A comparison of the Canadian Occupational Performance Measure and the Health Assessment Questionnaire

Occupational performance problems in people with depression and anxiety

BACKGROUND

Depression and anxiety often reduce people's ability to cope with everyday occupations. There is a lack of knowledge about such problems in people of working age with depression and anxiety.

AIM

To describe which problems people with depression or anxiety disorders experience when performing everyday occupations and which occupations are affected.

MATERIALS AND METHODS

Data based on the Canadian Occupational Performance Measure was used in this cross-sectional study. A total of 118 participants aged 18-65 years, with depression or anxiety, were recruited from primary healthcare and general mental healthcare services. The data were analysed with descriptive statistics and directed content analysis.

RESULTS

The participants rated a low level of occupational performance, and their satisfaction with performance even lower. They described a great number of problems with their everyday occupations. The most frequent problem areas concerned household management, socialization and personal care. Detailed descriptions of which type of problem they experienced during everyday occupations are included.

CONCLUSIONS

This study provides knowledge of which problems people with depression and anxiety disorders experience in everyday occupations within self-care, productivity, as well as leisure. Furthermore, they rate performance and satisfaction with performance of the five occupations they find the most important to change in everyday life.

[Perception and mindfulness-based occupational therapy in people with mental disorders-A retrospective observational study on the SELWA-treatment]

During occupational therapeutic treatment of clients with mental disorders, perception and mindfulness-based techniques are used. However, little is known regarding relevant outcomes. Aim of the present study is to describe the results of a perception and mindfulness-based occupational therapeutic intervention (self-control techniques using perception-based methods (SELWA®) by S. Thielen) regarding the outcomes occupational performance and satisfaction in self-care, productivity and leisure, as well as concentration. The data of 28 clients (22 ♀, 6 ♂; mean age = 42.8 (±SD 14.7) years) with mental disorders, that were collected before and after prescribed occupational therapeutic treatment, were analyzed. The outcomes were quantified using the Canadian Occupational Performance Measure (COPM) and the revision test, respectively. Significance of changes after the intervention was tested using the Wilcoxon-Signed Rank Test (p < 0.05). Effect sizes Cohen's d_z and r were determined to evaluate the meaningfulness of changes. The occupational performance as well as the satisfaction in the COPM improved significantly after the therapeutic intervention (p < 0.001; d_z = 2.37, r = 0.77 and d_z = 2.24, r = 0.75). Moreover, the clients improved significantly in the revision test after the therapeutic intervention (p < 0.001; d_z = 0.65, r = 0.31). Clients with mental disorders seem to benefit meaningfully from the SELWA®-treatment by S. Thielen regarding occupational performance and satisfaction in self-care, productivity and leisure. Furthermore, a moderate improvement of concentration seems to occur after the therapeutic intervention.

Occupational Performance Outcome for Survivors of Childhood Cancer: Feasibility of the Canadian Occupational Performance Measure

The aim of the study was to determine the feasibility of the Persian version of the Canadian Occupational Performance Measure (COPM) to assess self-reported occupational performance in a group of children with cancer at least one-year post-cancer diagnosis and intervention and to describe the self-reported occupational performance problems of children with cancer. Forty-three children with cancer (mean age 11.59 years; SD 4.94) participated in a cross-sectional study, using a convenience sampling approach. Performance and satisfaction were assessed through a validated Persian version of the COPM and feasibility and ease of administration were also considered. This study showed that feasibility was found to be adequate and this measurement was perceived as easy to understand; completion took from 20 to 51 minutes. Children with cancer prioritized 115 occupations within six of the nine COPM subcategories. Among the prioritized occupations, the highest number was found in self-care 61.7%, followed by productivity (26%), and leisure (12.1%). The mean ratings of performance varied from 3.7 to 8.4. The lowest mean rating was in the subgroup play/school (3.7). For satisfaction, the mean ratings were from 2.6 to 5.2, with functional mobility as the highest and play/school the lowest. The results support the use of the COPM in clinical practice for children with cancer. Based on these findings, children with cancer perceive problems with occupations related to all aspects of daily life. This underlines the need to provide rehabilitation services, especially occupational therapy services for these children.

Measurement Properties of the Canadian Occupational Performance Measure: A Systematic Review

IMPORTANCE

The Canadian Occupational Performance Measure (COPM) is widely used in clinical practice and research. However, the measurement properties of the COPM were not reviewed using rigorous systematic methodology.

