ObjectiveThis study aimed to develop Clinical Functioning Information Tool-musculoskeletal, an International Classification of Functioning, Disability and Health-based clinical tool for the assessment and reporting of the functioning and rehabilitation potential of patients with a musculoskeletal condition.DesignThis multistep, mixed-methods tool development process encompassed developing an initial shortlist of International Classification of Functioning, Disability and Health categories (comprising the aggregation of the International Classification of Functioning, Disability and Health Core Sets for musculoskeletal conditions and a literature search), identifying the Clinical Functioning Information Tool-musculoskeletal items feasible for clinical use via a two-round Delphi survey, developing a simple description for each item and deciding on the rating scale through development working group consultations. These consultations were also instrumental at each step of tool development.ResultsBased on a shortlist of 33 categories, the Delphi survey generated 17 items (7 body function and 10 activity and participation categories), which can be rated with a 0-4 scale (0 = no problem to 4 = complete problem) accompanied with rating specifications or with a 0-10 numeric rating scale without specification.ConclusionsClinical Functioning Information Tool-musculoskeletal can be used by rehabilitation professionals to support individualized care and track functional outcomes. It can also be employed in research and public health. Psychometric testing and cross-cultural validation will be pursued to ensure Clinical Functioning Information Tool-musculoskeletal's scientific robustness and applicability across diverse settings.

Objectives To develop and validate a functional assessment tool for inpatient rehabilitation in China using the International Classification of Functioning, Disability, and Health (ICF) Rehabilitation Set (ICF-RS) framework and the Delphi method. Methods A three-round Delphi process engaged 15 experts to refine ICF-RS items via a 5-point importance questionnaire. Validation involved 2,574 inpatients assessed with a numerical rating scale. Reliability (Cronbach’s alpha) and structural validity (factor analysis) were evaluated. Results Through three rounds of Delphi meetings, 10, 2, and 1 ICF items with mean importance scores below the threshold were respectively removed, resulting in 17 ICF items achieving expert consensus for inclusion in the final assessment tool, named ICF-RS-17. Expert authority coefficient was 0.81. Cronbach’s alpha exceeded 0.9. Factor analysis identified two factors explaining 68.86% (admission) and 73.25% (discharge) of variance, confirming structural validity. Conclusions The study developed a 17-item functional assessment tool, ICF-RS-17, demonstrating strong reliability and validity for inpatient rehabilitation. These findings help promote the application of the ICF in clinical settings, enhance rehabilitation clinical management, and potentially support the further development of rehabilitation insurance policies.

BACKGROUND: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. METHODS: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. RESULTS: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. CONCLUSION: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.

BACKGROUND AND AIMS:Disrupting liver immune homeostasis drives inflammation. Recent evidence shifts immunoregulatory focus to hepatocytes, though the mechanisms remain poorly defined. Forkhead box O1 (FoxO1) is a critical homeostasis regulator, but its function in liver immune homeostasis is unknown. We aimed to clarify the role of hepatocyte FoxO1 in liver immune homeostasis and inflammation. APPROACH AND RESULTS:Human liver FoxO1 expression and its association with inflammation were analyzed in patients with various inflammation-related liver diseases. Hepatocyte-specific Foxo1 knockout (FoxO1 △hepa ) mice were established. Hepatocyte-specific gene interference was employed in alcoholic hepatitis and hepatic schistosomiasis murine models. Transcriptomic, single-cell RNA sequencing, and CUT&Tag analyses were performed to elucidate the underlying mechanisms. Hepatocyte FoxO1 levels in human inflammatory livers declined prevalently and were inversely correlated with inflammation and fibrosis. Around 15-18 weeks after birth, FoxO1 △hepa mice exhibited mild spontaneous hepatic inflammation with natural killer T (NKT) cell and neutrophil accumulation. NKT cell depletion in FoxO1 △hepa mice with alcoholic hepatitis or hepatic schistosomiasis (HS) significantly reduced neutrophil accumulation and protected against liver inflammation and damage. Mechanistically, FoxO1 promoted retinoic acid synthesis to induce hepatocyte CD1d expression, which is necessary for regulating NKT cell apoptosis. Innovatively, decreased JMJD1C expression in hepatocytes caused histone H3 lysine 9 (H3K9) dimethylation at the Foxo1 promoter, repressing its transcription and disrupting local immune homeostasis. CONCLUSIONS:Our findings uncover a hitherto unrecognized mechanism for hepatocyte-based control of liver inflammation, in which hepatocyte FoxO1 maintained by JMJD1C restrains local NKT cells and neutrophils via CD1d induction, providing promising targets for inflammatory liver diseases.

