康復(fù)概論ICF在康復(fù)醫(yī)學(xué)中應(yīng)用

1、關(guān)于康復(fù)概論ICF在康復(fù)醫(yī)學(xué)中的應(yīng)用第一張，PPT共七十二頁，創(chuàng)作于2022年6月2環(huán)境因素個(gè)人因素相關(guān)因素活動身體功能與身體結(jié)構(gòu)參與健康狀況(疾病、外傷)功能與殘疾的綜合模式第二張，PPT共七十二頁，創(chuàng)作于2022年6月3健康狀況健康狀況是疾病、疾患、損傷或者外傷的總稱健康狀況可以包括其他情況，例如老齡、應(yīng)激、先天畸形以及遺傳因素等健康狀況使用ICD-10作為標(biāo)準(zhǔn)編碼第三張，PPT共七十二頁，創(chuàng)作于2022年6月第四張，PPT共七十二頁，創(chuàng)作于2022年6月第五張，PPT共七十二頁，創(chuàng)作于2022年6月第六張，PPT共七十二頁，創(chuàng)作于2022年6月第七張，PPT共七十二頁，創(chuàng)作于2022年6

2、月8環(huán)境因素個(gè)人因素相關(guān)因素活動身體功能與身體結(jié)構(gòu)參與慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式第八張，PPT共七十二頁，創(chuàng)作于2022年6月9身體功能與身體結(jié)構(gòu)身體功能指身體的生理功能，包括心理功能身體結(jié)構(gòu)指身體的解剖結(jié)構(gòu)，例如器官、肢體和相關(guān)部件第九張，PPT共七十二頁，創(chuàng)作于2022年6月10環(huán)境因素個(gè)人因素相關(guān)因素活動疼痛、關(guān)節(jié)穩(wěn)定性、交叉韌帶參與慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式第十張，PPT共七十二頁，創(chuàng)作于2022年6月11活動與參與活動指個(gè)人執(zhí)行任務(wù)或者個(gè)人的行動，代表個(gè)體功能參與指參加生活環(huán)境的活動，代表社會功能活動限制參與限制第十一張，PPT共七十二頁，創(chuàng)作

3、于2022年6月12環(huán)境因素個(gè)人因素相關(guān)因素?cái)y帶物體、彎膝、步行、攀爬疼痛、關(guān)節(jié)穩(wěn)定性、交叉韌帶照顧孫子、家務(wù)、協(xié)助丈夫工作慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式第十二張，PPT共七十二頁，創(chuàng)作于2022年6月13環(huán)境因素人們居住和生活的物理、社會和態(tài)度環(huán)境環(huán)境因素是個(gè)人之外的因素積極因素 (facilitator)消極因素(barrier)第十三張，PPT共七十二頁，創(chuàng)作于2022年6月14-住在4樓，無電梯+使用拐杖/康復(fù)/藥物治療個(gè)人因素相關(guān)因素?cái)y帶物體、彎膝、步行、攀爬疼痛、關(guān)節(jié)穩(wěn)定性、交叉韌帶照顧孫子、家務(wù)、協(xié)助丈夫工作慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式第十四張，

4、PPT共七十二頁，創(chuàng)作于2022年6月15個(gè)人因素包括性別、年齡、人種、體質(zhì)、生活方式、習(xí)慣、社會背景、其它社會功能第十五張，PPT共七十二頁，創(chuàng)作于2022年6月16-住在4樓，無電梯+使用拐杖、康復(fù)治療、藥物治療60歲，生性積極相關(guān)因素?cái)y帶物體、彎膝、步行、攀爬疼痛、關(guān)節(jié)穩(wěn)定性、交叉韌帶照顧孫子、家務(wù)、協(xié)助丈夫工作慢性膝關(guān)節(jié)不穩(wěn)M 23.5功能與殘疾的綜合模式第十六張，PPT共七十二頁，創(chuàng)作于2022年6月17身體結(jié)構(gòu)和功能障礙活動受限參與限制殘疾第十七張，PPT共七十二頁，創(chuàng)作于2022年6月18身體結(jié)構(gòu)和功能 與參與活動功能改善第十八張，PPT共七十二頁，創(chuàng)作于2022年6月19功能改

