Occupational Concerns of Women Who Are Homeless and Have Children: An Occupational Justice Critique

SUMMARY

The purpose of this exploratory study was to describe the occupational goals and concerns of women who are homeless with children. Twenty-seven women with children living in homeless shelters completed interviews using the Canadian Occupational Performance Measure (COPM). Occupational issues and concerns were identified for each participant, and then they were pooled. A total of 169 occupational concerns were described and analyzed. The most common occupational issues identified by participants concerned finances, employment, education, transportation, housing, time for self, personal appearance, home management, and parenting. Analysis of identified occupational concerns suggests that the homeless women with children experienced a range of institutional and social barriers to occupational participation: essentially a form of occupational injustice. This study raises questions concerning the most effective roles for occupational therapists to facilitate empowerment so that women who are homeless may fully participate in the communities where they live.     

A client‐centred,occupation‐based occupational therapy programme for adults with psychiatric diagnoses

The purpose of this study was to assess the effectiveness of a client‐centred, occupation‐based occupational therapy programme for individuals with psychiatric diagnoses. The study took place in a college campus. A pre‐test/post‐test design was used. There were 38 participants which included college students and community members who desired to attend college, work and/or address life skill goals. The Canadian Occupational Performance Measure (COPM) was used as a pre‐ and post‐test measure. Goals were based on problems identified in the COPM, reflected academic, vocational, life skill, and leisure goals, and were systematically addressed weekly through activities developed by the participant and a graduate occupational therapy student who acted as a mentor. The Participant Overall Satisfaction Scale was completed by each participant. A case study was used to describe the programme in more depth. The results support that the client‐centred, occupation‐based occupational therapy programme increased client scores on satisfaction and performance of occupational performance problems identified on the COPM. Further research is recommended to explore how client‐centred occupational therapy programmes can be effective in improving academic, vocational and life skill goals. Copyright © 2010 John Wiley & Sons, Ltd.     

Efficacy of Occupational Therapy Task‐oriented Approach in Upper Extremity Post‐stroke Rehabilitation

There is a need for more effective rehabilitation methods for individuals post‐stroke. Occupational Therapy Task‐Oriented (TO) approach has not been evaluated in a randomized clinical trial. The purpose of this study was to evaluate functional and impairment efficacies of TO approach on the more‐affected Upper Extremity (UE) of persons post‐stroke. A randomized single‐blinded cross‐over trial recruited 20 participants post‐stroke (mean chronicity = 62 months) who demonstrated at least 10° active more‐affected shoulder flexion and abduction and elbow flexion‐extension. Participants were randomized into immediate (n = 10) and delayed intervention (n = 10) groups. Immediate group had 6 weeks of 3 hr/week TO intervention followed by 6 weeks of no‐intervention control. Delayed intervention group underwent the reversed order. Functional measures included Canadian Occupational Performance Measure (COPM), Motor Activity Log (MAL), and Wolf Motor Function Test (WMFT). Impairment measures included UE Active Range of Motion (AROM) and handheld dynamometry strength. Measurements were obtained at baseline, cross over, and end of the study. TO intervention showed statistically higher functional change scores. COPM performance and satisfaction scores were 2.83 and 3.46 units greater respectively (p < .001), MAL amount of use and quality of use scores were 1.1 and 0.87 units greater, respectively (p < .001), WMFT time was 8.35 seconds faster (p = .009). TO impairment outcomes were not significantly larger than control ones. TO approach appears to be an effective UE post‐stroke rehabilitation approach inducing clinically meaningful functional improvements. More studies are needed with larger samples and specific stroke chronicity and severity. Copyright © 2016 John Wiley & Sons, Ltd.     

Validity of the Canadian occupational performance measure

The Canadian Occupational Performance Measure (COPM) is used to assess clients' perceived performance of daily activities and their satisfaction with their performance. This study gathered evidence on the content-related and criterion-related validity of the instrument. Thirty-nine adult clients with orthopaedic and stroke disabilities were assessed using the COPM as well as three criterion instruments. Nine individuals with expertise in clinical and measurement participated in a panel review to evaluate the test content of the COPM. Results suggested that the assessment content and processes reflected clients' occupational performance issues. Criterion-related validity between the COPM and Functional Independence Measure was (r=?0.14 to 0.38), and with the Satisfaction with Performance Scaled Questionnaire was (r=?0.13 to 0.40). Evidence gathered indicated the importance of vigorously testing the appropriateness and meaningfulness of this clinical outcome measure. Further research should be directed at improving the standardization and clinical application of the COPM. Copyright © 1997 Whurr Publishers Ltd.     