OBJECTIVE:This study aimed to develop Clinical Functioning Information Tool-musculoskeletal, an International Classification of Functioning, Disability and Health-based clinical tool for the assessment and reporting of the functioning and rehabilitation potential of patients with a musculoskeletal condition. DESIGN:This multistep, mixed-methods tool development process encompassed developing an initial shortlist of International Classification of Functioning, Disability and Health categories (comprising the aggregation of the International Classification of Functioning, Disability and Health Core Sets for musculoskeletal conditions and a literature search), identifying the Clinical Functioning Information Tool-musculoskeletal items feasible for clinical use via a two-round Delphi survey, developing a simple description for each item and deciding on the rating scale through development working group consultations. These consultations were also instrumental at each step of tool development. RESULTS:Based on a shortlist of 33 categories, the Delphi survey generated 17 items (7 body function and 10 activity and participation categories), which can be rated with a 0-4 scale (0 = no problem to 4 = complete problem) accompanied with rating specifications or with a 0-10 numeric rating scale without specification. CONCLUSIONS:Clinical Functioning Information Tool-musculoskeletal can be used by rehabilitation professionals to support individualized care and track functional outcomes. It can also be employed in research and public health. Psychometric testing and cross-cultural validation will be pursued to ensure Clinical Functioning Information Tool-musculoskeletal's scientific robustness and applicability across diverse settings.

BackgroundHow to effectively quantify and enhance the rehabilitation progress and treatment efficacy of stroke patients, as well as reduce the economic burden on patients, is of particular significance. We employed the International Classification of Functioning, Disability and Health(ICF) to assess and analyze the functional improvement of stroke inpatients during rehabilitation, to investigate the trend of rehabilitation outcome and its influencing factors in patients with different admission functional statuses, and to explore the relationship between rehabilitation efficacy and cost-effectiveness.MethodsThe ICF Disability Assessment Tool was utilized to gather clinical functional data of patients at different stages of rehabilitation. Group-based trajectory modeling(GBTM) was adopted to identify the trajectories of ICF total scores, and logistic regression was applied to explore the specific factors affecting the grouping of rehabilitation trajectories, and the dysfunction, functional improvement, and cost of rehabilitation treatment in different subgroups were also comparatively analyzed.ResultsA total of 95 stroke patients were included in this study. GBTM analyses generated 4 distinct ICF trajectories, namely the mild dysfunction group (17.89%), the moderate dysfunction group (35.79%), the severe dysfunction group (27.37%), and the extremely severe dysfunction group (18.95%). Patients who were older, utilized walking aids upon admission, and had dysphagia were more prone to possess the trajectory characteristics of extremely severe dysfunction. The average daily improvement in total ICF disability score decreased with the increase in disability. The rehabilitation costs were the highest in the extremely severe dysfunction group, followed by the mild dysfunction group, and the lowest in the moderate dysfunction group.ConclusionThe group-based trajectory modeling disclosed that disparities existed in functional recovery among stroke patients with varying degrees of dysfunction, with those who were older, utilized walking aids upon admission, and had dysphagia exhibited a slower recovery. Rehabilitation can improve the functional status of stroke patients, but its cost-effectiveness varies depending on the severity of dysfunction.

