康复概论ICF在康复医学中的应用专家讲座

1环境原因个人原因相关原因活动身体功效与身体结构参加健康情况

(疾病、外伤)功效与残疾综合模式康复概论ICF在康复医学中的应用专家讲座第1页2健康情况健康情况是疾病、疾患、损伤或者外伤总称健康情况能够包含其它情况，比如老龄、应激、先天畸形以及遗传原因等健康情况使用ICD-10作为标准编码康复概论ICF在康复医学中的应用专家讲座第2页康复概论ICF在康复医学中的应用专家讲座第3页康复概论ICF在康复医学中的应用专家讲座第4页康复概论ICF在康复医学中的应用专家讲座第5页康复概论ICF在康复医学中的应用专家讲座第6页7环境原因个人原因相关原因活动身体功效与身体结构参加慢性膝关节不稳

M23.5功效与残疾综合模式康复概论ICF在康复医学中的应用专家讲座第7页8身体功效与身体结构身体功效指身体生理功效，包含心理功效身体结构指身体解剖结构，比如器官、肢体和相关部件康复概论ICF在康复医学中的应用专家讲座第8页9环境原因个人原因相关原因活动疼痛、关节稳定性、交叉韧带参加慢性膝关节不稳

M23.5功效与残疾综合模式康复概论ICF在康复医学中的应用专家讲座第9页10活动与参加活动指个人执行任务或者个人行动，代表个体功效参加指参加生活环境活动，代表社会功效活动限制参加限制康复概论ICF在康复医学中的应用专家讲座第10页11环境原因个人原因相关原因携带物体、弯膝、步行、攀爬疼痛、关节稳定性、交叉韧带照料孙子、家务、帮助丈夫工作慢性膝关节不稳

M23.5功效与残疾综合模式康复概论ICF在康复医学中的应用专家讲座第11页12环境原因人们居住和生活物理、社会和态度环境环境原因是个人之外原因主动原因

(facilitator)消极原因(barrier)康复概论ICF在康复医学中的应用专家讲座第12页13-住在4楼，无电梯+使用拐杖/康复/药品治疗个人原因相关原因携带物体、弯膝、步行、攀爬疼痛、关节稳定性、交叉韧带照料孙子、家务、帮助丈夫工作慢性膝关节不稳

M23.5功效与残疾综合模式康复概论ICF在康复医学中的应用专家讲座第13页14个人原因包含性别、年纪、人种、体质、生活方式、习惯、社会背景、其它社会功效康复概论ICF在康复医学中的应用专家讲座第14页15-住在4楼，无电梯+使用拐杖、康复治疗、药品治疗60岁，生性主动相关原因携带物体、弯膝、步行、攀爬疼痛、关节稳定性、交叉韧带照料孙子、家务、帮助丈夫工作慢性膝关节不稳

M23.5功效与残疾综合模式康复概论ICF在康复医学中的应用专家讲座第15页16身体结构和功效障碍活动受限参加限制残疾康复概论ICF在康复医学中的应用专家讲座第16页17身体结构和功效与参加活动功效改进康复概论ICF在康复医学中的应用专家讲座第17页18功效改进康复概论ICF在康复医学中的应用专家讲座第18页19ICF是国际通用描述功效、残疾和健康情况国际语言和概念康复概论ICF在康复医学中的应用专家讲座第19页20康复概论ICF在康复医学中的应用专家讲座第20页21健康情况（疾病、外伤）253项环境原因个人原因相关原因384项活动与参加493项身体结构310项身体功效康复概论ICF在康复医学中的应用专家讲座第21页22b1

–

b8s1

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s8d1

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d9e1

–

e5章ICF–

金字塔结构ICF身体功效身体结构活动与参加环境原因个人原因bsde康复概论ICF在康复医学中的应用专家讲座第22页23第一级：身体结构与功效

SkinandrelatedstructuresStructuresrelatedtomovementStructuresrelatedtothegenitourinaryandreproductivesystemsStructuresrelatedtothedigestive,metabolicandendocrinesystemsStructuresofthecardiovascular,immunologicalandrespiratorysystems声音和言语相关组织结构Theeye,earandrelatedstructuresStructuresofthenervoussystemFunctionsoftheskinandrelatedstructuresNeuromusculoskeletalandmovement-relatedfunctionsGenitourinaryandreproductivefunctionsFunctionsofthedigestive,metabolicandendocrinesystemsFunctionsofthecardiovascular,haematological,immunologicalandrespiratorysystems声音和言语功效SensoryfunctionsandpainMentalfunctionsChapter8Chapter7Chapter6Chapter5Chapter4Chapter3Chapter2Chapter1身体结构(s)身体功效

(b)康复概论ICF在康复医学中的应用专家讲座第23页24第一级：活动与参加主要生活区域 人际关系家庭区域 个人自理活动交流普通任务与需求学习与应用技术小区、社会和公民活动Chapter8Chapter7Chapter6Chapter5Chapter4Chapter3Chapter2Chapter1Chapter9康复概论ICF在康复医学中的应用专家讲座第24页25第一级：环境原因(e)服务、体系与政策态度支持与关心自然环境和人类对环境改造产品与技术Chapter5Chapter4Chapter3Chapter2Chapter1康复概论ICF在康复医学中的应用专家讲座第25页26b1