OBJECTIVE

To evaluate the measurement properties of the COPM.

DATA SOURCES

MEDLINE, Web of Science, Scopus, OTseeker, and Cochrane Library. Study Selection and Data Collection: We used the updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist to evaluate the measurement properties of the COPM reported in relevant studies.

FINDINGS

Our search identified 35 articles that reported measurement properties for the COPM with samples that differed in age, country, diagnosis, and disease stage. For content validity, the evidence was inconsistent and of low quality; no studies assessed structural validity. For reliability, the internal consistency was indeterminate and of low quality. One study reported indeterminate and very low quality evidence for cross-cultural validity. According to the evidence reported in these studies, the COPM has inconsistent and moderate reliability, construct validity, and responsiveness and insufficient and high-quality evidence for criterion validity.

CONCLUSIONS AND RELEVANCE

Our review of the evidence using the COSMIN Risk of Bias checklist indicates that the Canadian Occupational Performance Measure lacks high-quality validation. What This Article Adds: High-quality validation of the Canadian Occupational Performance Measure is lacking. Further examination of its measurement properties using updated relevant guidelines is required.

Validity and Reliability of the Turkish Canadian Occupational Performance Measure (COPM-TR) for People with Multiple Sclerosis

The Canadian Occupational Performance Measure (COPM) is a generic questionnaire based on a semi-structured interview. We aimed to translate a Turkish version of the COPM (COPM-TR) and assess its reliability and validity. The COPM-TR was administered to 82 participants (42.2 ± 11.6 years and 32.9% of the participants were male) with multiple sclerosis (MS) for convergent validity and reliability analysis. The COPM-TR was administered with the Multiple Sclerosis Quality of Life-54 (MSQoL-54), and Expanded Disability Status Scale (EDSS) to determine its convergent validity. Test-retest reliability (a week interval) was assessed by the Intraclass Correlation Coefficient (ICC). There were moderately strong negative correlations between EDSS and performance and satisfaction score of COPM-TR. There were moderately strong positive correlations between MSQoL-54 physical and performance of COPM-TR and moderate positive correlations between MSQoL-54 physical and satisfaction of COPM-TR. Moderate positive correlations found between the MSQoL-54 mental and COPM-TR performance and satisfaction scores. Test re-test reliability of COPM-TR performance indicated excellent reliability. The current study demonstrates that the COPM-TR is a valid and reliable tool for measuring the perceived occupational performance and satisfaction of people with MS.

Construct validity, test-retest reliability, and the ability to detect change of the Canadian Occupational Performance Measure in a spinal cord injury population

Study design

Cross-sectional study.

Objectives

To examine the construct validity and the ability to detect change, of the Italian version of the Canadian Occupational Performance Measure (COPM) in a spinal cord injury (SCI) population.

Settings

Rehabilitation service of the Paraplegic Center of Ostia, Italy.

Methods

Thirty-nine spinal cord injury participants were recruited. The clinimetric properties of the measure were assessed following international guidelines. Cronbach's alpha and the intraclass correlation coefficient were assessed for internal consistency and test-retest reliability, respectively. Construct validity was evaluated, by calculating correlation between COPM and the Spinal Cord Independence Measure (SCIM) through Pearson's correlation coefficient and Spearman's Rho. The ability to detect change was evaluated on the overall sample.

Results

The COPM was shown to be reliable in a spinal cord injury sample with positive and statistically significant results for Cronbach's alpha (0.89) and ICC (0.99 for the performance subtest and 0.98 for the satisfaction subtest). Correlation coefficients did not show a correlation between the COPM total score and the SCIM. The COPM scores improved significantly during in-patient rehabilitation, moreover the mean change between the start of treatment and the end of the therapy as evaluated with the Wilcoxon signed-rank test was -4.25 points for the performance score and -2.96 points for the satisfaction score.

Conclusions

This study showed that the COPM is a reliable tool for assessing SCI clients' perceived performance of daily activities and their satisfaction with their performance.

