Demographic information COMPREHENSIVE ICF CORE SET for RHEUMATOID ARTHRITIS H1 이 checklist 를완성할때가능한모든정보를사용하고출처를기록하시오 [1] 서면기록 [2] 대상자 [3] 다른정보제공자 [4] 직접관찰 H2 Date / / H3 Case ID,, H4 Participant No,, day month year CE or CS Case No 1st or 2nd Evalu FTC Site Participant A 인구통계학적정보 DEMOGRAPHIC INFORMATION A1 성명 성 : 이름 : A2 성별 여자 : 남자 : A3 생년월일 년 월 일 A4 주소 ( 선택사항 ) A5 정규교육 ( 학력 ) A6 결혼상태 가장적당한것을선택하시오 [1] 미혼 [4] 이혼 [2] 기혼 [5] 사별 [3] 별거 [6] 동거 A7 현재직업 가장적당한것을선택하시오 [1] 유급고용직 [6] 은퇴 [2] 자영업 [7] 해직 ( 건강상이유 ) [3] 자선사업 [8] 해직 ( 다른이유 ) [4] 학생 [9] 기타 [5] 가사 특이사항 A8 현재나타나는의학적진단, 가능한국제질병분류코드를기입할것 [1] 나타나는의학적상태없음 [2] ICD code : [3] ICD code : [4] ICD code : [5] 질병, 장애, 손상이있으나특성이나진단을모르는경우 [ 문서정보 ] 이 ICF Checklist 는 광주씨티재활병원재활센터 에서사용하기위해관련문헌을참고하여제작한것입니다 우리말용어는보건복지부에서번역발행한 국제기능 장애 건강분류 에나오는용어를사용하였습니다 참고문헌 : Jerome B et al ICF Core Sets; Manual for Clinical Practice Hogrefe 2012
Body functions PART 1a: IMPAIRMENTS OF BODY FUNCTIONS 평가치 Qualifier: Extent of impairments 0 손상없음 No impairment 1 경도손상 Mild impairment 2 중도손상 Moderate impairment 3 고도손상 Severe impairment 4 완전손상 Complete impairment 8 분류되어있지않음 Not specified 9 적용불가 Not applicable 신체기능요약목록 Short List of Body Functions 평가치 b1 정신기능 MENTAL FUNCTIONS b130 에너지와욕동기능 Energy and drive functions b1300 에너지수준 Energy level b1301 동기부여 Motivation b1302 식욕 Appetite b1303 갈망 Craving b1304 충동조절 Impulse control b134 수면기능 Sleep functions b1340 수면의양 Amount of sleep b1341 수면의시작 Onset of sleep b1342 수면의유지 Maintenance of sleep b1343 수면의질 Quality of sleep b1344 수면주기를침해하는기능 Functions involving the sleep cycle b152 감정기능 Emotional functions b1520 정서의적절성 Appropriateness of emotion b1521 감정의조절 Regulation of emotion b1522 감정의범위 Range of emotion b180 자아및시간인식기능 Experience of self and time functions b1801 신체상 Body image b2 감각기능및통증 SENSORY FUNCTIONS AND PAIN b280 통증감각 Sensation of pain b2800 전신적통증 Generalized pain b2801 신체부위통증 Pain in body part b28010 두부및경부통증 Pain in head and neck b28013 배부통 Pain in back b28014 상지통증 Pain in upper limb b28015 하지통증 Pain in lower limb b28016 관절통증 Pain in joints b4 심혈관계, 혈액학적, 면역학적그리고호흡기계의기능 FUNCTIONS OF THE CARDIOVASCULAR, HAEMATOLOGICAL, IMMUNOLOGICAL AND RESPIRATORY SYSTEMS
Body functions 신체기능요약목록 Short List of Body Functions 평가치 b430 혈액계의기능 Haematological system functions b4300 혈액생산 Production of blood b4301 혈액의산소운반기능 Oxygen-carrying functions of the blood b4302 혈액의대사물운반기능 Metabolite-carrying functions of the blood b4303 응고기능 Clotting functions b455 운동내성기능 Exercise tolerance functions b4550 일반적인신체적지구력 General physical endurance b4551 유산소능력 Aerobic capacity b4552 피로도 Fatiguability b5 소화기계, 대사및내분비계의기능 FUNCTIONS OF THE DIGESTIVE, METABOLIC AND ENDOCRINE SYSTEMS b510 섭취기능 Ingestion functions b5100 빨기 Sucking b5101 물기 Biting b5102 씹기 Chewing b5103 입안에서음식물을다루기 Manipulation of food in the mouth b5104 타액분비 Salivation b5105 연하 Swallowing b51050 구강연하 Oral swallowing b51051 인두연하 Pharyngeal swallowing b51052 식도연하 Oesophageal swallowing b5106 역류와구토 Regurgitation and vomiting b6 비뇨생식기와생식기능 GENITOURINARY AND