鈴木 めぐみ

BACKGROUND: The International Classification of Functioning, Disability, and Health (ICF) Generic-30 (Rehabilitation) Set is a tool used to assess the functioning of a clinical population in rehabilitation. The ICF Generic-30 consists of nine ICF categories from the component "body functions" and 21 from the component "activities and participation". This study aimed to develop a rating reference guide for the nine body function categories of the ICF Generic-30 Set using a predefined, structured process and to examine the interrater reliability of the ratings using the rating reference guide. METHODS: The development of the first version of the rating reference guide involved the following steps: (1) a trial of rating patients by several raters; (2) cognitive interviews with each rater to analyze the thought process involved in each rating; (3) the drafting of the rating reference guide by a multidisciplinary panel; and (4) a review by ICF specialists to confirm consistency with the ICF. Subsequently, we conducted a first field test to gain insight into the use of the guide in practice. The reference guide was modified based on the raters' feedback in the field test, and an inter-rater reliability test was conducted thereafter. Interrater agreement was evaluated using weighted kappa statistics with linear weights. RESULTS: The first version of the rating reference guide was successfully developed and tested. The weighted kappa coefficient in the field testing ranged from 0.25 to 0.92. The interrater reliability testing of the rating reference guide modified based on the field test results yielded an improved weighted kappa coefficient ranging from 0.53 to 0.78. Relative improvements in the weighted kappa coefficients were observed in seven out of the nine categories. Consequently, seven out of nine categories were found to have a weighted kappa coefficient of 0.61 or higher. CONCLUSIONS: In this study, we developed and modified a rating reference guide for the body function categories of the ICF Generic-30 Set. The interrater reliability test using the final version of the rating reference guide showed moderate to substantial interrater agreement, which encouraged the use of the ICF in rehabilitation practice.

発病から15年の慢性脳血管障害者で介護保険利用の14名と非利用の14名を対象とし、能力障害(ADL)と社会参加障害(IADL)の推移を調査した。内訳は男性20名、女性8名、年齢は67.0歳±9.7であり、診断名は脳出血10名、脳梗塞16名、その他2名で、麻痺11例、片麻痺17例であった。発病から15年間のADLとIADLを追跡調査した。その結果、介護保険利用者と非利用者におけるADLの推移に特徴がみられた。本研究から抽出された地域包括ケアシステムの課題として、ADLの自立支援や介護予防、就労支援で適切な介入時期を個々に発見すること、生活期リハビリテーションにおける訪問リハビリテーションやデイケアで適切な介入プログラムを設定して社会参加を促すプランを作り、積極的に解決に向けて粘り強く進めること、があげられた。