Determining Occupational Performance Issues in Women with Breast Cancer Referred to Treatment Centers of Hamadan, Iran

Objective: Women with breast cancer experience functional limitations at the time of diagnosis and after the initial treatment of cancer. Such limitations interfere with participation in self-care, work affairs, and leisure activities. The present study aimed to determine occupational performance priorities in women with breast cancer who had referred to treatment centers in Hamadan, Iran. Methods: In this cross-sectional, descriptive-analytical study, 102 women with breast cancer who had referred to treatment centers in Hamadan were selected through convenience sampling. The participants’ information was gathered using their medical records and a demographic information questionnaire. Then, they were interviewed using the Canadian Occupational Performance Measure (COPM) to determine their occupational performance issues. The gathered data were coded and analyzed using the SPSS statistical software, version 16. Results: The results indicated that out of the 22 defined codes for the patients’ selected activities, 45.8%, 30.8%, and 23.4% belonged to self-care, productivity, and leisure domains, respectively. Conclusion: Women with breast cancer experience various occupational performance issues due to disease complications and received treatments. In the present study, self-care comprised the occupational performance priority. Determining the clients’ intervention priorities, which is among the bases of occupational therapy interventions, can help women with breast cancer reach the desired quality of life.

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.

The Canadian occupational performance measure for patients with stroke: a systematic review

[Purpose] This study investigated whether the Canadian Occupational Performance Measure is a suitable outcome measure for assessing patients with stroke in research and clinical settings. [Subjects and Methods] The study included into two parts: (1) an investigation of the reliability and validity of the Canadian Occupational Performance Measure for patients with stroke and (2) an exploration of Canadian Occupational Performance Measure results in randomized controlled trials of patients with stroke. For this review, the study searched the MEDLINE, PubMed, and CINAHL Plus with Full Text databases for articles published before September 2015. [Results] Finally, three eligible articles were collected in part 1, and ten randomized controlled trials studies were collected in part 2. The findings of part 1 revealed that the Canadian Occupational Performance Measure had efficient test-retest reliability, however, the Canadian Occupational Performance Measure revealed weak associations with other assessment tools such as Barthel Index used for patients with stroke. Six of the randomized controlled trials studies used the Canadian Occupational Performance Measure as a primary outcome and two as a secondary outcome, while the other two as a goal-setting instrument. [Conclusion] This review indicates that the Canadian Occupational Performance Measure is appropriate for clinicians, including physiotherapists, in assessing outcome for patients with stroke. The Canadian Occupational Performance Measure can assist patients in identifying their outcome performance and provide therapists with directions on interventions.

A Systematic Review of the Canadian Occupational Performance Measure: A Clinical Practice Perspective

Occupational therapists working to a philosophy of client-centred practice will benefit from a reliable and well reviewed outcome measure to provide an evidence base. A systematic review of the literature was undertaken to evaluate worldwide publications on the use of the Canadian Occupational Performance Measure (COPM) to determine its impact on clinical practice in occupational therapy.

A literature search strategy was deployed which resulted in a review of 64 articles. A themed analysis approach was used to integrate the results into linked and recurring themes. The focus of the systematic review was to concentrate on issues affecting clinical practice and the following were selected as key factors for consideration: negative and positive issues arising from the use of the COPM; impact on practice for the therapist, client, process and clinical work; and change initiatives for the therapist, client, process and clinical practice. A profile of all articles, which identifies where these factors are indicated, is presented as a summary guide to assist the clinician.

The findings of the review indicated that the greatest impact of using the COPM was within clinical practice. Change initiatives indicated the need for further research in different clinical areas, as well as the continual development and need for more training of occupational therapists in the use of COPM as an outcome measure.

The reproducibility of the Canadian Occupational Performance Measure

Objective: To assess the reproducibility (reliability and inter-rater agreement) of the client-centred Canadian Occupational Performance Measure (COPM).

Design: The COPM was administered twice, with a mean interval of seven days (SD 1.6, range 4-14), by two different occupational therapists. Data analysis was based on intraclass correlation coefficients, the Bland and Altman method and Cohen's weighted kappas.

Setting: Occupational therapy departments of two university medical centres.

Subjects: Consecutive clients, with various diagnoses, newly referred to the outpatient clinic of two occupational therapy departments, were included. They were all over 18 years of age and perceived limitations in more than one activity of daily life. Complete data on 95 clients were obtained: 31 men and 64 women.

