Adapting the Canadian Occupational Performance Measure for use in a paediatric clinical trial

Background.?The Canadian Occupational Performance Measure (COPM) is a commonly used outcome measure in rehabilitation. In this study it was adapted for very young children by deleting paid/unpaid work and household management categories and having parents act as proxies to rate child performance and their own satisfaction.

Purpose.?To assess the internal consistency reliability, content and construct validity, responsiveness, and impact of half scores (20 not 10-point scale) of the adapted COPM.

Method.?Parent proxies of subjects aged 2 – 8 (mean 3.9) years with spastic hemiplegic cerebral palsy (n = 41) participating in a clinical trial. There was a total of 214 occupational performance problems for analysis and an additional 56 which had used half score ratings. Internal consistency reliability and construct validity were evaluated using Cronbach alpha statistic. Proxy views explored content validity. Responsiveness was evaluated using pre-post intervention scores and a comparison with Goal Attainment Scaling scores which were assumed to be a suitable benchmark measure. The effect of half scores was assessed by two-sample t-tests.

Results.?The COPM adaptations did not have a negative impact on internal consistency reliability as this was acceptable for performance (0.73) and satisfaction (0.83). The high Cronbach alpha scores indicated good construct validity. Content of occupations and rating approach was considered valid by proxies. Use of half scores did not result in significantly different performance ratings, but mean satisfaction ratings were significantly higher when half scores were used (p = 0.0001). This suggests that half scores may provide more precise proxy satisfaction ratings, but at the cost of rigour as internal consistency with satisfaction half scores was lower (0.63 vs. 0.82). Responsiveness to change in clinical status was demonstrated by significant pre-post scores and moderate correlations with goal attainment scores.

Conclusion.?The adapted COPM is a psychometrically robust tool and the use of half scores is not recommended.     

The clinical utility of the Canadian Occupational Performance Measure

A qualitative research project was undertaken to investigate the clinical utility of the Canadian Occupational Performance Measure (COPM) among therapists from the Regional Municipality of Ottawa-Carleton's Home Care Programme. Nineteen occupational therapists participated in one of four focus groups and in a plenary session to elicit reasons why some therapists used the COPM to assess clients and why others did not. The participants presented a wide range of opinions on the same theme, often from two polarities. The five themes that emerged from the focus groups and which were validated during the plenary session were: Use, environment, administration, outcome and suggested changes. The results demonstrated that COPM utility depended upon the degree to which therapists had incorporated the client-centred approach in their practice, the degree to which management valued and supported the use of the COPM and the degree to which the COPM could be flexible to fit practice context.     

The Canadian Occupational Performance Measure: a research and clinical literature review

BACKGROUND: It has been 73 years since the Canadian Occupational Performance Measure (COPM) was published. In that time there has been a remarkable growth in its acceptance as an outcome measure within the occupational therapy practice and research. PURPOSE: The purpose of this paper is to review the emerging research and clinical literature related to the COPM since 1994 and to document its impact upon occupational therapy practice and research throughout the world. METHOD: A systematic search was conducted to the professional and research literature in English publications (primarily occupational therapy). Eighty-eight papers that met the inclusion criteria were reviewed, 86% of which examined the COPM in relation to its psychometric properties (19 papers), research outcomes (33 papers) or practice (33 papers). RESULTS: Overall, although there are a few limitations discussed in the review, the conclusion is that the COPM is a valid, reliable, clinically useful and responsive outcome measure acceptable for occupational therapist practitioners and researchers. PRACTICE IMPLICATIONS: The COPM is used with a wide variety of clients, enables client-centred practice, facilitates evidence-based practice and supports outcomes research.     

Clinical report: use of the Canadian Occupational Performance Measure in vision technology

BACKGROUND: The Canadian Occupational Performance Measure (COPM) has gained wide acceptance in general occupational therapy research and practice, however, the use of the COPM in assistive technology assessments and outcomes is not as well documented. PURPOSE: This clinical report discusses the utility of the COPM in assistive technology, as illustrated by the assessment and follow-up of clients requiring high technology vision aids. RESULTS: The COPM makes important contributions to the outcomes of providing vision aids. The COPM ensures a needs review that incorporates all areas of occupational performance, which in turn directs the clinician to match the technology to client needs. From a clinical perspective, the quantitative follow-up data are helpful to determine clients' improvement in occupational performance as well as their satisfaction with the assistive technology. For administrative purposes, the COPM results provides accountability to the funding agency. PRACTICE IMPLICATIONS: The COPM can be readily integrated into the assessment and follow-up of assistive technology service delivery and adds value to both components of the process.     