The application of client-centred occupational therapy for Korean children with developmental disabilities

The aim of this paper was to investigate the effectiveness of client-centred occupational therapy using the Canadian Occupational Performance Measure (COPM) and the Assessment of Motor and Process Skills (AMPS). Eight girls and 23 boys from Korea, with developmental disabilities and from 3 to 10 years of age participated in this study. Each child participated in 20 to 24 sessions of client-centred occupational therapy. Both the COPM and the AMPS change scores demonstrated statistically significant improvement (p < 0.01) in occupational performance. Significant correlations were found between COPM - Performance and AMPS - Motor skills (r(s) = 0.64, p < 0.05), and COPM - Satisfaction and AMPS - Process skills (r(s) = 0.62, p < 0.05) in a group positive towards client-centred occupational therapy. The COPM was a valuable tool in guiding and measuring the client-centred occupational therapy for children with developmental disabilities. The small sample size of 31 children limits the generalizability of the study's results. Future research needs to use a larger and more diverse sample of children to further validate the effectiveness of client-centred occupational therapy.     

The Validity of the Canadian Occupational Performance Measure (COPM) When Used in a Sub-Acute Rehabilitation Setting with Older Adults

This study investigated the validity of the Canadian Occupational Performance Measure (COPM) when included as one of the scales used by therapists with older adults on an inpatient sub-acute rehabilitation setting. Quantitative data from 36 participants in a sub-acute rehabilitation setting was obtained via the COPM, the Functional Independence Measure (FIM) and the Short Form 36 Health Survey (SF-36) using a pre-post methodology. Pearson's r correlations and linear regression analyses were computed. The COPM Performance admission score was significantly correlated with the FIM Total and FIM Physical admission scores (p <.05) while the COPM Satisfaction admission score was significantly correlated with the FIM Total and FIM Physical admission scores (p <.05). The COPM Performance discharge score was significantly associated with the FIM Total, FIM Physical, and SF-36 Physical Health discharge scores (p <.01) while the COPM Satisfaction discharge scores was significantly associated with the FIM Total, FIM Physical, and SF-36 Physical Health discharge scores (p <.01) respectively. Linear regression analyses determined that the COPM's Performance admission score uniquely explained 8.4% of the SF-36 Physical Health discharge score's total variance (p <.05). The results contribute to the COPM's evidence base, supporting its convergent validity and predictive validity.     

Family‐centred care: a qualitative study of Chinese and South Asian immigrant parents' experiences of care in paediatric oncology

Background Over the past two decades, there is increasing emphasis being placed upon providing family‐centred care (FCC) in paediatric oncology settings. However, there is a lack of knowledge of FCC in paediatric oncology from the perspectives of immigrant parents. The purpose of this paper is to describe Chinese and South Asian immigrant parents' experiences of FCC in paediatric oncology settings in Canada. Methods This study adopted a constructivist grounded theory approach. Fifty first generation Chinese and South Asian parents of children with cancer who were at least 6 months post‐diagnosis were recruited from six Canadian paediatric oncology centres. Interviews were conducted in English, Cantonese, Mandarin, Urdu, Punjabi or Hindi, and transcribed into English. Analysis involved line‐by‐line, focused and theoretical coding, and the use of the constant comparison method. Results Findings indicated that overall parents were highly satisfied with the care and services they received, and their experiences were reflective of the key elements of FCC. However, there were some areas of concern identified by participants: parents not perceiving themselves as a member of the medical team; inconsistency in the quality and co‐ordination of services among healthcare providers; disrespectful and mechanical manner of a few healthcare providers; and parents' discomfort with healthcare providers communicating sensitive health‐related information directly with their child. Conclusions In order to successfully provide family‐centred services to immigrant parents of children with cancer, better communication of the elements of FCC between healthcare staff and families is needed to negotiate a clear role for the parents as partners of the healthcare team. Moreover, a better understanding of how family relationships are structured in immigrant families will assist healthcare providers to balance the best interests of the child with that of the family as a unit.     