5、善第十九張，PPT共七十二頁，創(chuàng)作于2022年6月20ICF是國際通用的描述功能、殘疾和健康狀況的國際語言和概念第二十張，PPT共七十二頁，創(chuàng)作于2022年6月21第二十一張，PPT共七十二頁，創(chuàng)作于2022年6月22健康狀況（疾病、外傷）253項(xiàng)環(huán)境因素個(gè)人因素相關(guān)因素384項(xiàng)活動與參與493項(xiàng)身體結(jié)構(gòu)310項(xiàng)身體功能第二十二張，PPT共七十二頁，創(chuàng)作于2022年6月23b1 b8s1 s8d1 d9e1 e5章ICF 金字塔結(jié)構(gòu)ICF身體功能身體結(jié)構(gòu)活動與參與環(huán)境因素個(gè)人因素bsde第二十三張，PPT共七十二頁，創(chuàng)作于2022年6月24第一級：身體結(jié)構(gòu)與功能Skin and related

6、 structuresStructures related to movementStructures related to the genitourinary and reproductive systemsStructures related to the digestive, metabolic and endocrine systemsStructures of the cardiovascular, immunological and respiratory systems聲音和言語相關(guān)的組織結(jié)構(gòu)The eye, ear and related structuresStructure

7、s of the nervous systemFunctions of the skin and related structuresNeuromusculoskeletal and movement-related functionsGenitourinary and reproductive functionsFunctions of the digestive, metabolic and endocrine systemsFunctions of the cardiovascular, haematological, immunological and respiratory syst

8、ems聲音和言語功能Sensory functions and painMental functionsChapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1身體結(jié)構(gòu) (s)身體功能 (b)第二十四張，PPT共七十二頁，創(chuàng)作于2022年6月25第一級：活動與參與主要的生活區(qū)域人際關(guān)系家庭區(qū)域個(gè)人自理活動交流一般任務(wù)與需求學(xué)習(xí)與應(yīng)用技術(shù)社區(qū)、社會和公民活動Chapter 8Chapter 7Chapter 6Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1Chapt

9、er 9第二十五張，PPT共七十二頁，創(chuàng)作于2022年6月26第一級：環(huán)境因素 (e)服務(wù)、體系與政策態(tài)度支持與關(guān)心自然環(huán)境和人類對環(huán)境的改造產(chǎn)品與技術(shù)Chapter 5Chapter 4Chapter 3Chapter 2Chapter 1第二十六張，PPT共七十二頁，創(chuàng)作于2022年6月27b1 b8s1 s8d1 d9e1 e5ChaptersICF 第二級結(jié)構(gòu)ICF身體功能身體結(jié)構(gòu)活動與參與環(huán)境因素個(gè)人因素bsdeb110 b899s110 s899d110 d999e110 e5992nd Level第二十七張，PPT共七十二頁，創(chuàng)作于2022年6月28第二級結(jié)構(gòu) 舉例章節(jié)b1 腦高

10、級功能 Mental function整體腦高級功能 (b110 b139)b110意識b114 定向b117 智力b122 整體心理功能b126 個(gè)性b130 主觀能動性b134 睡眠b139 非特指的整體心理功能特定的腦高級功能Specific mental functions (b140 b189)第二十八張，PPT共七十二頁，創(chuàng)作于2022年6月29ICFBody Functions bb1100 b7809b11420 b54509b1 b8b110 b899Body Structuresss1 s8s110 s899s1100 s8309s11000 s76009Activity

11、& Participationdd1 d9d110 d999d1150 d9309Environmental Factorsee1 e5e110 e599e1100 e5959ICF 三級結(jié)構(gòu)The higher the more precise第二十九張，PPT共七十二頁，創(chuàng)作于2022年6月30b 腦高級功能Mental functions一級 b114 定向功能 二級 b1141 地點(diǎn)定向 b1142 人物定向 b11420自我定向b11421他人定向ICF 條目舉例三級四級第三十張，PPT共七十二頁，創(chuàng)作于2022年6月第三十一張，PPT共七十二頁，創(chuàng)作于2022年6月第三十二張，PP

12、T共七十二頁，創(chuàng)作于2022年6月d b 第三十三張，PPT共七十二頁，創(chuàng)作于2022年6月第三十四張，PPT共七十二頁，創(chuàng)作于2022年6月第三十五張，PPT共七十二頁，創(chuàng)作于2022年6月第三十六張，PPT共七十二頁，創(chuàng)作于2022年6月37ICF總條目：1454有多少在特定的疾病需要？臨床和科研有何用途？評判標(biāo)準(zhǔn)？第三十七張，PPT共七十二頁，創(chuàng)作于2022年6月發(fā)展ICF核心組合 Core Sets第三十八張，PPT共七十二頁，創(chuàng)作于2022年6月39盲人摸象的故事第三十九張，PPT共七十二頁，創(chuàng)作于2022年6月40ICF and ICF Core Sets確定評定條目what to