Results: Sixty-six per cent of the activities prioritized at the first assessment were also prioritized at the second assessment. The intraclass correlation coefficients were 0.67 (95% confidence interval (CI) 0.54-0.78) for the mean performance score and 0.69 (95% CI 0.56-0.79) for the mean satisfaction score. The limits of agreement were-2.5 to 2.4 for the mean performance score and-2.3 to 2.7 for the mean satisfaction score. For the separate prioritized problems, the weighted kappas ranged from 0.37 to 0.49.

Conclusions: Inter-rater agreement of the prioritized problems was moderate. The reproducibility of the mean performance and satisfaction scores was moderate, but it was poor for the scores of the separate problems. Therefore, the mean scores should be used for individual assessment.

Canadian Occupational Performance Measure performance scale: validity and responsiveness in chronic pain

The construct validity and construct responsiveness of the performance scale of the Canadian Occupational Performance Measure (COPM) was measured in 87 newly admitted patients with chronic pain attending an outpatient rehabilitation clinic. At admission and after 12 wk, patients completed a COPM interview, the Pain Disability Index (PDI), and the RAND 36-Item Health Survey (RAND-36). We determined the construct validity of the COPM by correlations between the COPM performance scale (COPM-P), the PDI, and the RAND-36 at admission. Construct responsiveness was assessed by calculating the correlations between the change scores (n = 57). The COPM-P did not significantly correlate with the PDI (r = -0.260) or with any subscale of the RAND-36 (r = -0.007 to 0.248). Only a moderate correlation was found between change scores of the COPM-P and PDI (r = -0.380) and weak to moderate correlations were found between change scores of the COPM-P and the RAND-36 (r = -0.031 to 0.388), with the higher correlations for the physical functioning, social functioning, and role limitations (physical) subscales. In patients with chronic pain attending our rehabilitation program, the COPM-P measures something different than the RAND-36 or PDI. Therefore, construct validity of the COPM-P was not confirmed by our data. We were not able to find support for the COPM-P to detect changes in occupational performance.

Enacting Occupation-Based Practice: Exploring the Disjuncture between the Daily Lives of Mothers with Rheumatoid Arthritis and Institutional Processes

Introduction:

Occupation-based approaches are a hallmark of excellence in occupational therapy practice. This article focuses on the disjuncture between how women with rheumatoid arthritis go about their daily lives, that is to say their occupations, and what is addressed during routine visits at a specialized rheumatology outpatient clinic.

Method:

Institutional ethnography was employed as a method of inquiry to identify the occupations and related issues that were or were not accounted for in health records and addressed within institutional processes. Interviews and participant observations were conducted with seven women with rheumatoid arthritis who were mothers. Hospital records were analysed as texts mediating between the women's daily lives and the rheumatology outpatient clinic.

Findings:

The analysis revealed that despite the diversity in the ways that the women managed their daily lives, the things that they did were viewed, understood, and addressed only within the boundaries of the standardizing relations that ruled practice in this clinical setting. Institutional processes grounded in biomedical concepts such as functional status or disease activity, as well as clinical assessments that depict these concepts, both shape and limit opportunities for occupational therapists to advance and enact occupation-based practice.

Conclusion:

In this setting, the complexity of the participants' daily lives and the occupations they engage in remain unaddressed.

The inclusion of activities of daily living in flexor tendon rehabilitation: a survey

Studies have shown that patients restricted to one-handed use due to trauma or surgery often have difficulty with activities of daily living (ADLs). In order to assess hand therapists' perspectives and practices regarding ADL assessment and intervention, a 21-item survey was e-mailed to members of the American Society of Hand Therapists (ASHT). Results of the survey indicate that the majority of hand therapists surveyed (97.5%) feel that ADL performance is an important part of hand therapy practice and that teaching adaptive strategies is a high priority in the early weeks of flexor tendon rehabilitation, but less than half (45.5%) actually provide a formal assessment of ADL performance in order to discover patients' ADL needs. Reasons for this discrepancy between beliefs and practices are explored through participants' comments in the survey.

LEVEL OF EVIDENCE

3b.

The validity of occupational performance assessments: a validity generalization meta-analysis

The purpose of this meta-analysis was to determine sample weighted mean validity effect sizes for occupational performance assessments, and their generalizability from research to clinical settings. The bare-bones Validity Generalization (VG) guidelines developed by Hunter and Schmidt ( 2004 ) augmented by Maximum Likelihood (ML) procedures were used to complete the meta-analysis. The sample consisted of 27 studies in which convergent, divergent, and predictive validity estimates of occupational performance assessments were investigated. The mean coefficients of assessments validated in the studies constituting the sample for this meta-analysis ranged from medium to large. Further meta-analysis with complete dis-attenuation of observed mean validity coefficients is indicated.

