A feasibility study of the Canadian Occupational Performance Measure (COPM) in the burn cohort in an acute tertiary facility

An Occupation-Based Review of Outcome Measures Used to Assess Hand Function After Burn Injury

While occupation began as the central concept of occupational therapy at the dawn of the profession, the use of occupation throughout the therapy process, including assessment, has wavered in recent decades. Occupation is defined as meaningful and purposeful activities that individuals do to occupy their time and attention. The use of occupation-based assessments is vital to establishing care with an occupational focus. The purpose of this article is to review the outcome assessment tools commonly used in the burn literature to evaluate hand function and critique the presence of occupation in each assessment using the Occupation-Based Practice Assessment. Knowledge of the occupational nature of assessments is important to the delivery of an occupational therapy evaluation comprised of a battery of assessments inclusive of discrete measures of movement as well as performance-based tools to represent the person from an occupational perspective. Many outcome measures used in upper extremity burn rehabilitation are discrete in nature and do not measure occupations of clients. The Suitcase Packing Activity may be a viable addition to an assessment battery to address this essential need.

Canadian Occupational Performance Measure the state of the art - a review

BACKGROUND

Occupational therapists aim to deliver interventions to enhance clients' occupational performance and document the outcomes of clients' experience. The Canadian Occupational Performance Measure (COPM) is a measurement tool designed for such documentation, and a recognised measurement used worldwide. However, the authors' research and teaching experiences have revealed that there are often misinterpretations and uncertainties administering the COPM. Therefore, the aim of this paper was to present information to answer these issues.

METHODS

Based on a state-of-the-art review, 856 papers were identified on PubMed, of which 36 were included together with the first author's work, to summarise relevant answers.

RESULTS

Answers to the four key issues are unfolded to address the misinterpretations and uncertainties regarding: (1) the core content of the COPM, focussing on being client-centred; (2) understanding the term occupational performance; (3) reflecting on the psycho-metric status on the COPM, what it provides; (4) reflecting on necessary considerations when administering the measurement, understanding the measurement's five steps to ensure a valid and reliable use.

CONCLUSION

The valid, reliable, and applicable use of the COPM can be enhanced through therapists' commitments to and understanding of these four issues. Based on this, guidelines on how to best administer the COPM are provided.

Timepoint for return to occupations post-burn injury using the Canadian Occupational Performance Measure (COPM)

INTRODUCTION

The Canadian Occupational Performance Measure (COPM) was implemented at a state-wide burns service to ensure compliance with current best evidence as outlined by the Australian and New Zealand Burns Association 'burn trauma rehabilitation: allied health practice guidelines'- Chapter 7 Measuring Post-Burn Recovery, as a standard outcome measure for individuals with an admission time greater than 24 h. The primary aim of this study is to determine if individuals have a minimal important change in performance and satisfaction with activities that were identified as problematic on the COPM prior to their acute discharge. Previous research confirmed the feasibility of using the COPM in the acute burn ward and recommended the most appropriate timepoint for re-measurement be confirmed, which is the secondary objective of this study. The benefits of confirming this timepoint include ensuring efficient use of clinicians' time without compromising the accuracy of the assessment and ensuring effective translation of the guidelines' recommendation.

METHODS

A prospective longitudinal study was undertaken, where all individuals who previously completed a COPM prior to acute discharge were sought to complete a re-assessment while accessing outpatient services. Time frames for re-assessment were open. Only individuals who were actively receiving occupational therapy outpatient services were included. COPM assessments were completed in person where possible, particularly for participants who required an interpreter, with phone and video calls also used when needed.

RESULTS

A total of 37 participants were included, with the timeframe between initial and post-COPM assessment ranging from 2 to 643 days. Outcomes plateaued at approximately 12 months (365 days) post-initial measurement (prior to discharge from acute ward). The most common occupational performance goals that participants identified were returning to work, sport, and driving. 86.5% of participants increased their satisfaction with these activities. The results of this study demonstrate improvements across the domains of performance and satisfaction occur for individuals with burns at approximately 3 months and 12 months post-injury.

CONCLUSION

Based on this study, it is suggested that when using the COPM assessment in a tertiary burn setting, re-measurement be completed no earlier than 3 months and later than 12 months from burn injury, or upon discharge from the service. The findings from this study will be translated into clinical practice at this facility.