The use of the Canadian occupational performance measure as an outcome of a pain management program

Modified Constraint-Induced Movement Therapy for Elderly Clients With Subacute Stroke

A growing body of research, including evidence from numerous randomized controlled trials, suggests that constraint-induced movement therapy (CIMT) reduces impairment. The mean age of participants in most studies has been <65 yr, even though most stroke survivors are older than that. We investigated the efficacy of a modified CIMT protocol on participation, activity, and impairment in a population of older adults experiencing subacute stroke. Using an interrupted time series design, 4 older adults (mean age = 82) were assessed before and after intervention. Although none of the participants adhered to the 6-hr per day self-practice aspect of the CIMT protocol, considerable improvements were noted in participation, as measured using the Canadian Occupational Performance Measure. Some improvements were also noted at the level of impairment and activity. This work accords with previous literature on CIMT and has important implications for the evolution of stroke rehabilitation in elderly people.

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.

A study of the effect of desensitization on hyperaesthesia in the hand and upper extremity after injury or surgery

Introduction

Hyperaesthesia is a common problem in hand rehabilitation. A desensitization programme has successfully been used in our occupational therapy department for patients with hyperaesthesia in the hand or upper extremity. Our objectives were to investigate self-perceived pain/discomfort at rest, with use or touch, size of sensitive skin area and occupational performance in daily occupations for patients with hyperaesthesia before and after a six-week desensitization programme.

Methods

Thirty-nine patients with pain/discomfort at or near scars from hand injury or surgery participated in the study. The patients were recruited consecutively to the study. They were instructed to massage the sensitive skin area three times a day with a piece of texture until numbness occurred (2–5 minutes). The textures were upgraded continuously. A study-specific questionnaire was developed including demographic data and questions concerning perceived pain/discomfort. Pain/discomfort was assessed with a visual analogue scale 0–100. The size of the sensitive skin area was assessed in mm2. Occupational performance was assessed with the Canadian Occupational Performance Measure.

Results

The results showed statistically significant improvements ( P ≤ 0.001) in all areas after six weeks with reduced pain/discomfort at rest and with use or touch, a decreased size of the sensitive skin area and a higher occupational performance in daily occupations.

Discussion

The results indicate the importance of paying attention to sensory disturbances during rehabilitation. The cost for such a programme is low. Further research is needed to confirm the results in a larger sample using a control group, and in comparison with spontaneous healing and other treatment modalities.

Clinical efficacy of the vertebral wedge osteotomy for the fusionless treatment of paralytic scoliosis

STUDY DESIGN

Pre-post intervention study using outcome measure design.

OBJECTIVE

To evaluate the clinical efficacy and functional impact of a fusionless treatment for paralytic scoliosis at 2-year follow-up.

SUMMARY OF BACKGROUND DATA

It has been shown that 67% of pediatric patients with progressive paralytic scoliosis require spinal fusion to correct the curve. However, maintenance of spinal flexibility, motion, and potential growth is desirable.

METHODS

Fourteen patients with scoliosis secondary to spinal cord injury or myelodysplasia underwent a fusionless vertebral wedge osteotomy. Thirteen patients were available for minimum 2-year follow-up, using standard scoliosis radiographs. The functional impact of the procedure was evaluated using the Pediatric Outcomes Data Collection Instrument (PODCI), the Functional Independence Measure (FIM), and the Canadian Occupational Performance Measure (COPM).

RESULTS

At a minimum 2-year follow-up, 10 patients of 13 (77%) had improvement of greater than 5 degrees in their coronal Cobb angle. Two (15%) patients' curves measured the same (+/-5 degrees). One patient's curve had worsened by 12 degrees as compared to the preoperative Cobb angle. The overall average correction of the 13 patients was 56.1%. Two patients required fusion with an average delay to fusion of 30 months. At current follow-up, range of motion across the treated levels averaged 43 degrees (range 8 degrees to 103 degrees). The FIM showed no changes pre to post, and the PODCI scores showed some increases at 2-year follow-up. Clinical and statistical improvement in performance and satisfaction scores was seen pre to post on the Canadian Occupational Performance Measure.