Grip strength, perceived ability, and health status in individuals with arthritis: an exploratory study

The purpose of this study is twofold: (1) to describe the hand strength, self-reported manual ability and health status in individuals with osteo- or rheumatoid arthritis, and (2) to evaluate the scale (psychometric) properties of the 36-item Manual Ability Measure (MAM) as it applied to this sample. We administered four self-report assessments to the participants and measured their grip and pinch strength. The results indicated that persons with arthritis had decreased grip and pinch strength, more functional limitations, compromised health status and restricted participation in everyday occupations when compared to the general population. Manual ability was not related to grip strength, but was significantly related to role restriction (i. e., SF-36 Role Physical domain). The study provides evidence that the MAM has adequate psychometric properties when used with patients with osteo- or rheumatoid arthritis.

Interests among Older People in Relation to Gender, Function and Health-Related Quality of Life

Introduction:

Older people should have opportunities to be active participants in society because aspects such as lifestyle, physical and social environment and physical and mental status have influence on active ageing. The purpose of this study was to explore the interests pursued by 85-year-old people living in ordinary housing in relation to gender, cognition, depression and health-related quality of life (HRQoL).

Method:

A sample of 240 participants completed a postal questionnaire, including the EuroQoL HRQoL measurement. Additional instruments used during a subsequent home visit were the Canadian Occupational Performance Measure, Mini Mental State Examination and Geriatric Depression Scale.

Results:

Women experienced poorer health than men, lived alone to a greater extent and used more mobility devices. Compared with men, women had a larger number of interests within household management, but there were no gender differences in the leisure area. A lower number of interests in active recreation was associated with lower cognitive function, poorer HRQoL and a higher risk of depressive symptoms.

Conclusion:

The main finding is that engaging in active recreation interests is associated with better cognition, less depression and higher HRQoL in these 85-year-old people and is, therefore, a concern of occupational therapists.

Individualized outcome measures of daily activities are sensitive tools for evaluating hand surgery in rheumatic diseases

OBJECTIVES

To explore the ability of six outcome measures to capture clinically important changes in patients with rheumatic diseases undergoing hand surgery and to study predictors of changes in activity performance in different patient and surgery strata.

METHODS

A total of 172 patients (median age 59 years, disease duration 18 years) were stratified into subgroups: diagnosis, age, general function, type of surgery. Performance of daily activities and satisfaction were assessed by the Canadian Occupational Performance Measure (COPM). Clinically important improvement was defined as a two-step improvement in COPM. Hand function was assessed by reference to grip strength (Grippit), pinch strength (pinch gauge), hand pain (visual analogue scale) and grip ability (Grip Ability Test). Responsiveness was calculated as effect size (ES) at 6-month follow-up compared with baseline.

RESULTS

Clinically important improvement was reached by 25-69% depending on outcome measure and type of surgery. Improvement was smaller in patients with multiple simultaneous procedures. Regardless of diagnosis, age, general function and type of surgery, patients improved significantly in all measures, with the largest changes in COPM(performance) and COPM(satisfaction) (ES 0.7-1.9). The ES of pain ranged from 0.2 to 0.7, Grippit from 0.1 to 0.5 and pinch gauge from 0.4 to 0.8. Hand pain was the only significant predictor of clinically important improvement of COPM(performance): odds ratio 0.71, 95% CI 0.51, 0.98 (P = 0.041).

CONCLUSION

COPM was the most sensitive instrument to capture clinically important improvement, and hand pain was a significant predictor of improvement, irrespective of diagnosis, age, general functional level and type of surgery.