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b8s1

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s8d1

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d9e1

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e5ChaptersICF–

第二级结构ICF身体功效身体结构活动与参加环境原因个人原因bsdeb110

–

b899s110

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s899d110

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d999e110

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e5992ndLevel康复概论ICF在康复医学中的应用专家讲座第26页27第二级结构–

举例章节 b1脑高级功效Mentalfunction整体脑高级功效(b110

–b139)b110 意识b114 定向b117 智力b122 整体心理功效b126 个性b130 主观能动性b134 睡眠b139 非特指整体心理功效特定脑高级功效Specificmentalfunctions(b140

–b189)康复概论ICF在康复医学中的应用专家讲座第27页28ICFBodyFunctionsbb1100

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b7809b11420

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b8b110

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b899BodyStructuresss1

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s8309s11000

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s76009Activity&Participationdd1

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d9d110

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d999d1150

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d9309EnvironmentalFactorsee1

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e5e110

–

e599e1100

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e5959ICF–

三级结构Thehigherthemoreprecise康复概论ICF在康复医学中的应用专家讲座第28页29b

脑高级功效Mentalfunctions 一级

b114

定向功效

二级

b1141地点定向

b1142人物定向

b11420自我定向

b11421他人定向ICF条目举例三级四级康复概论ICF在康复医学中的应用专家讲座第29页康复概论ICF在康复医学中的应用专家讲座第30页康复概论ICF在康复医学中的应用专家讲座第31页d

b

康复概论ICF在康复医学中的应用专家讲座第32页康复概论ICF在康复医学中的应用专家讲座第33页康复概论ICF在康复医学中的应用专家讲座第34页康复概论ICF在康复医学中的应用专家讲座第35页36ICF总条目：1454

有多少在特定疾病需要？

临床和科研有何用途？

评判标准？康复概论ICF在康复医学中的应用专家讲座第36页发展ICF关键组合CoreSets

康复概论ICF在康复医学中的应用专家讲座第37页38盲人摸象故事康复概论ICF在康复医学中的应用专家讲座第38页39ICFandICFCoreSets确定评定条目whattomeasure应用基础：howtomeasure康复概论ICF在康复医学中的应用专家讲座第39页40b1b130b134b152b180b1801

s299s710s720s730s73001s73011

d170d230d360d410d415d430

e110e115e120e125e135e150

1454ICF关键组合康复概论ICF在康复医学中的应用专家讲座第40页41b1b130b134b152b180b1801

s299s710s720s730s73001s73011

d170d230d360d410d415d430

e110e115e120e125e135e150

1454ICF关键组合特定疾病特定环境康复概论ICF在康复医学中的应用专家讲座第41页42骨关节炎OA–

身体功效b280 疼痛感觉 b710 关节活动功效 b730 肌肉功效b770 步态b715 关节稳定性b740 肌肉耐力b780 与肌肉相关感觉和运动功效b760 自主运动控制b134 睡眠功效b735肌肉张力简明ICF关键组合全套ICF关键组合康复概论ICF在康复医学中的应用专家讲座第42页43

s750 下肢结构s730 上肢结构s770 其它与运动相关肌肉骨骼结构

s740 骨盆结构s720 肩部结构OA–

身体结构简明ICF关键组合全套ICF关键组合康复概论ICF在康复医学中的应用专家讲座第43页44d450 步行d540 穿衣d445手和手臂使用d510 自我洗浴d470 使用交通工具d530 如厕d430 抬举和携带物品d640 做家务d910 小区生活d440 手精细活动d410 改变身体位置OA–

活动与参加简明ICF关键组合全套ICF关键组合康复概论ICF在康复医学中的应用专家讲座第44页45e115

与个人日常生活相关产品与技术e310 近亲e580 医疗服务、体系和政策e150 公共场所建筑设计、产品和技术

e355 医务人员e540 交通服务、体系和政策e120 个人室内和室外活动和交通产品与技术

e135 就业相关产品与技术e155 私人使用建筑设计、建造和建筑产品

e340个人护理人员和助手OA–

环境原因简明ICF关键组合全套ICF关键组合康复概论ICF在康复医学中的应用专家讲座第45页46

定量分级Qualifiers

问题严重程度怎样量化已经清楚?是功效障碍是什么并不清楚?是b1141.0123489康复概论ICF在康复医学中的应用专家讲座第46页康复概论ICF在康复医学中的应用专家讲座第47页48定量分级(qualifier)0 没有问题(无、缺乏、能够忽略等)

0-4%

1轻度问题(轻、低等)

5-24%

2中度问题(中等、很好等)

25-49%

3 严重问题(高、极端等)