The Occupational Profile of Women with Fibromyalgia Syndrome

The aims of this study were to assess the functional level of women with fibromyalgia; to investigate the differences in the occupational activities between women with fibromyalgia and healthy women; and to analyse the perceived importance of occupational performance during self‐care, productivity and leisure activities. A cross‐sectional case control study was performed. Twenty women with fibromyalgia and 20 healthy women completed the Functional Independence Measure (FIM), the Canadian Occupational Performance Measure (COPM), a Numerical Pain Rating Scale, the Fibromyalgia Impact Questionnaire and the SF‐36 health survey. The Chi‐square test (χ2), the Student's t test and the Spearman's test were used on the data. The FIM revealed significant differences regarding several activities: personal hygiene, bathing and memory (p < 0.01). The COPM scores did not reveal significant differences between groups (p > 0.10). Women with fibromyalgia had higher disability and reduced quality of life and required greater assistance to perform specific activities of daily living, i.e. hygiene, than healthy women. This highlights the specific occupational therapy needs these women have for performing many basic activities and for improving their quality of life. Limitations of the study include the small sample size, the exclusion of male participants and the possible influence of the women's psychological status on the assessments performed. Findings should be generalized with caution. Copyright © 2015 John Wiley & Sons, Ltd.     

Utility of the Canadian Occupational Performance Measure as an admission and outcome measure in interdisciplinary community-based geriatric rehabilitation

Abstract

In a community-based geriatric rehabilitation project, the Canadian Occupational Performance Measure (COPM) was used to develop a coordinated, interdisciplinary, and client-centred approach focusing on occupational performance. The purpose of this study was to evaluate the utility of the COPM as an admission and outcome measure in an interdisciplinary geriatric rehabilitation context in Denmark. Eighteen occupational and physiotherapists administered the COPM among elderly citizens. Of 185 citizens referred to the study, 152 were admitted to rehabilitation based on health indices, and 124 completed the COPM after their admission, identifying 404 occupational performance issues in all. Post-assessment data were obtained from 95 participants and revealed statistically significant positive change (p < 0.001) in both performance and satisfaction with performance. Furthermore the therapists answered a questionnaire evaluating their experiences, showing that they found development in knowledge and community between the professions to benefit both therapists and citizens, and gained a better insight into their clients' everyday lives through the COPM. In conclusion, the COPM may be useful as an admission and outcome measurement for the rehabilitation of elderly citizens; however, aspects of education and administration must be considered before the instrument can be successfully administered in an interdisciplinary geriatric rehabilitation context.     

Performance of activities of daily living among hospitalized cancer patients

Background: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data. Methods: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55). Results: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results differed between women and men. There was significant overlap between problems identified using the COPM and the ADL-Q instruments. Results from the COPM showed that 65% of problems were related to self-care, 25% to leisure, and 19% to productivity. Using both instruments identified more ADL problems than when using only one of the instruments. Conclusion: Adult hospitalized disabled cancer patients experience a high degree and variation in difficulties performing ADL, illustrating the need for a comprehensively planned assessment of problems and needs.     

Use of a Modified Canadian Occupational Performance Measure for Assistive Technology Outcomes in Postsecondary Education

The Canadian Occupational Performance Measure (COPM) has been used to assess the effectiveness of assistive technology (AT). We explored whether a modified COPM was sensitive to change in perceived performance and satisfaction, and whether frequency of AT use resulted in greater change in the domains measured (reading, writing, note-taking, test-taking, and study skills). Significant interactions were found between time and use frequency with greater change in perceived performance in the daily-use group in several domains. In addition, the intra-class correlation showed moderate to strong equivalent forms reliability between two assessment formats. Based on these preliminary results, the ATRC-mCOPM was found to be a sensitive measure of perceived performance and satisfaction utilizing AT services in a postsecondary education setting.     

Reliability and validity of the Canadian Occupational Performance Measure for clients with psychiatric disorders in Taiwan

The purpose of the study was to examine the reliability and validity of the Canadian Occupational Performance Measure (COPM) in Taiwanese clients with psychiatric disorders. The COPM was translated into Mandarin and tested on 141 Taiwanese clients. The average age of the clients was 35.6 years; 94% were diagnosed with schizophrenia. The results of the study showed that the test retest reliability of the COPM was r = 0.842. The COPM identified occupational performance problems that included self-care (37%), productivity (25%), and leisure occupations (20%). Fifty percent of the therapists were receptive in adapting the client-centred approach and applying the COPM in their clinical practice. It was concluded that the COPM can be applied reliably to Taiwanese clients. Furthermore, the COPM was valuable in identifying information related to occupational performance that could not be identified elsewhere. Since 50% of the therapists felt reluctant about the appropriateness of the client-centred approach in their culture, it was important to examine the gap between clients' judgements and actual performance, as well as to evaluate the feasibility of the client-centred concept in clinical practice. Finally, the concept of the client-centred approach needs to be disseminated and communicated to the occupational therapy profession in order that the COPM can be adequately applied in mental health practice.     