A patient-prioritized ability assessment in haemophilia: the Canadian Occupational Performance Measure

Assessment of musculoskeletal function in individuals with haemophilia has been attempted with clinimetric instruments, which use predetermined domains for assessing the same. This study introduces the application of an instrument, the Canadian Occupational Performance Measure (COPM), which is an open-ended questionnaire that allows patients to prioritize their needs and rate their performance in different tasks of daily living as well as their satisfaction in performing them. To study the utility of COPM in evaluating the musculoskeletal functional status of patients with haemophilia and to assess its effectiveness in planning individualized management plans for them. COPM was administered to 67 individuals with haemophilia aged 10-55 years and the data were compared with functional deficits identified through FISH (Functional Independence Score for Haemophilia). A total of 31 performance difficulties in the areas of self-care (62%), productivity (21%) and leisure (17%) were identified by COPM. All eight domains of FISH were identified in COPM as problems in self-care. In addition to these, COPM identified problems in the areas of productivity and leisure. In 78% of the responses on COPM, there was concordance between the performance and satisfaction scores. However, there was discordance between the two in the remaining 22% of responses. COPM is a useful tool for assessment of musculoskeletal dysfunction in haemophilia. It provides a greater insight into the needs of each patient and helps in planning individualized intervention strategies.

Measure of function in rheumatoid arthritis: individualised or classical scales?

BACKGROUND

The Health Assessment Questionnaire Disability Index (HAQ-DI) is the most widely used measure of function in rheumatoid arthritis (RA).

OBJECTIVE

To evaluate individualised forms of the HAQ-DI and thus enhance the incorporation of patients' views in outcome assessment.

PATIENTS AND METHODS

HAQ-DI data were prospectively obtained from 370 outpatients with RA treated with leflunomide over a 6-month period. At baseline and final visits, patients had to rate the importance they attached to each activity addressed by the 20 HAQ-DI items, and to select the five activities they considered the most important. Different individualised scales were evaluated: scales preserving all domains, in which the score for each item is multiplied by or added to its importance; and scales involving, for each patient, only the five most important items. The psychometric properties of these scales were compared with those of the HAQ-DI.

RESULTS

For each HAQ-DI item, severity and importance scores were weakly correlated. Scores for all individualised scales were highly correlated with the HAQ-DI score (r(s)>0.75). All scales had a good internal consistency (Cronbach's alpha 0.87-0.88). Compared with the HAQ-DI, individualised scales did not have better sensitivity to change (standardised response mean 0.64-0.69 vs 0.74).

CONCLUSION

Individualised scales have similar properties to the HAQ-DI. However, individualised questionnaires measuring importance gave complementary information to the measure of disability. Individualisation is probably not needed for group assessment in all randomised controlled trials but, the use of individualised questionnaires may be clinically relevant for individual patients with RA.

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.

Measures and time points relevant for post-surgical follow-up in patients with inflammatory arthritis: a pilot study

Background

Rheumatic diseases commonly affect joints and other structures in the hand. Surgery is a traditional way to treat hand problems in inflammatory rheumatic diseases with the purposes of pain relief, restore function and prevent progression. There are numerous measures to choose from, and a combination of outcome measures is recommended. This study evaluated if instruments commonly used in rheumatologic clinical practice are suitable to measure outcome of hand surgery and to identify time points relevant for follow-up.

Methods

Thirty-one patients (median age 56 years, median disease duration 15 years) with inflammatory rheumatic disease and need for post-surgical occupational therapy intervention formed this pilot study group.

Hand function was assessed regarding grip strength (Grippit), pain (VAS), range of motion (ROM) (Signals of Functional Impairment (SOFI)) and grip ability (Grip Ability Test (GAT)). Activities of daily life (ADL) were assessed by means of Disabilities of the Arm, Shoulder and Hand Outcome (DASH) and Canadian Occupational Performance Measure (COPM). The instruments were evaluated by responsiveness and feasibility; follow-up points were 0, 3, 6 and 12 months.

Results

All instruments showed significant change at one or more follow-up points. Satisfaction with activities (COPM) showed the best responsiveness (SMR>0.8), while ROM measured with SOFI had low responsiveness at most follow-up time points. The responsiveness of the instruments was stable between 6 and 12 month follow-up which imply that 6 month is an appropriate time for evaluating short-term effect of hand surgery in rheumatic diseases.

Conclusion

We suggest a core set of instruments measuring pain, grip strength, grip ability, perceived symptoms and self-defined daily activities. This study has shown that VAS pain, the Grippit instrument, GAT, DASH symptom scale and COPM are suitable outcome instruments for hand surgery, while SOFI may be a more insensitive test. However, the feasibility of this protocol in clinical practice awaits prospective studies.

Occupational therapy during the first 10 years of rheumatoid arthritis

OBJECTIVE

To describe disease development and occupational therapy during the first 10 years of rheumatoid arthritis (RA), and to assess patients' experiences of occupational therapy and comprehensive care.