Weight-bearing activity was the primary rehabilitation problem after knee meniscus repair, a scientific weight-bearing protocol was an important guarantee for injury healing and functional improvement. With the popularization of the concept of enhanced recovery after surgery, accelerated weight-bearing activities after knee meniscus repair surgery had gradually gained clinical promotion. However, the effectiveness and safety of accelerated weight-bearing activities were still controversial, and the appropriate weight-bearing protocol after knee meniscus repair with different injury types was still unclear. In this paper, we aimed to explore the decision-making elements of weight-bearing protocols after knee meniscus repair, and explore the effectiveness and safety of different weight-bearing protocols based on knee meniscus injury classification, providing evidences for clinical decision-making.

BACKGROUND:The International Classification of Functioning, Disability and Health (ICF) offers a comprehensive biopsychosocial model widely used to capture functioning and disability status. The development of the national assessment standard regarding the ICF-Rehabilitation Set (ICF-RS)-17 represents the first step in implementing value-based healthcare (VBHC) in China. However, studies relating the ICF to managing goal setting and guiding VBHC are scarce. AIM:This study aims to investigate the psychometric properties of the ICF-17 and further tailor goal settings in inpatient rehabilitation settings. DESIGN:A multi-centered, cross-sectional study. SETTING:Three general hospitals and two rehabilitation hospitals in Jiangsu Province, China. POPULATION:Patients received inpatient rehabilitation treatment. METHODS:We administrated ICF-RS-17 and Barthel index to assess inpatient patients' function, and quality of life with the Short Form-12 (SF-12). We performed a non-parametric and parametric Item response modeling (IRM) pipeline as a psychometric measurement. We further constructed graphical modeling (GM) to visualize the network structure of functional categories and calculate the treatment benefit index (TBI). RESULTS:The 2-parametric logistic model (2PLM) emerged as the optimal model generating a unidimensional scale with 17 ICF items (9 'd - Activities and Participation', 8 'b - Body Functions'). The final scale presented strong reliability with a latent class reliability coefficient=0.963, indicating great internal reliability. The estimated individual functional competence by the 2PLM model was moderately related to the index score of the PCS (p = 8.68 × 10-114, ȓPearson = 0.52) and MCS (p = 7.41 × 10-45, ȓPearson = 0.34), as well as a strong positive correlation with the BI (p = 7.41 × 10-45, ȓPearson = 0.81). The findings also demonstrated measurement equivalence of the final model for individuals with different gender and across age groups as well as different measurement points (e.g. admission and discharge). Moreover, the GM indicates "d510 Washing oneself" possesses the most potent alleviating effect in the functional network (perturbance power=1.019). CONCLUSIONS:The IRM-verified ICF-RS-17 tool has good construct validity and internal consistency for assessing the inpatient functional level. Moreover, enhancing "d510 Washing oneself" ability demonstrates the highest benefit for overall functional performance. CLINICAL REHABILITATION IMPACT:The IRM might be helpful in facilitating person ability-matched goal setting by comparing person abilities and item difficulties along the same logit scale. GM visualizes the spread and perturbance power of functional limitations within the network model, which may manifest process-oriented goals within a complex network of functional tasks. The combination of IRM and GM might aid in transitioning towards VBHC and optimize patient care.