The Perceived Efficacy and Goal Setting System (PEGS), Part II: Evaluation of test–retest reliability and differences between child and parental reports in the Swedish version

Abstract

Objective: to evaluate the test–retest reliability of children's perceptions of their own competence in performing daily tasks and of their choice of goals for intervention using the Swedish version of the Perceived Efficacy and Goal Setting System (PEGS). A second aim was to evaluate agreement between children's and parents' perceptions of the child's competence and choices of intervention goals. Methods: Forty-four children with disabilities and their parents completed the Swedish version of the PEGS. Thirty-six of the children completed a retest session allocated into one of two groups: (A) for evaluation of perceived competence and (B) for evaluation of choice of goals. Cohen's kappa, weighted kappa and absolute agreement were calculated. Results: Test–retest reliability for children's perceived competence showed good agreement for the dichotomized scale of competent/non-competent performance; however, using the four-point scale the agreement varied. The children's own goals were relatively stable over time; 78% had an absolute agreement ranging from 50% to 100%. There was poor agreement between the children's and their parents' ratings. Goals identified by the children differed from those identified by their parents, with 48% of the children having no goals identical to those chosen by their parents. These results indicate that the Swedish version of the PEGS produces reliable outcomes comparable to the original version.     

Combining goal setting and achievement with occupational therapy to improve pain,psychological factors and physical activity in patients after high tibial osteotomy: A non-randomized controlled study

BackgroundPsychological factors contribute to chronic pain and may lead to physical inactivity and poor functional outcomes.PurposeWe conducted a non-randomized controlled study to evaluate the effectiveness of goal setting and achievement following occupational therapy (OT) intervention to improve pain, psychological factors, and physical activity among patients after high tibial osteotomy (HTO).MethodWe analyzed the data of 31 patients who underwent HTO, allocated into OT intervention and control groups. Goal achievement was encouraged through OT in the intervention groups; the control groups did not receive OT intervention. Outcome measures included the Canadian Occupational Performance Measure (COPM) score (before and after the OT intervention), walking pain, pain catastrophizing, anxiety, depression, pain self-efficacy, and physical activity level.ResultsOT significantly improved the COPM score, depression, and physical activity. At the final assessment, the depression score was lower while the step count and physical activity time were significantly higher in the intervention group than in the control group (p < 0.05).ConclusionEmbedding goal setting and achievement as part of an OT intervention improved the outcomes after HTO.     

The Perceived Efficacy and Goal Setting System (PEGS), Part I: Translation and cross-cultural adaptation to a Swedish context

Abstract

Objective: To translate, adapt, and evaluate the applicability of the Perceived Efficacy and Goal Setting System (PEGS) for use in Sweden. Method: Based on guidelines for cross-cultural adaptation of self-reports, the study was performed in several phases involving (i) translation and back-translation, (ii) pre-testing of the translated version, (iii) development of adjusted items and, finally, (iv) field testing of the proposed Swedish version. Participants were 63 parent–child dyads recruited through convenience sampling by 19 therapists. Results: Overall, five items in the original PEGS required adaptation, and one new item was added. Using the Swedish version of the PEGS, both children and parents were able to identify individual strengths and weaknesses in the child's performance of daily tasks as well as to select goals for intervention. Conclusions: The Swedish version of the PEGS thus showed evidence of validity based on test content and was applicable for use with children enrolled in paediatric rehabilitation who had a variety of disabilities and who were between five and 12 years of age.     