13、 measure應(yīng)用基礎(chǔ)：how to measure第四十張，PPT共七十二頁，創(chuàng)作于2022年6月41b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e150 1454ICF 核心組合第四十一張，PPT共七十二頁，創(chuàng)作于2022年6月42b1b130b134b152b180b1801 s299s710s720 s730s73001s73011 d170d230d360d410 d415d430 e110e115e120e125e135e15

14、0 1454ICF 核心組合特定疾病特定環(huán)境第四十二張，PPT共七十二頁，創(chuàng)作于2022年6月43骨關(guān)節(jié)炎OA 身體功能b280 疼痛的感覺b710 關(guān)節(jié)活動功能b730 肌肉功能b770 步態(tài)b715 關(guān)節(jié)穩(wěn)定性b740 肌肉耐力b780 與肌肉相關(guān)的感覺和運(yùn)動功能b760 自主運(yùn)動的控制b134 睡眠功能b735 肌肉張力簡要ICF核心組合全套ICF核心組合第四十三張，PPT共七十二頁，創(chuàng)作于2022年6月44 s750下肢結(jié)構(gòu)s730上肢結(jié)構(gòu)s770其它與運(yùn)動相關(guān)的 肌肉骨骼結(jié)構(gòu)s740骨盆結(jié)構(gòu)s720肩部結(jié)構(gòu)OA 身體結(jié)構(gòu)簡要ICF核心組合全套ICF核心組合第四十四張，PPT共七十二頁

15、，創(chuàng)作于2022年6月45d450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如廁d430抬舉和攜帶物品d640做家務(wù)d910社區(qū)生活d440手精細(xì)活動d410改變身體位置OA 活動與參與簡要ICF核心組合全套ICF核心組合第四十五張，PPT共七十二頁，創(chuàng)作于2022年6月46e115 與個(gè)人日常生活相關(guān)的產(chǎn)品與技術(shù)e310 近親e580 醫(yī)療服務(wù)、體系和政策e150 公共場合的建筑設(shè)計(jì)、產(chǎn)品和技術(shù)e355 醫(yī)務(wù)人員e540 交通服務(wù)、體系和政策e120 個(gè)人室內(nèi)和室外活動和交通的產(chǎn)品與技術(shù)e135 就業(yè)相關(guān)的產(chǎn)品與技術(shù)e155 私人使用的建筑設(shè)計(jì)、建造和

16、建筑產(chǎn)品e340 個(gè)人護(hù)理人員和助手OA 環(huán)境因素簡要ICF核心組合全套ICF核心組合第四十六張，PPT共七十二頁，創(chuàng)作于2022年6月47 定量分級Qualifiers 問題的嚴(yán)重程度如何量化已經(jīng)清楚的?是 功能障礙是什么并不清楚的?是b1141.0123489第四十七張，PPT共七十二頁，創(chuàng)作于2022年6月第四十八張，PPT共七十二頁，創(chuàng)作于2022年6月49定量分級(qualifier)0沒有問題(無、缺乏、可以忽視等) 0-4% 1 輕度問題(輕、低等) 5-24% 2 中度問題(中等、較好等) 25-49% 3 嚴(yán)重問題(高、極端等) 50-95% 4 全部問題(最嚴(yán)重、全部受累等

17、)96-100% 8無法特定 (當(dāng)前的信息無法確定嚴(yán)重程度)9無法應(yīng)用 (不恰當(dāng)或者不可能使用)第四十九張，PPT共七十二頁，創(chuàng)作于2022年6月50第五十張，PPT共七十二頁，創(chuàng)作于2022年6月51Problem-solving approach第五十一張，PPT共七十二頁，創(chuàng)作于2022年6月52Rehab-CycleAssessmentEvaluationAssignmentIntervention第五十二張，PPT共七十二頁，創(chuàng)作于2022年6月53AssessmentEvaluationAssignmentInterventionRehab-CycleICF ModelICF &

18、ICF Core Sets第五十三張，PPT共七十二頁，創(chuàng)作于2022年6月54Diagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspectiveWhat are the patients problems and needs from his/her perspective?What are the patients problems f

19、rom the team perspective?Use the ICF Core Sets!第五十四張，PPT共七十二頁，創(chuàng)作于2022年6月55Diagnosis (ICD-10)Rehabilitaton goalsteam perspectiveenvironmental factorspersonal factorsbody structures & functionsactivities & participationpatient perspective第五十五張，PPT共七十二頁，創(chuàng)作于2022年6月56Assessment with the ICF SheetPatients

20、 perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist

21、and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband

22、 is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+What are the patients problems and needs from his/her perspective?What are the patients problems from the rehab

23、ilitation team perspective?Use the ICF-Core-sets as a Checklist !Goals of rehabilitationIntervention program goal:Long-term goal: 第五十六張，PPT共七十二頁，創(chuàng)作于2022年6月57Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal Fact