METHODS

A total of 168 early RA patients with variable disease severity were followed up with regular team visits. The occupational therapist evaluated hand function and activity and performed the necessary interventions. These were recorded and the number of visits generating interventions was calculated. Semi-structured interview of 11 patients regarding their views of occupational therapy and team contact was performed.

RESULTS

Impairments of hand function were in general mild to moderate and remained fairly unchanged over time. Activity limitations increased slowly. Half of the follow-up visits generated interventions. Most common were prescriptions of assistive devices and orthoses, hand-training instructions and patient education. The patients interviewed were positive regarding occupational therapy and felt safe with comprehensive care.

CONCLUSION

RA patients in all stages of the disease benefit from regular contact with an occupational therapist and team care.

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.

Activity limitations and participation restrictions in women with hand osteoarthritis: patients' descriptions and associations between dimensions of functioning

OBJECTIVE

To describe the functional consequences of hand osteoarthritis, and analyse associations between personal factors, hand impairment, activity limitations, and participation restrictions within the framework of the International Classification of Functioning (ICF).

METHODS

87 women with hand osteoarthritis completed a clinical examination including recording of sociodemographic data, measures of hand impairment, and completion of self reported health status measures. The function subscale of the AUSCAN Osteoarthritis Hand Index was used as a measure of hand related activity limitations, while the Canadian Occupational Performance Measure (COPM) was used to describe and measure activity limitations and participation restrictions as perceived by the individual. The study variables were categorised using the dimensions in the ICF framework and analysed using bivariate and multivariate statistical approaches.

RESULTS

The patients described problems in many domains of activity and participation. The most frequently described hand related problems were activities requiring considerable grip strength combined with twisting of the hands. On the impairment level, the patients had reduced grip force and joint mobility in the hands, and resisted motion was painful. Regression analyses showed that hand related activity limitations were associated with measures of hand impairment, while activity and participation (as measured by the COPM) were more strongly associated with personal factors than with hand impairment.

CONCLUSIONS

Hand osteoarthritis has important functional consequences in terms of pain, reduced hand mobility and grip force, activity limitations, and participation restrictions. Rehabilitation programmes should therefore be multidisciplinary and multidimensional, focusing on hand function, occupational performance, and coping strategies.

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.

A crossover trial of custom-made and commercially available wrist splints in adults with inflammatory arthritis

OBJECTIVE

To compare the effect of 3 wrist splints (2 prefabricated commercial splints and 1 custom made) on perceived wrist pain, hand function, and perceived upper extremity function in adults with inflammatory arthritis.

METHODS

Subjects (n = 45, mean age 49 years, mean disease duration 8.6 years) were randomly assigned to treatment order in a 3-phase crossover trial. Splints were worn for 4 weeks, separated by 1-week washouts. Outcomes were assessed at baseline, after each splint phase and washout period, and at 6 months' followup using a pain visual analog scale (VAS), the Arthritis Hand Function Test, and McMaster-Toronto Arthritis Patient Function Preference questionnaire. Data were analyzed with multivariate analyses of variance (MANOVAs), t-tests, and chi-square tests.

RESULTS

There did not appear to be order or carryover effects. MANOVA indicated that wrist splints significantly reduced pain (P = 0.007). The custom leather splint was most effective in reducing pain, from 4.1 cm to 2.8 cm on the VAS (P = 0.001). All splints improved hand strength, and the commercial Rolyan splint provided significantly stronger grip than the Anatech commercial splint (P = 0.04). In contrast to previous studies, splints did not compromise dexterity. There were several significant differences among splints, depending on the outcome measure. Improvements were maintained at 6 months.

CONCLUSION

After 4 weeks' use, wrist splints reduce pain, improve strength, and do not compromise dexterity. Similar improvements were achieved with the custom leather splint and Rolyan commercial splint, which were superior to the Anatech commercial splint.

Norwegian version of the Canadian Occupational Performance Measure in patients with hand osteoarthritis: Validity, responsiveness, and feasibility

OBJECTIVE

To test the Norwegian version of the Canadian Occupational Performance Measure (COPM) for validity, responsiveness, and feasibility in patients with hand osteoarthritis.