Purpose:This study aims to examine the predictive value of Craniocervical Flexion Test (CCFT) scores in individuals with chronic non-specific neck pain (CNNP) and to identify factors that may affect CCFT scores. Methods:This case-control study included 73 patients with CNNP and 127 healthy controls. We assessed baseline information such as demographics, duration and frequency of CNNP onset, Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores. All subjects were evaluated by the same rater for CCFT, maximal muscle strength, and endurance of the deep cervical flexors. Head and neck posture was measured using two-dimensional videography, capturing sagittal head angle (SHA), forward head angle (FHA), and protracted shoulder angle (PSA). The predictive capacity of CCFT for CNNP was evaluated using the ROC curve and area under the curve (AUC). Univariate and multivariate ordered logistic regression models were employed to analyze factors influencing CCFT scores. Results:The final analysis included 70 participants in the CNNP group and 123 in the control group. The CNNP group demonstrated lower CCFT scores, reduced maximal muscle strength, and decreased endurance of the deep cervical muscles (P<0.05). Among maximum muscle strength, endurance, and CCFT scores, the latter exhibited the highest AUC. Univariate and multivariate ordered logistic regression analyses revealed that maximal muscle strength, muscle endurance, FHA, and lower NDI scores significantly increased the likelihood of higher CCFT scores (P<0.05), while SHA significantly decreased this likelihood (P<0.05). Conclusion:CCFT demonstrates good predictive value for CNNP, surpassing muscle strength and endurance. Maximal muscle strength, muscle endurance, FHA, and lower NDI scores were positive influencing factors for CCFT scores, whereas SHA was a negatively influencing factor.

Background & Aims: Hepatocyte apoptosis, a well-defined form of cell death in non-alcoholic steatohepatitis (NASH), is considered the primary cause of liver inflammation and fibrosis. However, the mechanisms underlying the regulation of hepatocyte apoptosis in NASH remain largely unclear. We explored the anti-apoptotic effect of hepatocyte CD1d in NASH. Methods: Hepatocyte CD1d expression was analyzed in patients with NASH and mouse models. Hepatocyte-specific gene overexpression or knockdown and anti-CD1d crosslinking were used to investigate the anti-apoptotic effect of hepatocyte CD1d on lipotoxicity-, Fas-, and concanavalin (ConA)-mediated liver injuries. A high -fat diet, a methionine-choline-deficient diet, a Fas agonist, and ConA were used to induce lipotoxic and/or apoptotic liver injuries. Palmitic acid was used to mimic lipotoxicityinduced apoptosis in vitro. Results: We identified a dramatic decrease in CD1d expression in hepatocytes of patients with NASH and mouse models. Hepatocyte-specific CD1d overexpression and knockdown experiments collectively demonstrated that hepatocyte CD1d protected against hepatocyte apoptosis and alleviated hepatic inflammation and injuries in NASH mice. Furthermore, decreased JAK2-STAT3 signaling was observed in NASH patient livers. Mechanistically, anti-CD1d crosslinking on hepatocytes induced tyrosine phosphorylation of the CD1d cytoplasmic tail, leading to the recruitment and phosphorylation of JAK2. Phosphorylated JAK2 activated STAT3 and subsequently reduced apoptosis in hepatocytes, which was associated with an increase in antiapoptotic effectors (Bcl-xL and Mcl-1) and a decrease in pro-apoptotic effectors (cleaved-caspase 3/7). Moreover, anti-CD1d crosslinking effectively protected against Fas- or ConA-mediated hepatocyte apoptosis and liver injury in mice. Conclusions: Our study uncovered a previously unrecognized anti-apoptotic CD1d-JAK2-STAT3 axis in hepatocytes that conferred hepatoprotection and highlighted the potential of hepatocyte CD1d-directed therapy for liver injury and fibrosis in NASH, as well as in other liver diseases associated with hepatocyte apoptosis. (c) 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

BackgroundIn the previous research, the Disability Assessment Scale based on ICF had been constructed for LTC insurance in China. To apply this scale in further studies, it is essential to establish assessment standards for disability levels.ObjectiveTo establish standardized disability classification criteria and identify the disability statuses and levels in older people.MethodsThis is a cross-sectional study, in which 1,610 older individuals in 15 long-term care institutions in China were assessed by the disability assessment scale based on ICF. Cluster analysis was used for classification of the disability levels. Mean (SD) and median (IQR) were used to describe the scores for each item and each dimension.ResultsThe total scores of the disability assessment scale were classified into six disability levels. The overall disability level of the 1,610 participants was moderate-to-severe. The disability in the dimension of “self-care ability and activity” was the most obvious and severe.ConclusionThe Disability Assessment Scale is capable of identifying disability statuses and levels of older people, and it can serve as a valuable tool for investigating the disabilities among old people and for conducting cross-national comparisons of disability levels.