REPRODUCTIVE FUNCTIONS b640 성기능 Sexual functions b6400 성의각성기기능 Functions of sexual arousal phase b6401 성의준비기기능 Functions of sexual preparatory phase b6402 절정기기능 Functions of orgasmic phase b6403 성해소기의기능 Functions of sexual resolution phase b7 신경근육골격및운동과연관된기능들 NEUROMUSCULOSKELETAL AND MOVEMENT-RELATED FUNCTIONS b710 관절의가동기능 Mobility of joint functions b7102 전반적인관절가동성 Mobility of joints generalized b715 관절의안정기능 Stability of joint functions b7150 한관절의안정성 Stability of a single joint b7151 여러관절의안정성 Stability of several joints b7152 전반적인관절의안정성 Stability of joints generalized b730 근력기능 Muscle power functions b7300 분리된근육과근육군의근력 Power of isolated muscles and muscle groups b7301 한지근육의힘 Power of muscles of one limb b7302 신체편측근육의힘 Power of muscles of one side of the body b7303 하반신근육의힘 Power of muscles in lower half of the body b7304 사지근육의힘 Power of muscles of all limbs
Body functions 신체기능요약목록 Short List of Body Functions 평가치 b7305 몸통근육의힘 Power of muscles of the trunk b7306 신체전체근육의근력 Power of all muscles of the body b740 근지구력기능 Muscle endurance functions b7400 분리된근육의지구력 Endurance of isolated muscles b7401 근육군의지구력 Endurance of muscle groups b7402 신체모든근육의지구력 Endurance of all muscles of the body b770 보행형태기능 Gait pattern functions b780 근육과운동기능과관련된감각 Sensations related to muscles and movement functions b7800 근육강직감각 Sensation of muscle stiffness b7801 근육경련감각 Sensation of muscle spasm 그외신체기능 ANY OTHER BODY FUNCTIONS
Body structures PART 1b: IMPAIRMENTS OF BODY STRUCTURES 첫번째평가치 : 손상정도 Extent of impairment 두번째평가치 : 변화상태 Nature of the change 세번째평가치 : 손상위치 Location of impairment 0 손상없음 No impairment 1 경도손상 Mild impairment 2 중도손상 Moderate impairment 3 고도손상 Severe impairment 4 완전손상 Complete impairment 8 기타특이적인사항 Not specified 9 상세불명 Not applicable 0 구조변화없음 No change in structure 1 완전손실 Total absence 2 부분손실 Partial absence 3 부분추가 Additional part 4 이형차원 Aberrant dimensions 5 불연속성 Discontinuity 6 일탈상황 Deviating position 7 구조상의질적변화, 분비액의누적포함 Qualitative changes in structure, including accumulation of fluid 8 기타특이적인사항 Not specified 9 상세불명 Not applicable 0 한부위이상 More than one region 1 우측 Right 2 좌측 Left 3 양측 Both sides 4 앞면 Front 5 뒷면 Back 6 기부 ( 근위 ) Proximal 7 원심 ( 원위 ) Distal 8 기타특이적인사항 Not specified 9 상세불명 Not applicable 신체구조요약목록 Short List of Body Structures 평가치 1 Extent 평가치 2 Nature 평가치 3 Location s2 눈, 귀및관련구조 THE EYE, EAR AND RELATED STRUCTURES s299 상세불명의눈, 귀및관련구조 Eye, ear and related structures, unspecified s7 운동관련구조 STRUCTURES RELATED TO MOVEMENT s710 두부및경부구조 Structure of head and neck region s7100 두개골 Bones of cranium s7101 안면골 Bones of face s7102 경부골 Bones of neck region s7103 두부및경부관절 Joints of head and neck region s7104 두부근및경부근 Muscles of head and neck region s7105 두부및경부의인대와근막 Ligaments and fasciae of head and neck region s720 견관절부구조 Structure of shoulder region s7200 견관절부골 Bones of shoulder region s7201 견관절 Joint of shoulder region s7202 견관절부근육 Muscles of shoulder region s7203 견관절부인대및근막 Ligaments and fasciae of shoulder region s730 상지구조 Structure of upper extremity s7300 상완구조 Structure of upper arm s73001 주관절 Elbow joint s7301 전완구조 Structure of forearm s73011 손목관절 Wrist joint -- -- -- -- -- --