Pilot testing of the Canadian Occupational Performance Measure: clinical and measurement issues

The Canadian Occupational Performance Measure (COPM) is a measure of a client's self-perception of occupational performance in the areas of self-care, productivity and leisure. The COPM is administered using a semi-structured interview in which the client identifies significant issues in daily activities which are causing difficulty. Extensive pilot testing of the COPM has been completed with 268 clients in communities across Canada and in New Zealand, Greece and Britain. Results indicate the COPM has a median administration time of 30 minutes, is able to identify a wide range of occupational performance issues and appears to be responsive to changes in measurement issues centering around the interview, test construction, scoring, timing of the assessment, respondents, and the assessment process are discussed.     

Validity of the Canadian Occupational Performance Measure: a client-centred outcome measurement

OBJECTIVE: To study the convergent and divergent validity of the Canadian Occupational Performance Measure (COPM). DESIGN: Cross-sectional study. SETTING: The occupational therapy departments of two university hospitals in Amsterdam. SUBJECTS: One hundred and five consecutive outpatients. OUTCOME MEASURES: The COPM is a measure of a client's self-perception of occupational performance in the areas of self-care, productivity and leisure. Outcome measures of the COPM are: the client's most important problems in occupational performance and a total score for performance and a total score for satisfaction for these problems. Problems reported in the COPM were compared with the Sickness Impact Profile (SIP68), the Disability and Impact Profile (DIP) and an open-ended question. RESULTS: Complete data were obtained for 99 clients. The identification of occupational performance problems with the COPM surpassed the items reported in the SIP68, the DIP and the open-ended question, which confirms the surplus value of the COPM. Divergent validity was further demonstrated by the low correlation coefficients between the total SIP68 scores and the COPM. Seventy-four per cent of the occupational performance problems reported in the COPM had a corresponding item in the DIP and 49% had a corresponding item in the SIP68. Convergent validity was supported by the fact that 63% of the corresponding problems in the DIP were reported to be a disruption of quality of life and 74% of the corresponding problems in the SIP68 were identified as a disability. CONCLUSION: The results of this study provide supportive evidence for the convergent and divergent validity of the COPM. The data support the assumption that the COPM provides information that cannot be obtained with current standardized instruments to measure health.     

Discriminant ability and criterion validity of the Trunk Impairment Scale for cerebral palsy

Aims: To compare the performance of children with mild and moderate-to-severe cerebral palsy (CP) on the Trunk Impairment Scale (TIS), Gross Motor Function Measure (GMFM), and on center-of-pressure variables; to establish the discriminant ability of these tools to predict severity of motor impairment in CP; and to investigate the criterion validity of the TIS.

Methods: Children with mild (n?=?18, 11 males, 7 females, mean age?=?9.5?±?2.9 years, Gross Motor Function Classification System I–II) and moderate-to-severe (n?=?18, 11 males, 7 females, mean age?=?9.2?±?229, Gross Motor Function Classification System III–IV) CP were tested using the TIS and the GMFM, and during static sitting on force-plate.

Results: Children with mild CP showed better trunk (median; 95% confidence interval?=?22.5; 21.29–22.59 vs. 13; 11.97–14.8; p?<?0.001) and gross motor (60; 57.73–59.3 vs. 40; 38.96–46.25; p?<?0.001) scores, and better postural control (lower center of pressure (CoP) displacement [anterior–posterior: (0.42; 0.32–1.11 vs. 0.89; 0.70–1.65; p?=?0.022); medial–lateral: (0.42; 0.31–1.08 vs. 0.91; 0.65–1.17; p?=?0.044)], and lower area of sway, (0.05; ?0.15–0.97 vs. 0.44; 0.23–0.90; p?=?0.008) than the moderate-to-severe group. Trunk control and gross motor function explained 81.5% of the variance in the severity of motor condition. Correlations between the TIS and the GMFM were excellent (ρ?=?0.944, p?<?0.001); correlations between the TIS and CoP variables were low (anterior–posterior displacement: ρ?=??0.411, p?<?0.05; medial–lateral displacement: ρ?=??0.327, p?<?0.05); area of sway: ρ?=??0.430, p?<?0.05; velocity of sway: ρ?=??0.308, p?<?0.05).

