parameters, while a Bayesian Graphical Modeling technique was applied to build a Graphical Modeling (GM) for estimating intervention benefit parameters. Results The established Rasch model demonstrated good reliability (Cronbach’s α=0.966) and validity.The visualization tool identified categories that matched the patients’ ability levels and offered suitable intervention benefits. Thirty-seven of these categories showed significant benefits. Conclusions Building on the existing comprehensive ICF core sets for strokes, the parametric assessment tool incorporates category difficulties and treatment benefit indices. This tool facilitates quantitative decision-making tailored to the capabilities of community-dwelling elderly patients with stroke.

Key words: aged, chronic stroke, International Classification of Functioning, Disability and Health, Item Response Theory, Bayesian discrete graphical model, rehabilitation

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