BACKGROUND: Given the complex etiology, multidimensional impact, and widespread prevalence of low back pain (LBP), it is crucial to prioritize intervention targets based on understanding the relationships between functional impairments in patients. This prioritization maximizes the physical and psychological benefits for patients, and graph modeling holds promise in achieving these objectives. AIM: The aim of this study was establishing a graphical model of functioning variables for LBP based on the International Classification of Functioning, Disability, and Health (ICF) to identify the most infiuential items (i.e., functioning variables) on the physical and mental well-being of patients. Exploring feasible intervention measures by understanding the dysfunction correlations among these variables. DESIGN: Cross-sectional survey. SETTING: Nine hospitals in Jiangsu Province, China. POPULATION: Three hundred and six persons with LBP aged >18 years. METHODS: All patients were assessed using the Comprehensive ICF Core Sets for LBP. The scoring system was converted to dichotomous data, with 1 indicating dysfunction and 0 indicating no dysfunction. In the graphical model, network parameters and the results of Item Response Theory modeling (as detailed in our other article) were used to determine the importance of items, while partial correlations were utilized to estimate the dysfunction correlations between functioning variables. RESULTS: 1) A total of 56 ICF items were located in the backbone structure of LBP, among which d430 (Lifting and carrying objects) occupied the most central position, followed by b126 (Temperament and personality functions). 2) In the main component of backbone structure, d430 has moderate dysfunction correlation with looking after one's health (0.6027), social norms, practices and ideologies (0.597), stability of joint functions (0.5759), and emotional functions (0.4078). b126 has moderate dysfunction correlation with basic interpersonal interactions (0.6595). CONCLUSIONS: d430 and b126 significantly impact the physical and mental well-being of LBP patients. To improve d430, maintaining exercise habits, reducing working hours, enhancing lumbar stability, and overcoming fear-related emotions are recommended. Similarly, improving b126 can be achieved through enhancing interpersonal relationships. CLINICAL REHABILITATION IMPACT: Through the identification of crucial functioning variables and the associated dysfunctional correlation relationships, graphical model of Comprehensive ICF Core Set for LBP can offer healthcare decision-makers valuable insights into potential treatment targets and pathways aimed at improving the condition of LBP patients.

BACKGROUND:Despite the growing interest of the item response theory (IRT) in assessment of person abilities and functioning difficulties in screening tools, there is scarcity of research using IRT on ICF-based tools for persons with low back pain (LBP).AIM:To generate and validate a parsimonious core set of ICF (PCSI) for LBP based on the IRT modelling.DESIGN:A cross-sectional study.SETTING:Nine hospitals in Jiangsu Province, China.POPULATION:We recruited patients with LBP.METHODS:All participants completed the 78 items of the comprehensive ICF Core Set for LBP. The five-point scoring system was converted to dichotomous data with 1 as functioning/independent and 0 as impairment/dependent. Psychometric properties of the data were examined using Mokken Scale analysis and parametric item response modelling.RESULTS:This study recruited 306 participants (185 females and 121 males) with LBP. The overall median age of the study participants was 50.28 (95% CI 23.34; 82.05) years. We constructed a three-parameter logistic model with 28 ICF categories (8 of body function, 18 of activities and participation, and two of body structures). The internal consistency was good with Cronbach's alpha = 0.927 and latent class reliability coefficient (LCRC) = 0.955. The model was validated by significant correlations (P<0.001) of its estimated person abilities with the Oswestry Disability Index (ODI, r=-0.41), the Roland-Morris Disability Questionnaire (RMDQ, r=-0.57), the Physical Component Summary (PCS, r=0.63), and the Mental Component Summary (MCS, r = 0.46) of 12-Item Short Form Survey (SF-12). The person abilities and item difficulties were integrated into a Wright map that offered a background for making individualized clinical decisions.CONCLUSIONS:The PCSI of LBP with 28 categories has good construct validity and internal consistency, and is a convenient instrument for assessing functioning among persons with LBP. The IRT model provided theoretical and algorithmic support for deriving a simplified model for functioning assessment hence serving a basis for formulating rehabilitation plans in clinical practice and research.CLINICAL REHABILITATION IMPACT:A parsimonious core set of ICF (PCSI) for LBP based on the IRT modelling provides a background for making individualized clinical decisions based on item difficulties.