CONCLUSION

Vertebral wedge osteotomy is potentially an effective treatment option for paralytic scoliosis. At 2-year follow-up, there was no loss of function as measured by the PODCI and FIM, and there was improvement in the COPM. Cobb angle measurements were either improved or maintained in 12 of 13 patients. Although 2 patients required fusion, they had an average of 2.5 years of subsequent growth before surgery.

A randomized single blind crossover trial comparing leather and commercial wrist splints for treating chronic wrist pain in adults

BACKGROUND

To compare the effectiveness of a custom-made leather wrist splint (LS) with a commercially available fabric splint (FS) in adults with chronic wrist pain.

METHODS

Participants (N = 25, mean age = 54) were randomly assigned to treatment order in a 2-phase crossover trial. Splints were worn for 2 weeks, separated by a one-week washout period. Outcomes were assessed at baseline and after each splint phase using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Canadian Occupational Performance Measure (COPM) and Jamar dynamometer by an observer blinded to treatment allocation.

RESULTS

Both styles of wrist splint significantly reduced pain (effect size LS 0.79, FS 0.43), improved hand function and increased grip strength compared to baseline (all p < 0.05) with no increase in wrist stiffness. There was a consistent trend for the LS to be superior to the FS but this was statistically significant only for patient perceived occupational performance (p = 0.008) and satisfaction (p = 0.015). Lastly, 72% of patients preferred the custom-made leather splint compared to the commercially available splint.

CONCLUSION

Leather wrist splints were superior to a commercially available fabric splint for the short-term relief of pain and dysfunction.

Effectiveness and expectations of intensive training: A comparison between child and youth rehabilitation and conductive education

OBJECTIVE

To compare the effectiveness of two intensive training-programmes from a professional and parent perspective. To describe and compare the type of expectations of the two intensive training programmes with the self-reported individualized goals.

DESIGN

Quasi-experimental with two groups.

SETTING AND INTERVENTION

Traditional health care and conductive education. PATIENTS AND THEIR PARENTS: Fifty-four children with cerebral palsy, 3-16 years old.

METHODS

Data included a self-reported individualized goal measure (SRIGM), before and after the ITP. Individualized goals were classified according to the International Classification of Functioning (ICF). Clinical measures (CM) included repeated measures with Gross Motor Function Measure (GMFM) and Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS).

RESULTS

Twenty-eight parents out of 54 perceived a clinically significant improvement on the SRIGM with no significant difference between the training programmes. Most individualized goals were formulated in the domain of Mobility (115 out of 248) and Neuromusculoskeletal and movement-related functions (64 out of 248 goals) of ICF in both training programmes. There was no difference in the proportion of improvement measured with SRIGM compared to the CM, if an improvement in any dimension in GMFM or domain in PEDI FS was counted.

CONCLUSION

There were no major differences in outcome and expectations between the training programmes. Parents' expectations were mainly directed towards improvement in prerequisites of motor function and mobility skills. The SRIGM confirmed the outcome on the CM.

A review and critique of assessment instruments for patients with persistent pain

BACKGROUND

Early identification of individuals at risk of developing persistent pain is important to decrease unnecessary treatment costs and disability. However there is scant comprehensive information readily available to assist clinicians to choose appropriate assessment instruments with sound psychometric and clinical properties.

OBJECTIVE

A national insurer commissioned the development of a compendium of assessment instruments to identify adults with, or at-risk of developing, persistent pain. This paper reports on the instrument identification and review process.

METHODS

A comprehensive systematic literature review was undertaken of assessment instruments for persistent pain of noncancer origin, and their developmental literature. Only assessment instruments which were developed for patients with pain, or tested on them, were included. A purpose-built 'Ready Reckoner' scored psychometric properties and clinical utility.

RESULTS

One hundred sixteen potentially useful instruments were identified, measuring severity, psychological, functional and/or quality of life constructs of persistent pain. Forty-five instruments were short-listed, with convincing psychometric properties and clinical utility. There were no standard tests for psychometric properties, and considerable overlap of instrument purpose, item construct, wording, and scoring.

CONCLUSION

No one assessment instrument captured all the constructs of persistent pain. While the compendium focuses clinicians' choices, multiple instruments are required for comprehensive assessment of adults with persistent pain.