Body structures 신체구조요약목록 Short List of Body Structures 평가치 1 Extent 평가치 2 Nature 평가치 3 Location s7302 손구조 Structure of hand s73021 손및손가락관절 Joints of hand and fingers s73022 손근육 Muscles of hand s750 하지구조 Structure of lower extremity s7500 대퇴부구조 Structure of thigh s75001 대퇴관절 Hip joint s7501 하퇴부구조 Structure of lower leg s75011 슬관절 Knee joint s7502 발목및발구조 Structure of ankle and foot s75020 발목및발뼈 Bones of ankle and foot s75021 족관절과발, 발가락관절 Ankle joint and Joints of foot and toes s75022 발목및발근육 Muscles of ankle and foot s75023 발목과발인대및근막 Ligaments and fasciae of ankle and foot s760 흉곽구조 Structure of trunk s7600 척추구조 Structure of vertebral column s76000 경추 Cervical vertebral column s770 운동과관련된그외근골격계구조 Additional musculoskeletal structures related to movement s7700 골 Bones s7701 관절 Joints s7702 근육 Muscles -- -- -- -- -- -- s7703 관절외인대 (Extra-articular ligaments), 근막 (Fasciae), 근육외널힘줄 (Extramuscular aponeuroses), 소지대 (Retinacula), 격벽 (Septa), 낭 (Bursae), 명시되지않은불특정사항 (Unspecified) s8 피부및관련구조 SKIN AND RELATED STRUCTURES s810 피부관련구조 Structure of areas of skin s8100 두부및경부피부 Skin of head and neck region s8101 견관절부피부 Skin of the shoulder region s8102 상지부피부 Skin of upper extremity s8103 골반부피부 Skin of pelvic region s8104 하지부피부 Skin of lower extremity s8105 흉곽및등피부 Skin of trunk and back 그외신체구조 ANY OTHER BODY STRUCTURES
Activities & Participation PART 2: ACTIVITY LIMITATIONS & PARTICIPATION RESTRICTIONS 첫번째요건 : 수행 (Performance) 참여제약 (Participation Restriction) 의정도 두번째요건 : 능력 (Capacity; 도움없이 ) 활동제한 (Activity Limitation) 의정도 0 어려움없음 No difficulty 1 경도어려움 Mild difficulty 2 중도어려움 Moderate difficulty 3 고도어려움 Severe difficulty 4 완전어려움 Complete difficulty 8 분류되어있지않음 Not specified 9 적용불가 Not applicable 0 어려움없음 No difficulty 1 경도어려움 Mild difficulty 2 중도어려움 Moderate difficulty 3 고도어려움 Severe difficulty 4 완전어려움 Complete difficulty 8 분류되어있지않음 Not specified 9 적용불가 Not applicable 활동과참여영역의요약목록 Short List of A&P domains 수행평가치 능력평가치 d1 학습및지식의적용 LEARNING AND APPLYING KNOWLEDGE d170 쓰기 Writing d2 일반적인임무와요구 GENERAL TASKS AND DEMANDS d230 일상생활이행 Carrying out daily routine d2301 일상생활관리 Managing daily routine d2302 일상생활완수 Completing the daily routine d2303 자기자신의활동수위관리 Managing one s own activity level d3 의사소통 COMMUNICATION d360 의사소통장비및기술의이용 Using communication devices and techniques d3600 원거리통신장비이용 Using telecommunication devices d3601 기록장비이용 Using writing machines d3602 의사소통기술이용 Using communication techniques d4 이동 MOBILITY d410 기본적인자세변화 Changing basic body position d4100 눕기 Lying down d4101 쪼그리고앉기 Squatting d4102 무릎꿇기자세 Kneeling d4103 앉기 Sitting d4104 기립 Standing d4105 구부리기자세 Bending d4106 몸의중심이동 Shifting the body s centre of gravity d415 자세유지 Maintaining a body position d4150 눕기자세유지 Maintaining a lying position d4151 쪼그리고앉기자세유지 Maintaining a squatting position d4152 무릎꿇기자세유지 Maintaining a kneeling position