Background and Objectives Haemophilia comprises a continuum of blood disorders that often include joint and muscular dysfunction, which may lead to a constellation of activity limitations and participation restrictions. However, there is scant research incorporating functional assessment scales into the common language provided by the International Classification of Functioning, Disability and Health (ICF). This study aims to identify the ICF categories to include in an item bank of functioning aspects relevant for haemophilia. Design and Methods A systematic search was carried out in July 2021 based on the PubMed MEDLINE, CLINICAL, and Cochrane databases for qualified articles, investigating haemophilia-specific scales and the scales recommended by the World Federation of Haemophilia (WFH) linked to ICF categories between 2001 and 2021. Well-trained healthcare professionals in the haemophilia field and ICF evaluation conducted group discussions to determine the ICF items for haemophilia. Results A total of 112 out of 176 items measuring function were collected for the haemophilia ICF item bank, including 32 items for body function (b), 45 items for activity and participation (d), 27 items for environmental factors (e), and 8 items for body structure(s). Interpretation and Conclusions We recommend that future haemophilia research use the haemophilia-specific ICF item bank, which could capture a whole spectrum of functional measurements and facilitate multidisciplinary and worldwide communication. This study also indicates that further development and analysis of the psychometric properties of the 112 haemophilia-related ICF items is warranted.

Objective:To explore the reliability and validity of the International Classification of Functioning, Disability and Health′s 17-item Rehabilitation Set (ICF-RS-17) when used to evaluate multidisciplinary inpatients.Methods:A total of 359 inpatients in the departments of rehabilitation, orthopedics, neurology, and neurosurgery of three hospitals in Jiangsu province were assessed with the ICF-RS-17 at admission and at discharge, and the internal consistency of the tool was calculated. Inter-rater and intra-rater reliability were quantified using interclass correlation coefficients (ICCs). Structural validity was analyzed using factor analysis.Results:The tool′s Cronbach′s α was 0.945. The overall inter-rater ICC was 0.946 with the ICCs of all of the items except b280 sensation of pain within the range from 0.630 to 0.948. The overall intra-rater ICCs ranged from 0.471 to 0.947. The factor analysis found three factors with eigenvalues greater than 1, accounting for 74% of the variation, without double-loaded items. The three influential factors were exercise ability, sleep perception communication ability and self-care ability.Conclusion:The ICF-RS-17 has good internal consistency, inter-rater and intra-rater reliability and structural validity in the evaluation of multidisciplinary inpatients.