Utility of the Canadian Occupational Performance Measure as an admission and outcome measure in interdisciplinary community-based geriatric rehabilitation

In a community-based geriatric rehabilitation project, the Canadian Occupational Performance Measure (COPM) was used to develop a coordinated, interdisciplinary, and client-centred approach focusing on occupational performance. The purpose of this study was to evaluate the utility of the COPM as an admission and outcome measure in an interdisciplinary geriatric rehabilitation context in Denmark. Eighteen occupational and physiotherapists administered the COPM among elderly citizens. Of 185 citizens referred to the study, 152 were admitted to rehabilitation based on health indices, and 124 completed the COPM after their admission, identifying 404 occupational performance issues in all. Post-assessment data were obtained from 95 participants and revealed statistically significant positive change (p < 0.001) in both performance and satisfaction with performance. Furthermore the therapists answered a questionnaire evaluating their experiences, showing that they found development in knowledge and community between the professions to benefit both therapists and citizens, and gained a better insight into their clients' everyday lives through the COPM. In conclusion, the COPM may be useful as an admission and outcome measurement for the rehabilitation of elderly citizens; however, aspects of education and administration must be considered before the instrument can be successfully administered in an interdisciplinary geriatric rehabilitation context.     

Routine administration of the Canadian Occupational Performance Measure: Effect on functional outcome

Background/aim: Routinely using outcome measures as an integral component of practice has been encouraged for decades yet has not been widely adopted. There are many reasons to measure outcomes yet any positive effect of measurement on our programs or clients has not been substantiated. If the time‐consuming nature of outcome measurement is to be encouraged, we need to begin addressing larger questions of the value of outcome measurement on care and outcomes. This cohort study evaluated the impact of routinely administering the Canadian Occupational Performance Measure on client outcomes on a geriatric rehabilitation unit. Methods: Changes in Functional Independence Measure? scores between an experimental group (n = 45) that received the routine use of the Canadian Occupational Performance Measure for evaluation/planning versus a historical comparison group (n = 58) that received ‘usual’ care were analysed using generalised linear modeling. Results: Both groups had significant changes in Functional Independence Measure? scores over time. Results for differences between groups were inconclusive with a significantly underpowered analysis; however, results suggest that a medium to large effect of this intervention cannot be expected. Conclusions: Results are significant for the field of routine outcome measurement, suggesting that when adding the Canadian Occupational Performance Measure to routine assessment within an inpatient rehabilitation setting, substantially improved Functional Independence Measure? score outcomes should not be expected. The value of routine outcome measurement on client outcomes remains largely unexplored. Routinely, using outcome measures requires additional research to determine the specific benefits to our programs and client outcomes.     

Rehabilitation for children with cerebral palsy in rural Cambodia: parental perceptions of family-centred practices

Background Rehabilitation service providers in Cambodia are increasingly adopting family‐centred practices when working with children with cerebral palsy and their families. This study examined the perceptions of parents living in rural Cambodia regarding family‐centred rehabilitation practices. Methods This qualitative study used in‐depth semi‐structured individual and small group interviews with a convenience sample of 24 parents of children with cerebral palsy from three rural provinces. Participants were drawn from Cambodia Trust's client database and had been involved in a rehabilitation planning process which incorporated family‐centred practices. Results Twenty‐four parents and carers of children with cerebral palsy aged 3–12 years were interviewed. Almost all parents valued family‐centred practices in rehabilitation, with many of the needs and preferences of parents living in rural Cambodia similar to those of parents in Western contexts. Conclusions Family‐centred approaches to paediatric rehabilitation were found to be valued in and appropriate for a rural Cambodian context. Social and cultural mechanisms to be considered when adapting a Western, family‐centred model of rehabilitation planning to the rural Cambodian context include the hierarchical nature of Cambodian culture, the emphasis on group relational patterns rather than individual needs and the context of chronic poverty.     

Responsiveness of the Swedish Version of the Canadian Occupational Performance Measure

In a client-centred approach, clients and therapists work together to define the occupational performance problem, the focus of and need for intervention and the preferred outcomes. Application of specific theories or techniques to involve clients in goal-setting may influence the therapist to use a client participation approach. The Canadian Occupational Performance Measure (COPM) presents a structure for formulating the treatment goals identified by the client in co-operation with the therapist. The aim of this study was to test the responsiveness of the Swedish version of the COPM. After translation into Swedish, the COPM was introduced to 21 occupational therapists who performed data collection. A sample of 108 clients within geriatric, neurologic and orthopaedic rehabilitation identified 418 problems at initial scoring and reassessment. Inclusion criteria for patients were the need for rehabilitation interventions and the ability to communicate well enough in an interview. The results indicate that the Swedish version of the COPM is responsive to change, with 73% of the problems identified having a change in score of 2 points or more.