Validity and Utility of the Canadian Occupational Performance Measure as an Outcome Measure in a Craniofacial Pain Center

Temporomandibular disorders and orofacial pain may cause impairment and functional limitations in activities involving the face, especially the mouth. The impact of chronic pain on occupational performance in this population has not been studied. The validity and utility of the Canadian Occupational Performance Measure (COPM) as an outcome measure in an orofacial pain setting was assessed, including specific occupational performance problems reported by individuals with temporomandibular disorder, orofacial pain, or both. Participants were patients ( N = 29) referred for treatment of chronic orofacial pain at a tertiary, university-based pain center. Assessments occurred prior to standard occlusal splint therapy and 8 weeks after the initial evaluation. Measures included the COPM, the Pain Disability Index, and numerical pain rating scales. The COPM scores showed significant correlations with other measures. Study participants identified a diverse range of occupational performance problems. The COPM may have utility as an outcome measure for use in orofacial pain. It provides the treatment team with data related to occupational performance and patient satisfaction.

The Canadian Occupational Performance Measure: Use in an independent living centre

This audit explores the use of the Canadian Occupational Performance Measure (COPM) in an independent living centre (ILC) in the UK. Although the COPM is widely used in a variety of situations, the audit setting is currently the only ILC in the UK using this outcome measure. It is used in this setting to prove the effectiveness of occupational therapy in order to secure ongoing funding for the ILC.

The audit took place over two years and examined results obtained with the COPM during this period. The findings of the audit were then compared to the findings and analyses of a pilot study carried out by Law et al (1994), which tested the use of the COPM as an outcome measure.

The audits highlights the effective use of COPM within this setting, recognizing its challenges and limitations, particularly when used by students and junior staff. It is suggested that this measure can be adopted by other organizations for the purpose of securing funding as well as to prove the value of occupational therapy in similar settings.

Quality of life in depression: predictive models

The purpose of this study was to examine the predictive factors of quality of life for inpatients with depressive disorders. Eighty-three patients (mean age 44; 73% female) with depressive disorders were recruited from the psychosomatic ward of a medical center in the northern part of Taiwan. The predictive models of this study were established by encompassing three constructs: clinical variables, demographics, and perceived competence. The outcome variables of this study included an overall quality of life score and four domains' scores of the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Stepwise regression analysis was used to identify significant factors related to the outcome variables. The results showed that there were five distinct models for the various domains of the quality of life. The predictive variables of the final model for overall quality of life included: the Beck Anxiety Inventory, the Canadian Occupational Performance Measure-satisfaction, and the Occupational Self Assessment-self. For the physical domain of the quality of life model, the adjusted Beck Depression Inventory-II, the Beck Anxiety Inventory, and the Activity of Daily Living Inventory were the significant predictors. In the psychological domain, the adjusted Beck Depression Inventory-II and age were the predictive factors. The adjusted Beck Depression Inventory-II, the Beck Anxiety Inventory and the Occupational Self Assessment-environment were the predictors for the social domain of quality of life. Finally, the adjusted Beck Depression Inventory-II, age, and the Occupational Self Assessment-environment were the predictors for the environmental domain of quality of life. The significance of the perceived competence variables in the quality of life of patients with depression indicates that occupational therapy intervention is warranted.

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.

A study compared nine patient-specific indices for musculoskeletal disorders

BACKGROUND AND OBJECTIVE

Patient-specific quality of life indices show great potential, but certain conceptual and methodological concerns have yet to be fully addressed. The present study reviewed nine patient-specific instruments used in musculoskeletal disorders: the Canadian Occupational Performance Measure (COPM), Juvenile Arthritis Quality of life Questionnaire (JAQQ), McMaster-Toronto Arthritis questionnaire (MACTAR), Measure Yourself Medical Outcome Profile (MYMOP), Patient-Specific Index (PASI) for total hip arthroplasty, Problem Elicitation Technique (PET), Patient Generated Index (PGI) of quality of life, Patient-Specific Functional Scale (PSFS), and Schedule for the Evaluation of Individual Quality of Life (SEIQoL).

STUDY DESIGN AND SETTING

Each tool was evaluated for purpose, content validity, face validity, feasibility, psychometric properties, and responsiveness.