Activities & Participation 활동과참여영역의요약목록 Short List of A&P domains 수행평가치 능력평가치 d4153 앉기자세유지 Maintaining a sitting position d4154 기립자세유지 Maintaining a standing position d430 물건들어올려나르기 Lifting and carrying objects d4300 들어올리기 Lifting d4301 손으로나르기 Carrying in the hands d4302 팔로나르기 Carrying in the arms d4303 어깨 둔부 등에짊어지고나르기 Carrying on shoulders, hip and back d4304 머리로나르기 Carrying on the head d4305 내려놓기 Putting down objects d440 미세한손동작 Fine hand use d4400 집어올리기 Picking up d4401 잡기 Grasping d4402 다루기 Manipulating d4403 풀어놓기 Releasing d445 손과팔이용 Hand and arm use d4450 당기기 Pulling d4451 밀기 Pushing d4452 뻗기 Reaching d4453 손이나팔로돌리거나뒤틀기 Turning or twisting the hands or arms d4454 던지기 Throwing d4455 붙잡기 Catching d449 기타특이적인또는상세불명의물건나르기, 옮기기, 다루기 Carrying, moving and handling objects, other specified and unspecified d450 보행 Walking d4500 단거리보행 Walking short distances d4501 장거리보행 Walking long distances d4502 상이한지면보행 Walking on different surfaces d4503 장애물선회보행 Walking around obstacles d455 이동 Moving around d4550 기어가기 Crawling d4551 오르기 Climbing d4552 달리기 Running d4553 점프 Jumping d4554 수영 Swimming d460 상이한장소로의이동 Moving around in different locations d4600 집안내이동 Moving around within the home d4601 집을제외한건물내이동 Moving around within buildings other than home d4602 집그리고여타건물외부에서의이동 Moving around outside the home and other buildings d465 장비를이용한이동 Moving around using equipment d470 운송수단이용 Using transportation
Activities & Participation 활동과참여영역의요약목록 Short List of A&P domains 수행평가치 능력평가치 d4700 인력운송수단이용 Using human-powered vehicles d4701 개인동력화운송수단이용 Using private motorized transportation d4702 대중동력운송수단이용 Using public motorized transportation d475 운전 Driving d4750 인력운송수단운전 Driving human-powered transportation d4751 동력화운전수단운전 Driving motorized vehicles d4752 동물이끄는운송수단운전 Driving animal-powered vehicles d5 자기관리 SELF-CARE d510 씻기 Washing oneself d5100 신체일부씻기 Washing body parts d5101 전신씻기 Washing whole body d5102 말리기 Drying oneself d520 신체일부관리 Caring for body parts d5200 피부관리 Caring for skin d5201 치아관리 Caring for teeth d5202 모발관리 Caring for hair d5203 손톱관리 Caring for fingernails d5204 발톱관리 Caring for toenails d530 대소변처리 Toileting d5300 배뇨조절 Regulating urination d5301 배변조절 Regulating defecation d5302 월경관리 Menstrual care d540 몸단장 Dressing d5400 옷입기 Putting on clothes d5401 옷벗기 Taking off clothes d5402 신발신기 Putting on footwear d5403 신발벗기 Taking off footwear d5404 적절한옷차림 Choosing appropriate clothing d550 먹기 Eating d560 마시기 Drinking d570 자신의건강돌보기 Looking after one s health d5700 신체적편안함유지 Ensuring one s physical comport d5701 식생활및체중조절 Managing diet and fitness d5702 건강유지 Maintaining one s health d6 가정생활 DOMESTIC LIFE d620 상품구매와서비스받기 Acquisition of goods and services d6200 쇼핑 Shopping d6201 일용필수품무상획득 Gathering daily necessities d630 식사준비 Preparing meals d6300 간단한식사준비 Preparing simple meals