24、orsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in l

25、ifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for

26、hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+b710 Mobility of joint functionsb715 Stability of joint functionsb730 Muscle power functionsb435 Immunological system functionss7302 Structure of hands73011 Wrist joints73021 Joints of hand and fingerss75011 Knee join

27、ts7502 Structure of ankle and footd440 Fine hand used445 Hand and arm used430 Lifting and carrying objectsd630 Preparing mealsd640 Doing houseworkd4500 Walking short distancesd4551 ClimbingGoals of rehabilitationIntervention program goal:Long-term goal: 第五十七張，PPT共七十二頁，創(chuàng)作于2022年6月58Assessment with the

28、 ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling

29、 in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationsh

30、ip with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation param

31、eters in bloodSubluxation of metacarpophalangeal (MCP) Degenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distances

32、Climbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 第五十八張，PPT共七十二頁，創(chuàng)作于2022年6月59REHAB-CycleAssessment in three stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycle goals andIdentification of interventi

33、on targets related to the cycle goals.第五十九張，PPT共七十二頁，創(chuàng)作于2022年6月60Assessment with the ICF SheetGoals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining Patients perspectiveRehabilitation team perspectiveBody-Structures/Functions A

34、ctivities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing tee

35、th and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth flo

36、or flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) Degenerative changes in fingersFi

37、ngers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal:Long-term goal: 第六十張，PP

38、T共七十二頁，創(chuàng)作于2022年6月61REHAB-CycleAssessment in three stepsIdentification of the problems and needs of the patient,Determination of the long-term, intervention program and cycle goals .Identification of intervention targets related to the cycle goals.第六十一張，PPT共七十二頁，創(chuàng)作于2022年6月62Assessment with the ICF Sh

39、eetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in fin

40、ger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with

41、 my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters i

42、n bloodSubluxation of metacarpophalangeal (MCP) Degenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbin

43、g stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining What is related to (determine) the cycle goals?Determine the intervention targets第六十二張，PPT共七十二頁，創(chuàng)作于2022年6月63Assessment with the ICF SheetPatients perspectiveRehabi

44、litation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDif

45、ficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected

46、because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacar

47、pophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift rightDegenerative changes in fingersFingers and wrist joints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking sh

48、ort distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework Long-term goal: Vocational retraining 第六十三張，PPT共七十二頁，創(chuàng)作于2022年6月64Rehab-CycleAssessmentAssignment第六十四張，PPT共七十二頁，創(chuàng)作于2022年6月65Assignment Health ProfessionalsProgram or serviceInpatient

49、 or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresher第六十五張，PPT共七十二頁，創(chuàng)作于2022年6月66Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chroni

50、c polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands and fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headPr

51、oblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my free-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+

52、Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift rightDegenerative changes in fingersFingers and wrist j

53、oints swollenRight knee swollenBoth ankle joints swollenHallux valgus positiion, rightleft Fine hand useHand and arm useLifting and carrying objectsPreparing mealsHouseworkWalking short distancesClimbing stairs Goals of rehabilitationIntervention program goal: Independence in self-care and housework

54、 Long-term goal: Vocational retraining 第六十六張，PPT共七十二頁，創(chuàng)作于2022年6月67Assignment Health ProfessionalsProgram or serviceInpatient or outpatient rehab, home rehabType of specific serviceSingle vs groupFirst intervention, refresherIntervention第六十七張，PPT共七十二頁，創(chuàng)作于2022年6月68AssessmentAssignmentInterventionRehab

55、-Cycle第六十八張，PPT共七十二頁，創(chuàng)作于2022年6月69Assessment with the ICF SheetPatients perspectiveRehabilitation team perspectiveBody-Structures/Functions Activities/ParticipationPersonal FactorsReha-diagnosis ICD-10chronic polyarthritis ICD: M05.9Environmental Factors Pain in right knee and shoulderPain in hands a

56、nd fingersShortened mobility and flexibilitySwelling in finger, wrist and knee jointsDifficulties in getting dressedProblems in brushing teeth and combing hairDifficulties in lifting things above the headProblems preparing mealsProblems doing houseworkI had to give up my job as a secretaryAll my fre

57、e-time activities are affectedMy intimate relationship with my husband is also affected because of the painMedication +Lives in a fourth floor flat; No elevator Needs aids for hand use+, Supportive husband+Self-help group+Motivated+adequate coping strategies+Impaired mobility of jointsImpaired joint stabilityImpaired muscle strengthInflammation parameters in bloodSubluxation of metacarpophalangeal (MCP) joints 2 and 3 right, beginning ulnar drift rightDegenerative changes in fingersFingers and