Conclusions: The TIS is able to differentiate levels of trunk control across various levels of motor impairments in CP. It is a valid tool to assess trunk control, showing very high concurrent validity with the GMFM sitting dimension.

• Implications for Rehabilitation

• Trunk Impairment Scale (TIS) can be used by rehabilitation professionals to differentiate levels of trunk control across levels of motor impairment.

• TIS showed concurrent validity with Gross Motor Function Measure and should be used to assess trunk control in children with cerebral palsy (CP) in clinical settings.

• The use of TIS allows a reliable assessment of postural control in children with CP in clinical settings.

     

Effectiveness of loaded sit-to-stand resistance exercise for children with mild spastic diplegia: a randomized clinical trial

OBJECTIVE: To investigate effectiveness of a functional strengthening program, the loaded sit-to-stand (STS) resistance exercise, for children with cerebral palsy (CP). DESIGN: A single-blind, randomized block design. SETTING: STS exercises were carried out at the children's homes. PARTICIPANTS: Twenty children (12 boys, 8 girls; age range, 5-12y) with spastic diplegia CP and classified by the Gross Motor Function Classification System as level I or II were stratified by their severity and age and randomly allocated into either the experimental or control group. INTERVENTION: Both groups received their regular physical therapy. The experimental group underwent loaded STS exercise 3 times a week for 6 weeks. MAIN OUTCOME MEASURES: Goal dimension scores of the Gross Motor Function Measure (GMFM), gait speed, 1 repetition maximum (1-RM) of the loaded STS, isometric strength of knee extensor, and Physiological Cost Index (PCI). The outcome measures were conducted at the beginning and end of the 6-week study. RESULTS: After loaded STS exercise, the experimental group showed statistically significant differences in GMFM goal dimension scores, 1-RM STS, and PCI from the control group. The changes in gait speed and isometric strength of the knee extensor did not differ significantly between the 2 groups. CONCLUSIONS: After the loaded STS exercise, children with mild spastic diplegia improved their basic motor abilities, functional muscle strength, and walking efficiency.     

Occupational therapy outcomes for clients with traumatic brain injury and stroke using the Canadian Occupational Performance Measure.

The purpose of this study was to determine whether 155 ethnically diverse clients with traumatic brain injury (TBI) and stroke (cerebrovascular accident; CVA) who received occupational therapy services perceived that they reached self-identified goals related to tasks of daily life as measured by the Canadian Occupational Performance Measure (COPM). This study found that a statistically and clinically significant change in self-perceived performance and satisfaction with tasks of daily life occurred at the end of a client-centered occupational therapy program (p < .001). There were no significant differences in performance and satisfaction between the TBI and CVA groups. However, the group with right CVA reported a higher level of satisfaction with performance in daily activities than the group with left CVA (p = .03). The COPM process can effectively assist clients with neurological impairments in identifying meaningful occupational performance goals. The occupational therapist also can use the COPM to design occupation-based and client-centered intervention programs and measure occupational therapy outcomes.     