Activities & Participation 활동과참여영역의요약목록 Short List of A&P domains 수행평가치 능력평가치 d6301 복잡한식사준비 Preparing complex meals d640 가사돌보기 Doing housework d6400 의복세탁및건조 Washing and drying clothes and garments d6401 주방청소및식기세척 Cleaning cooking area and utensils d6402 생활공간청소 Cleaning living area d6403 가전제품사용 Using household appliances d6404 일용필수품비축 Storing daily necessities d6405 쓰레기처리 Disposing of garbage d660 가족구성원돌보기 Assisting others d6600 가족구성원의자기관리돕기 Assisting others with self-care d6601 가족구성원의이동돕기 Assisting others in movement d6602 가족구성원의의사소통돕기 Assisting others in communication d6603 가족구성원의대인관계형성돕기 Assisting others in interpersonal relations d6604 가족구성원의영양섭취돕기 Assisting others in nutrition d6605 가족구성원의건강관리돕기 Assisting others in health maintenance d7 대인관계 INTERPERSONAL INTERACTIONS AND RELATIONSHIPS d760 가족관계 Family relationships d7600 부모로서자녀와의관계 Parent-child relationships d7601 자녀로서부모와의관계 Child-parent relationships d7602 형제자매관계 Sibling relationships d7603 확대가족관계 Extended family relationships d770 친밀한관계 Intimate relationships d7700 낭만적인관계 Romantic relationships d7701 배우자관계 Spousal relationships d7702 성관계 Sexual relationships d8 주요생활영역 MAJOR LIFE AREAS d850 유급고용 Remunerative employment d8500 자영업 Self-employment d8501 임시직근무 Part-time employment d8502 정규직근무 Full-time employment d859 기타특이적인또는상세불명의일과고용 Work and employment, other specified and unspecified d9 공동체생활, 사회생활및시민으로서의생활 COMMUNITY, SOCIAL AND CIVIC LIFE d910 공동체생활 Community life d9100 비공식적인조직 Informal associations d9101 공식적인조직 Formal associations d9102 의식 Ceremonies d920 레크리에이션과여가 Recreation and leisure d9200 놀이 Play d9201 스포츠 Sports d9202 예술및교양 Arts and culture
Activities & Participation 활동과참여영역의요약목록 Short List of A&P domains 수행평가치 능력평가치 d9203 수공예 Crafts d9204 취미 Hobbies d9205 사회화 Socializing 그외활동과참여 ANY OTHER ACTIVITIES AND PARTICIPATION
Environmental factors PART 3: ENVIRONMENTAL FACTORS 평가치 Qualifier in environment: Barriers or facilitators 0 방해요인없음 No barrier 1 경도방해요인 Mild barrier 2 중도방해요인 Moderate barrier 3 고도방해요인 Severe barrier 4 완전방해요인 Complete barrier 8 분류되어있지않은방해요인 Barrier, not specified 9 적용불가 Not applicable 0 촉진요인없음 No facilitator +1 경도촉진요인 Mild facilitator +2 중도촉진요인 Moderate facilitator +3 상당한촉진요인 Substantial facilitator +4 완전촉진요인 Complete facilitator +8 분류되어있지않은촉진요인 Facilitator, not specified 9 적용불가 Not applicable 환경요약목록 Short List of Environment 방해요인평가치 촉진요인평가치 e1 제품과기술 PRODUCTS AND TECHNOLOGY e110 개인소비용품또는물질 Products or substances for personal consumption e1100 식품 Food e1101 약품 Drugs e115 개인일상생활용품및기술 Products and technology for personal use in daily living e1150 개인의일상생활용일반제품및기술 General products and technology for personal use in daily living e1151 개인의일상생활용보조제품및기술 Assistive products and technology for personal use in daily living e120 개인의실내 외이동및수송용제품및기술 Products and technology for personal indoor and outdoor mobility and transportation e1200 개인의실내 외이동및수송용일반제품및기술 General products and technology for personal indoor and outdoor mobility and transportation e1201 개인의실내 외이동및수송용보조제품및기술 Assistive products and technology for personal indoor and outdoor mobility and transportation e125 커뮤니케이션용제품및기술 Products and technology for communication e1250 커뮤니케이션용일반제품및기술 General products and