50-95%

4全部问题(最严重、全部受累等) 96-100%

8 无法特定

(当前信息无法确定严重程度)9 无法应用

(不恰当或者不可能使用)康复概论ICF在康复医学中的应用专家讲座第48页49康复概论ICF在康复医学中的应用专家讲座第49页50Problem-solvingapproach康复概论ICF在康复医学中的应用专家讲座第50页51Rehab-CycleAssessmentEvaluationAssignmentIntervention康复概论ICF在康复医学中的应用专家讲座第51页52AssessmentEvaluationAssignmentInterventionRehab-CycleICFModelICF&ICFCoreSets康复概论ICF在康复医学中的应用专家讲座第52页53Diagnosis(ICD-10)Rehabilitatongoalsteamperspectiveenvironmentalfactors personalfactors bodystructures&functionsactivities&participationpatientperspectiveWhatarethepatient'sproblemsandneedsfromhis/herperspective?Whatarethepatient'sproblemsfromtheteamperspective?UsetheICFCoreSets!康复概论ICF在康复医学中的应用专家讲座第53页54Diagnosis(ICD-10)Rehabilitatongoalsteamperspectiveenvironmentalfactors personalfactors bodystructures&functionsactivities&participationpatientperspective康复概论ICF在康复医学中的应用专家讲座第54页55AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+Whatarethepatients'problemsandneedsfromhis/herperspective?Whatarethepatients'problemsfromtherehabilitationteamperspective?UsetheICF-Core-setsasaChecklist!GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

康复概论ICF在康复医学中的应用专家讲座第55页56AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+b710Mobilityofjointfunctionsb715Stabilityofjointfunctionsb730Musclepowerfunctionsb435Immunologicalsystemfunctionss7302Structureofhands73011Wristjoints73021Jointsofhandandfingerss75011Kneejoints7502Structureofankleandfootd440Finehandused445Handandarmused430Liftingandcarryingobjectsd630Preparingmealsd640Doinghouseworkd4500Walkingshortdistancesd4551ClimbingGoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

康复概论ICF在康复医学中的应用专家讲座第56页57AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

康复概论ICF在康复医学中的应用专家讲座第57页58REHAB-CycleAssessmentinthreestepsIdentificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoalsandIdentificationofinterventiontargetsrelatedtothecyclegoals.康复概论ICF在康复医学中的应用专家讲座第58页59AssessmentwiththeICFSheetGoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

Patient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Long-termgoal:

康复概论ICF在康复医学中的应用专家讲座第59页60REHAB-CycleAssessmentinthreestepsIdentificationoftheproblemsandneedsofthepatient,Determinationofthelong-term,interventionprogramandcyclegoals.Identificationofinterventiontargetsrelatedtothecyclegoals.康复概论ICF在康复医学中的应用专家讲座第60页61AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)DegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

Whatisrelatedto(determine)thecyclegoals?Determinetheinterventiontargets康复概论ICF在康复医学中的应用专家讲座第61页62AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

康复概论ICF在康复医学中的应用专家讲座第62页63Rehab-CycleAssessmentAssignment康复概论ICF在康复医学中的应用专家讲座第63页64Assignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresher康复概论ICF在康复医学中的应用专家讲座第64页65AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRightkneeswollenBothanklejointsswollenHalluxvalguspositiion,right>left

FinehanduseHandandarmuseLiftingandcarryingobjectsPreparingmealsHouseworkWalkingshortdistancesClimbingstairs

GoalsofrehabilitationInterventionprogramgoal:

Independenceinself-careandhousework

Long-termgoal:Vocationalretraining

康复概论ICF在康复医学中的应用专家讲座第65页66Assignment HealthProfessionalsProgramorserviceInpatientoroutpatientrehab,homerehabTypeofspecificserviceSinglevsgroupFirstintervention,refresherIntervention康复概论ICF在康复医学中的应用专家讲座第66页67AssessmentAssignmentInterventionRehab-Cycle康复概论ICF在康复医学中的应用专家讲座第67页68AssessmentwiththeICFSheetPatient‘sperspectiveRehabilitationteamperspectiveBody-Structures/Functions

Activities/ParticipationPersonalFactorsReha-diagnosisICD-10chronicpolyarthritis[ICD:M05.9]EnvironmentalFactorsPaininrightkneeandshoulderPaininhandsandfingersShortenedmobilityandflexibilitySwellinginfinger,wristandkneejointsDifficultiesingettingdressedProblemsinbrushingteethandcombinghairDifficultiesinliftingthingsabovetheheadProblemspreparingmealsProblemsdoinghouseworkIhadtogiveupmyjobasasecretaryAllmyfree-timeactivitiesareaffectedMyintimaterelationshipwithmyhusbandisalsoaffectedbecauseofthepainMedication+

Livesinafourthfloorflat;Noelevator–

Needsaidsforhanduse+,Supportivehusband+

Self-helpgroup+Motivated+

adequatecopingstrategies+ImpairedmobilityofjointsImpairedjointstabilityImpairedmusclestrengthInflammationparametersinbloodSubluxationofmetacarpophalangeal(MCP)joints2and3right,beginningulnardriftrightDegenerativechangesinfingersFingersandwristjointsswollenRig