METHODS

Seventy-nine patients completed a COPM interview and several self-reported health status questionnaires, including Arthritis Impact Measurement Scales 2, modified Health Assessment Questionnaire; Western Ontario and McMaster Universities Osteoarthritis Index, and the Australian/Canadian Osteoarthritis Hand Index. Rescoring of the same instruments was performed 4 months later, after an intervention.

RESULTS

The COPM detected a great variability of occupational performance problems. The hypotheses for testing validity were confirmed. Mean COPM change was 1.51 (P < 0.001) in performance score, and 2.22 (P < 0.001) in satisfaction score. The median time spent on the COPM interview was 30 minutes (range 10-70 minutes). The patients found the questions easy to understand, but 37% reported problems performing the scoring procedure.

CONCLUSIONS

The Norwegian version of the COPM is a valid and responsive instrument for use in clinical practice in osteoarthritis patients. It may serve as an instrument to promote a client-centered approach and as a supplement to other health measures in the planning and evaluating of interventions. Feasibility regarding scoring needs to be improved.

Empowerment in measurement: “muscle,” “voice,” and subjective quality of life as a gold standard 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

Measurement and assessment, occurring within both research and clinical service contexts, typically involve an imbalance of power between professionals and persons with disabilities. Power is evidenced in who controls decisions about measurement and whose perspective--the subjective values of the measured person or the objective or normative values of the measurer--is given primacy. The consequences of this imbalance are discussed with respect to both sides of the power relationship. For clinicians, evaluators, and researchers, who typically hold most, if not all of the power in measurement, the process may produce data that meet the highest professional standards. However, the utility of such data is limited in addressing many purposes. For research participants and service recipients, who typically have little if any control of measurement, the measurement process may be disempowering, because measures focus on areas of life that may be of little relevance to what they see as important. In effect, both sides lose, to the degree that resulting data are less revealing than would be the case in a more balanced power relationship. Methods are discussed for reducing power imbalances to improve the utility and efficacy of measurement.

Employment and work disability in rheumatoid arthritis

PURPOSE OF REVIEW

The cost of work disability due to rheumatoid arthritis is substantial to both individuals and society. Approximately one third of people with rheumatoid arthritis will leave employment prematurely. Several studies over the past two decades have identified risk factors for work disability, and recent literature suggests increasing interest in ways to assess work limitations and offer interventions to prevent work loss.

RECENT FINDINGS

Work disability results from a complex interaction of characteristics of individuals, the nature of their work, and their environment, including the physical workplace, policies related to work accommodation, and interpersonal relationships. Practitioners need tools to help identify patients experiencing limitations in the workplace and at risk for permanent work disability. Two new tools show promise in this area. Although there is general agreement that vocational assessment and intervention should occur early in the course of rheumatoid arthritis, evidence for vocational rehabilitation is sadly lacking. A recent systematic review identified only six studies, all uncontrolled, but suggestive of beneficial effects.

SUMMARY

Assessment of possible work limitations and potential for vocational rehabilitation should be considered in the evaluation of employed patients and those wishing to work. Further development and evaluation of work retention and return-to-work programs for people with rheumatoid arthritis is required.

Goal Priorities Identified through Client-Centred Measurement in Individuals with Chronic Stroke

PURPOSE: The purpose of this study was to identify goal priorities in a sample of individuals with chronic stroke. METHOD: In this descriptive study involving 19 community-dwelling individuals with stroke, participants were interviewed on the Canadian Occupational Performance Measure (COPM) to ascertain problem areas experienced after hospital discharge. Once problems were identified, they were classified under the three dimensions of the COPM: self-care, productivity, and leisure. RESULTS: The mean time since stroke was 6.8 (±2.9) years. Eighty-four problems were identified within the three dimensions of the COPM. The most frequently cited problems in each dimension were bathing (self-care) by 42% of participants, household maintenance (productivity) by 32% of participants, and walking outdoors (leisure) by 32% of participants. Overall, participants rated their performance of identified problems and satisfaction with their abilities as low and rated each dimension as equally important for problem priority. CONCLUSION: Long after hospital discharge, individuals with chronic stroke were able to identify issues of concern that could benefit from involvement of rehabilitation professionals. Clinicians should be aware that issues of bathing, walking, household maintenance, and recreational activities are of particular importance to people with chronic stroke living in the community. A client-centred approach to problem generation (ie, use of the COPM) may assist in enhancing client involvement and motivation towards rehabilitation.