technology for communication e1251 커뮤니케이션용보조제품및기술 Assistive products and technology for communication e135 업무용제품및기술 Products and technology for employment e1350 업무용일반제품및기술 General products and technology for employment e1351 업무용보조제품및기술 Assistive products and technology for employment e150 공공건물의설계 축조 건축관련제품및기술 Design, construction and building products and technology of buildings for public use e1500 공공건물의출입시설설계 축조 건축관련제품및기술 Design, construction and building products and technology for entering and exiting of buildings for public use e1501 공공건물의실내편의시설설계 축조 건축관련제품및기술 Design, construction and building products and technology for gaining access to facilities inside buildings for public use e1502 공공건물내, 길안내편의시설설계 축조 건축관련제품및기술 Design, construction and building products and technology for way finding, path routing and designation of locations in buildings for public use
Environmental factors 환경요약목록 Short List of Environment 방해요인평가치 촉진요인평가치 e2 e155 개인용건물의설계 축조 건축관련제품및기술 Design, construction and building products and technology of buildings for private use e1550 개인용건물의출입시설설계 축조 건축관련제품및기술 Design, construction and building products and technology for entering and exiting of buildings for private use e1551 개인용건물의실내편의시설설계 축조 건축관련제품및기술 Design, construction and building products and technology for gaining access to facilities inside buildings for private use e1552 개인용건물의길안내시설설계 축조 건축관련제품및기술 Design, construction and building products and technology for way finding, path routing and designation of locations in buildings for private use 자연환경및인위적환경변화 ENVIRONMENT e225 기후 Climate e2250 기온 Temperature e2251 습도 Humidity e2252 기압 Atmospheric pressure e2253 강수량 Precipitation e2254 풍속 Wind e2255 계절변화 Seasonal variations NATURAL ENVIRONMENT AND HUMAN-MADE CHANGES TO e3 지원과관계 SUPPORT AND RELATIONSHIPS e310 직계가족 Immediate family e320 친구 Friends e340 개인적도움제공자및개인보조원 Personal care providers and personal assistants e355 보건전문가 Health professionals e360 여타전문가 Other professionals e4 태도 ATTITUDES e410 직계가족구성원의개인적인태도 Individual attitudes of immediate family members e420 친구의개인적인태도 Individual attitudes of friends e425 지인, 동년배, 동료, 이웃및공동체구성원의개인적인태도 Individual attitudes of acquaintances, peers, colleagues, neighbours and community members e450 보건전문가의개인적인태도 Individual attitudes of health professionals e460 사회적인태도 Societal attitudes e5 서비스, 시스템및정책 SERVICES, SYSTEMS AND POLICIES e540 수송서비스, 시스템및정책 Transportation services, systems and policies e5400 수송서비스 Transportation services e5401 수송시스템 Transportation systems e5402 수송정책 Transportation policies e570 사회보장서비스, 시스템및정책 Social security services, systems and policies e5700 사회보장서비스 Social security services e5701 사회보장시스템 Social security systems e5702 사회보장정책 Social security policies e580 보건서비스, 시스템및정책 Health services, systems and policies
Environmental factors 환경요약목록 Short List of Environment 방해요인평가치 촉진요인평가치 e5800 보건서비스 Health services e5801 보건시스템 Health systems e5802 보건정책 Health policies 그외다른환경적인자들 ANY OTHER ENVIRONMENTAL FACTORS