Objectives The purpose of this literature review was to clarify the sufficiency and efficiency needs, as well as the stratification and the assignment scoring principles of the International Classification of Functioning, Disability and Health (ICF) core set, in conjunction with the Item Response Theory (IRT)-derived functioning outcome measures.Methods A literature search has been done on the PubMed database. We included studies involving the IRT-derived ICF evaluation tool. Our main outcome was the assignment and stratification scoring principle of IRT-derived ICF-based functioning outcome measures.Results 46 relative articles met the eligibility criteria of our review. On this basis, this review was undertaken to track the research progress of the ICF-based and IRT-modeling measurement tools and screen the final core set. This review included a classification of IRT modeling for ICF studies and a summary of existing research paradigms of IRT-derived ICF outcome measures. Moreover, this review identified blind spots related to scoring assignment principles and “difficulty parameter” in current ICF-based IRT studies.Conclusion The ICF is the worldwide terminology system for functioning categories, while ICF-based evaluation in clinical practice and scientific research has elicited the underlying challenges. However, the algorithm of the ICF-based IRT modeling may advance the understanding of ICF clinical application and enable a new paradigm for the design of IRT-derived ICF questionnaires, namely the parsimonious core set of ICF. Additionally, the Wright map has the potential to facilitate an understanding of the rehabilitation process and tailor rehabilitation goals.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis research is sponsored by Shanghai Sailing Program (23YF1433700).### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesData sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Background and objectivesThere is scant research investigating the user-friendly functional assessment tool conceptualized by the International Classification of Functioning, Disability and Health (ICF) among persons with haemophilia (PWH). This study aims to accomplish two goals: (1) quantifying comprehensive functioning measures of haemophilia through Item Response Theory (IRT); (2) discussing patient-centred care based on the Wright map of personal ability and item difficulty. MethodsA cross-sectional study was carried out in 70 PWH (mean age, 33.09 +/- 11.04) via convenience sampling. All patients completed the 45 ICF categories of haemophilic-specific activity and participation. Psychometric properties of the categories were examined using Mokken scale analysis and parametric item response modelling. ResultsWe extracted a unidimensional scale with 31 categories, and constructed a Rasch model with good fitness. The Cronbach's alpha of the scale was .9713, with the Guttman's lambda(2) = .9730, Molenaar Sijtsma rho = .9802, and latent class reliability coefficient = .9769, indicating great internal reliability. The estimated individual social competence by the Rasch model was highly related to the index score of the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L) (p , r = .62), and had a moderate correlation (p , r = .54) with the score of Haemophilia Activities List (HAL). ConclusionsThe ICF scale of haemophilic activity and participation with 31 categories (HAPPY-ICF) has good construct validity and internal consistency. The person-item threshold distribution map might be helpful in research and clinical practices for patient-oriented care.

目的:以脑卒中综合康复干预为例,为基于"国际功能,残疾和健康分类"(ICF)的康复质控体系提供真实世界证据.方法:选取125例脑卒中患者组成便利样本,构建项目反应理论(IRT)模型.进一步估算患者功能水平和类目难度,并计算出入院的功能水平变化,以及功能水平与巴氏指数(BI)的相关关系,并测算功能改善所需支付的经济成本.结果:出入院功能水平与BI显著正相关,且出院功能水平显著高于入院.21 d的住院周期内,约25%的患者可获得功能提升17%,治疗费约为520元/天,住院费约为800元/天.结论:项目反应理论模型为ICF康复质控体系下的功能水平测算、治疗靶点选择和经济成本核算提供分析策略和应用工具.

Objective: This study aimed to determine whether integrative medicine rehabilitation (IMR) that combines conventional rehabilitation (CR) with Tui Na and traditional Chinese external medicine Baimai-ruangao is more effective than CR alone for the treatment of post-stroke limb spasticity. Design: Multicenter randomized controlled intervention trial involving 16 hospitals across ten cities in China. Subject: 444 patients with post-stroke limb spasticity were randomly assigned toIMR group (n=222) or CR group (n=222). Methods: Tui Na was performed for patients with post-stroke limb spasticity. Traditional Chinese external medicine Baimai-ruangao as the massage medium was applied on the skin surface. The treatment course was 1 month. Muscle tone in the spastic muscles (elbow �exors, wrist �exors, �nger �exors, knee extensors, ankle plantar �exors) was evaluated using the Modi�ed Ashworth Scale (MAS), and the primary endpoint was the change in MAS score from baseline to 4 weeks. Results: The IMR group showed a signi�cantly better reduction in the MAS scores for �ve muscle groups than the CR group after the 4-week intervention. Improvements were sustained at the 3-month and 6-month follow-up. Patients with a baseline muscle tone score of 1+ to 4 on the MAS for the affected limb showed the greatest bene�t of IMR. No adverse reaction was observed in the IMR group. Conclusion: The combination of CR and IMR is safe and more effective than CR alone for alleviating post-stroke limb spasticity.