Effects of a postoperative resistive exercise program on the knee extension and flexion torque in children with cerebral palsy: a randomized clinical trial

OBJECTIVE: To investigate the effects of resistive exercise on the knee extension and flexion torque production during the rehabilitation period after multilevel orthopedic surgery. DESIGN: Randomized clinical trial. SETTING: Hospital rehabilitation department. PARTICIPANTS: Thirty-nine children with spastic diplegic cerebral palsy (CP) (age range, 6-16 y), randomly allocated to an exercise group (n=19) and a control group (n=20). All received conventional physiotherapy (PT), and the exercise group also followed a resistive exercise program. INTERVENTION: A 9-month standardized home-based resistive exercise program, which started about 3 months after the surgery. MAIN OUTCOME MEASURES: The Gross Motor Functional Measurement (GMFM) assessed before (E(0)) and 1 year (E(1)) after the surgery. The Modified Ashworth Scale and the isometric and isokinetic torque of the knee extensors and flexors were evaluated at E(0), E(1), and 6 months after the surgery. RESULTS: The knee extension and flexion moments had decreased 6 months after the surgery and recovered to the preoperative level 1 year after surgery. These changes were not group dependent. CONCLUSIONS: Additional long-term, home-based, low-cost resistive exercise that starts soon after the operation of patients with CP was not more beneficial than conventional PT only, in terms of strength and GMFM.     

应用加拿大作业活动测量表对120例地震伤员的作业活动和疗效分析

目的：分析120例地震伤员的作业活动需求,并给予治疗,观察疗效。方法：120例地震伤员在入院和出院时均应用加拿大作业活动测量表（COPM）进行作业活动测评,包括自理、生产及休闲三大类。根据测评结果制定康复治疗计划及假肢的安装,并对伤员作业活动的表现和满意度进行评价。结果：入院时伤员自认为重要并需要亟待解决的作业活动中,自理活动需求频数明显多于生产活动和休闲活动（P〈0.01）;经过平均55.2d的康复治疗后,出院时伤员对自己的作业活动表现总分和作业活动满意度总分明显高于入院时（P〈0.01）。结论：COPM能确认地震伤员亟待解决的作业活动,对临床治疗有指导意义,同时能评价康复疗效。     

The use of goal attainment scaling in neuropsychological rehabilitation in multiple sclerosis

Abstract

Purpose: The overall objective was to apply the goal attainment scaling (GAS) in neuropsychological rehabilitation in multiple sclerosis (MS). The specific aims were to evaluate whether (1) GAS-rated goals are attained; (2) attaining goals is related to standardized rehabilitation outcome measures; and (3) GAS-rated goals can be mapped to the International Classification of Functioning, Disability, and Health (ICF). Method: 56 relapsing-remitting MS patients received neuropsychological rehabilitation conducted once a week for 13 consecutive weeks. The attainment of GAS-rated personal goals and the association between achievement of goals and standardized rehabilitation outcome were evaluated. Moreover, GAS-rated goals were mapped to the ICF. Results: Median (interquartile range) GAS attainment T-score was 56.0 (50.0–62.0); 88.8% of personal goals set were fully achieved. The attainment of goals was not significantly associated with the outcome in majority of the standardized measures. Of the 182 meaningful concepts identified in the goals, 181 could be mapped to the ICF. Conclusions: GAS seems to be an appropriate outcome measure in neuropsychological rehabilitation in MS. GAS-rated personal goals were well achieved, and GAS was found to tap changes not covered with standardized outcome measures.

• Implications for Rehabilitation

• GAS seems to be an appropriate outcome measure in neuropsychological rehabilitation in MS.

• GAS-rated personal goals were well achieved, and GAS was found to tap changes in the areas not covered with standardized outcome measures.

• GAS seems to offer a possibility to take into account the specific needs of each individual patient.

• The ICF can be used to classify goals in neuropsychological rehabilitation in MS.

     

The Canadian Occupational Performance Measure as an outcome measure and team tool in a day treatment programme

Purpose: To investigate the usefulness of the Canadian Occupational Performance Measure (COPM) in a day treatment programme for clients with rheumatoid arthritis. Method: The study was conducted in two parts. In the first part rehabilitation without changes in the programme was performed (n = 16). After that the COPM was introduced to all team members. In part two the COPM was used (n = 40). Clients' experiences of participation in the process were studied via a structured interview 2 - 4 weeks after discharge in both parts. Qualitative interviews were conducted with team members before part one and after completion of part two. Results: Staff expressed that the COPM improved client participation in the rehabilitation process. Goals were formulated distinctly, and focused on activity and performance rather than function. Team conferences were focused on the client's needs. Outcome was considered clear and evident to the client. The changes in client routines demands thorough introduction, support and involvement, and takes time. Involvement and motivation for changing practice were difficult to obtain, this could be a result of a large staff turnover during the data collection period. Conclusions: The COPM should be seen as an aid to ensuring client participation in the goal formulation process, and facilitating treatment planning and evaluation of outcome.     

