BADL refers to the daily repetitive activities necessary for people to maintain the most basic survival and life, including self-care activities and functional sports, including eating, dressing, washing, bathing, going to the toilet and dressing. Functional movements include turning over, sitting up from bed, moving and driving wheelchairs up and down stairs.
IADL refers to some activities necessary for people to maintain independent life, including telephone shopping, cooking, housework, laundry and medicine, transportation to deal with emergencies and leisure activities in the community. These activities often require some tools to complete.
BADL's evaluation object is inpatients, while IADL's evaluation is mostly used for the disabled and the elderly living in the community.
The following table lists the items included in various BADL and IADL rating standards.
Items included in BADL and IADL assessment
The evaluation of ADL can be conducted in two ways: direct evaluation and indirect evaluation, requiring patients to complete various activities one by one, asking why patients can't complete them, observing the situation of patients completing activities, and asking about the influence of using assistive devices on activities. Indirect evaluation can obtain the information of the patient's activities from the patient's family and people around the patient by telephone or letter, rehabilitation medical group discussion, etc.
The following are several commonly used ADL evaluation methods:
1. Improved Basel Index (MBI)
Barthel index was first designed by FlorenceMahoney and DorothyBarthel in the United States in the mid-1950s, and was applied in clinic. Barthel index evaluation is simple, with high reliability and sensitivity. This is the most widely used ADL evaluation method in clinical practice and research. The method was modified in 1987. At present, the modified Barthelindex (MBI) is widely used. The scale has *** 10, and the total score is 100. The higher the score, the stronger the independence and the less the dependence. If the score reaches 100, it does not mean that the patient can live completely independently. He may not cook, do housework or get in touch with people, but
Contents and grading standards of MBI
2. Functional Independence Measurement (FIM)FIM is an important part of the unified data system of medical rehabilitation proposed by the American Institute of Physical Medicine and Rehabilitation in 1983. It not only evaluates physical function, but also includes verbal cognition and social function. It is an evaluation method developed in recent years that can reflect the daily living ability of disabled people more comprehensively and objectively. FIM is more detailed, accurate and sensitive than Barthel index to reflect the degree of disability or the amount of help needed. It is a powerful index to analyze and judge the curative effect of rehabilitation. It not only evaluates ADL disability caused by motor impairment, but also evaluates the impact of cognitive dysfunction on American daily life. It has been regarded as an objective index to measure the level of hospital medical management and medical quality. FIM is the only way to measure the degree of disability in medical rehabilitation by establishing a unified database system of rehabilitation medicine (UDSRM).
3. Evaluation content FIM evaluation content includes six aspects, *** 18, namely 13 motor ADL and 5 cognitive ADL.
Evaluation content of functional instruction manual
4. The scoring standard score is divided into 7 points, that is, the highest score for each item is 7 points, the lowest score is 1 point, and the lowest score is 126 point. The score is based on the degree of independence of the patient, the demand for assistive devices or assistive devices and the amount of help given by others. 4. The scoring standard is scored on a 7-point scale, that is, the highest score for each item is 7 points. Minimum score 1, minimum score 126. The score of 18 depends on the degree of independence of the patient, the demand for assistive devices or assistive devices and the amount of help given by others.
FIM scoring standard
5. The results are determined as follows:
Determination of the results of FIM scale
(b) Functional activity questionnaire
1982 was proposed by Pfeffer and modified in 1984. The questionnaire was originally used to study the independence of the elderly, and the scoring criteria for mild Alzheimer's disease are as follows:
0 points-normal or not done, but can do; 1-difficult, but you can do it alone or not; 2 points-need help; 3 points-totally dependent on others
The higher the score, the heavier the obstacle. The normal standard is less than 5 points. ≥5 is abnormal, and the patient cannot be independent in the family and community.
Functional Activity Questionnaire (Frequently Asked Questions)
(III) Assessment of Quality of Life (QOL) WHO defines QOL in 1997 as: in different cultural backgrounds and value systems, individuals living in life have their own understanding and experience of their own goals and aspirations and the living conditions of related things. QOL can be divided into objective QOL and subjective QOL. Ueda Min (Japan) divides QOL into three grades: quality of life, quality of life, quality of life, and subjective QOL.
Four aspects of Ueda QOL
QOL commonly used evaluation methods are:
1. WHO /QOL-26 World Health Organization Quality of Life-Introduction.
Developed by the World Health Organization, with the participation of 22 countries, the scale was completed in 1997. The scale is suitable for different cultural backgrounds and has many languages. Including 26 items in 5 fields (physiology, psychology, social environment and synthesis), divided into 1~5 grades. Among the 26 items, the alternative answers are divided into "very dissatisfied ~ very satisfied" and "very poor ~" according to the content or degree.
This table was developed by Boston Institute of Health on 1988. It is a health-centered international comprehensive evaluation scale, including 36 items in 8 fields (physical function 10, mental health 5, daily activities 4, daily psychological activities 3, physical pain 2, overall health 6, vitality 4 and social activities 2). The evaluation is divided into five grades. The maximum possible score of each field is 100, and the minimum score is 0. The sum of the scores in eight fields is the comprehensive score. The higher the score, the lighter the functional damage and the better the QOL. 3. Life Satisfaction Index Scale A (LISA).