The reproducibility and validity of the Canadian Occupational Performance Measure in parents of children with disabilities

OBJECTIVE: To study the reproducibility (inter-rater agreement), the construct and criterion validity of the Canadian Occupational Performance Measure (COPM) in the parents of children with disabilities. DESIGN: The COPM was administered twice by two different occupational therapists. The inter-rater agreement of the content of the prioritized problems was explored. Data analysis of the reproducibility of the scores was based on the Bland and Altman method.Measures used: The construct validity was studied by comparing the results of the COPM with the Pediatric Evaluation of Disability Inventory, and a quality of life questionnaire. The criterion validity was verified with an open-ended question. SETTING: Occupational therapy departments of a university hospital and three rehabilitation institutes. SUBJECTS: One hundred and twenty-nine consecutive parents of children referred for occupational therapy. RESULTS: Data were obtained for 80 children with a mean age of 3.7 years (range 1-7.5). Of the prioritized problems identified in the first interview, 80% were also prioritized in the second interview. The limits of agreement were - 2.4 to +2.3 for the mean performance score and - 2.3 to + 2.6 for the mean satisfaction score. Assumptions about the construct and criterion validity were confirmed. CONCLUSIONS: The inter-rater agreement of the prioritized problems is good enough for client-centred occupational therapy. The reproducibility of the performance and satisfaction scores is moderate. The results support the construct and criterion validity. The COPM identifies many child-unique problems that are not assessed with existing standardized measurement instruments or with a simple open-ended question.     

加拿大作业表现量表结合作业活动分析在手部损伤患者中的应用

目的 探讨手部损伤患者的作业需求以及基于活动分析的作业干预的效果。方法 选取2021年1月至2022年6月期间因腕手部损伤于南京医科大学第一附属医院康复医学中心进行作业治疗的患者212例,使用加拿大作业表现量表(COPM)进行面谈,收集患者“想做”“需要做”“被期望去做”但目前因损伤无法完成的作业需求,由2名高年资作业治疗师对作业需求进行活动分析,找出影响作业需求的作业成分,设计针对性的干预方案。干预前后采用COPM对表现和满意度进行评价。结果 累计收集到84项作业需求,涉及工作、基本日常生活活动、工具性日常生活活动、休闲娱乐和睡眠5大领域,累及率较高的作业活动是使用电脑(8.28%)、用筷子吃饭(6.42%)、拧毛巾(6.25%)、骑行交通工具出行(4.90%)和提重物(4.73%)等。治疗后,COPM表现分和满意度显著提高(t> 16.572, P <0.001)。结论 手部损伤患者作业需求具有当地文化特点;采用基于活动分析的作业干预能有效满足患者的作业需求。     

从113例不同疾病患者的活动障碍分析看作业治疗的必要性

损伤或患病后是否需要接受作业治疗在我国是一个认识模糊的问题。本文就此对１１３例不同疾病的患者采用加拿大作业活动测量表进行了采访调查。统计学分析表明，所有患者均有继发于损伤或疾病而亟待解决的日常作业活动方面的问题，他们都需要在不同的侧面接受作业治疗；ＣＯＰＭ是目前以患者为中心的作业治疗模式的一个很有用的测量工具，值得在临床工作中推荐。     

The Validity of Using the Canadian Occupational Performance Measure with Older Adults with and without Depressive Symptoms

No studies could be found that investigated the use of the Canadian Occupational Performance Measure (COPM) with older adults with clinically significant depressive symptoms. This retrospective study utilized a sample of community-living older adults, ten with a clinically significant number of depressive symptoms (CDS) and a matched sample of persons who did not have a CDS. Older adults with CDS identified significantly more occupational performance concerns on the COPM. The top five concerns identified for participants with CDS were walking and/or transfers, travel, house cleaning tasks, self-care, and shopping. The results of this pilot study support the use of COPM with older adults with CDS.