LISA is a commonly used subjective quality of life evaluation method. During the evaluation, patients are required to read 20 items carefully, and then mark the scores that accord with their opinions in the columns of "Agree" and "Disagree" on the right side of each item. If they agree with the first question, mark "2 points" under the right consent column, and the rest will get full marks of 20 points, and the normal ≥ 12 points. The higher the score, the better the quality of life. (4) Evaluation of Social Ability This chapter mainly introduces the evaluation method of French Day Activity Index. There are six categories of assessment contents, and each category has its own assessment criteria. The lowest score is 0 and the highest score is 47. According to the evaluation results, social life ability can be divided into: 47- completely normal; 30~44 points-close to normal; 15 ~ 29- moderate disorder; 1 ~ 14- serious obstacle; 0 points-completely lost
French activity index evaluation method
(V) Occupation ability assessment Occupation is an important part of personal social activities. People not only reflect their position and value in social activities, but also reflect the meaning and purpose of their lives. Occupation involves three aspects of personal social economy. The unification of roles and positions can enable individuals to give full play to their personal talents, perform social roles and obtain reasonable economic rewards.
The principles to be followed in choosing a career are: ① the principle of individual differences: to explore professional behavior from the perspective of individuals, individual needs, abilities, interests, values, personality and other factors should be considered; (2) emphasize the matching of personal characteristics and professional characteristics, emphasize the internal motivation of individuals as the core, and study individual professional behavior from a developmental perspective; (3) Sociology of working principle: It tends to study the social environment factors that affect personal career choice and career development, and emphasizes the role of external factors such as family and social environment.
Vocational ability assessment includes:
1. Pre-employment Preliminary Assessment (1) Choosing a career according to personality orientation should match personality needs, interests, attitudes, values and occupations.
(2) Choosing the abilities required for professional activities according to abilities The general abilities of professional abilities refer to the basic abilities that people must have to engage in various professional activities to ensure that people can master professional knowledge and skills smoothly and effectively. Special ability refers to the sum of the abilities necessary to engage in a certain professional activity, which are manifested in four skills: communication ability, work skills, intelligence level and behavior at work, such as teachers' language expression ability, accounting calculation ability and drivers' operation ability.
(3) The workload is determined according to the work intensity and the content of the professional type of work. At the beginning of job evaluation, we should choose the job with corresponding intensity according to the actual ability of patients.
(4) Choose an occupation according to the type of work.
2. Evaluation method (1) The professional evaluation adopts the JEVS job sampling system established under the auspices of the US Department of Labor, and its design integrates the skills and characteristics of various jobs. There are 26 kinds of jobs. Job characteristics include: manipulation, distribution, controlled inspection, drawing, etc. The system is evaluated in the actual working environment, and it takes 6-7 days to complete the JEVS system. The system comprehensively and thoroughly evaluates the potential of customers. The Tower (Test Orientation and Job Evaluation in Rehabilitation) system was established by new york Disabled Persons' Association. * * * There are 93 kinds of work examples, which can be combined to evaluate 14 kinds of vocational training scope, such as office work drawing, jewelry mail sewing and assembly. It is a comprehensive job evaluation system, which provides a real working environment to evaluate and analyze career potential. The completion time depends on the number of test items used, up to 3 weeks.
(2) Past ability and work behavior evaluation 1) shelteredworkshop: The workshop environment is used for "long-term" pre-job evaluation, and the general employment regulations may not be implemented. The sheltered workshop signed a detailed contract to be completed within a specific time to produce specific products for specific customers.
2) Workstation: advanced cabin workshop. The working period of this personal arrangement is generally 65,438+0 months, but some workstations can be extended according to the working environment and disability status. It is necessary to establish contact between supervisors and evaluators to facilitate feedback.
(3) Competency test measures and identifies the professional quality of patients through various effective testing tools.
Including:
1) professional physical fitness: including strength balance, bending, kneeling posture, squatting, crawling and stretching, hand operation or skin perception, oral expression, visual and auditory control coordination, etc.
2) Occupational ability tendency: To test the abilities that patients must have to engage in a specific occupation, including intelligence, verbal expression, calculation, spatial ability, body feeling, clerical affairs, action coordination, finger flexibility, hand dexterity, hand-eye football association tonality, color discrimination and so on.
3) Professional personality characteristics: including professional interests and personality characteristics. Vocational interest refers to the working tendency of workers to concentrate on a certain kind of work or activity because of being concerned or attracted; Personality characteristics refer to the relatively stable personality characteristics of workers, both of which can be measured by related psychological test scales.
4) Education and work experience
3. Evaluation content (1) The function evaluation questionnaire was drawn up by CreweN. W and AthelstanG. T It is a comprehensive functional status assessment table, which can help us to understand the damage and residual situation of disabled people's employability (see P49 Schedule 4 for details).
Occupation ability injury rating is as follows:
0~5 points: no obvious damage to professional ability; 6~3 1 min: professional ability is slightly impaired; 32~62 points: moderate damage to professional ability; 63~93 points: professional ability is seriously damaged.
It should be noted that all items with a score of "3" should be listed, and according to the characteristics of these items, the occupations that need these functional conditions should be indicated.
(2) intelligence evaluation career decision test WAIS (for senior staff) special ability test (motor skills-Minnesota operation speed test; Mechanical ability-Bennett's mechanical understanding test, essay ability test, art ability test, music ability test), multiple ability and interest test (Kuder's career interest survey), others (career achievement personality)
(3) Physical assessment: Assess the labor intensity that patients can bear, as follows:
Relationship between labor intensity and intensity
(6) Appraisal of labor ability
The commonly used method is microtower (MT), which mainly evaluates coordination ability, finger precise motor function, cognitive ability, etc. 10, and the normal values of the contents and parameters of each sub-test of Orientals are shown in the table.
Evaluation content of micro-tower method
Evaluation content and normal value of micro-tower method
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