RESULTS

This critical appraisal revealed important differences in terms of the concept underlying these indices, the domains covered, the item-generation techniques and the scoring (response scale, methods) in each scale. The nine indices would generate different responses and likely scores for the same patient, despite the fact that they all include patient-generated items.

CONCLUSION

Although the value of these indices in treatment planning and monitoring at an individual level is strong, more studies are needed to improve our understanding of how to interpret the numeric scores of patient-specific indices at both an individual and a group level.

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.

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.

Performance problems of patients with chronic low-back pain and the measurement of patient-centered outcome

STUDY DESIGN

In a prospective interventional study, problems with performance were evaluated in 101 consecutive patients with chronic low-back pain for more than 12 months, before and after participation in an outpatient-based multidisciplinary pain management program in Mansfield, United Kingdom.

OBJECTIVES

To describe problems identified as most important by patients with chronic low-back pain and to evaluate the Canadian Occupational Performance Measure (COPM) as a tool for measuring problem-specific outcomes.

SUMMARY OF BACKGROUND DATA

Patients with chronic low-back pain report difficulties with a variety of activities. The COPM permits the identification and measurement of problems of particular concern to the patient.

MATERIALS AND METHODS

COPM, likert-modified Roland and Morris Disability Questionnaire, Pain Self-Efficacy Questionnaire, and 5-minute walk test were administered at baseline, immediately after, and 9 months after intervention. Differences and statistical interactions were determined by nonparametric tests.

RESULTS

Participants identified 60 different types of problem activity, 45 of which were identified by nine or fewer participants. Decreased walking tolerance was the most frequently identified problem (56% of participants). Improvements were observed in all outcomes following intervention. Approximately one third of participants reported improvements two or more COPM units in overall performance and satisfaction with their performance at 9 months. Higher reported performance and satisfaction were associated with greater self-efficacy. Increased reported walking performance was associated with increased observed 5-minute walk distance (R = 0.35, P = 0.02).

CONCLUSIONS

Patients with chronic low-back pain report problems with diverse activities. The COPM provides a patient-centered outcome measure that displays good external validity and responsiveness to change when addressing the individual's goals.

Experiences with the COPM and client-centred practice in adult neurorehabilitation in Taiwan

The application of a client-centred approach and the Canadian Occupational Performance Measure (COPM) were investigated in a neurorehabilitation unit in Taiwan. Four Taiwanese occupational therapists were trained in the use of client-centred practice and the COPM before using them with 12 clients attending neurorehabilitation. The COPM and the Reintegration to Normal Living Index (RNL) were administered before treatment and after one month of neurorehabilitation to investigate the sensitivity of the COPM in measuring change. Pre and post interviews were also conducted with the participating occupational therapists to ascertain their perceptions of the clinical utility of the COPM, and to determine their views about the client-centred approach. Matched t-tests showed significant increases in clients' self-ratings of performance and satisfaction on the COPM and in RNL scores between pre and post tests. The qualitative findings highlighted issues regard-ing the administration, scoring and identification of problems in the COPM and client-centred practice, such as clients' willingness to manage their own health care and empowerment to participate in intervention, as well as therapists' knowledge of and confidence with this new approach. Although this study was limited by small sample size and the use of only one hospital neurorehabilitation unit, it has shown the utility of the COPM as an outcome measure in this setting. Further research is warranted to investigate cultural influences on client-centred practice.

Reliability and validity of the Canadian Occupational Performance Measure in stroke patients

OBJECTIVE

To research test-retest reliability and discriminant validity of the Canadian Occupational Performance Measure (COPM), a client-centred outcome measure, in stroke patients.

DESIGN

The COPM was administered twice with a mean interval of eight days (SD 2.5, range 5-16). On both occasions the patient identified a maximum of five problems in daily activities. The problems of both interviews were compared. The problems identified during the first COPM were rated by the patient on a performance and satisfaction rating scale on both occasions. The individually identified items with use of the client-centred COPM were compared with the fixed items of standardized measures (Barthel Index, Frenchay Activities Index, Stroke Adapted Sickness Impact Profile-30, Euroqol 5D and Rankin Scale).

SETTING

Patients were interviewed at their place of residence.

SUBJECTS

Twenty-six stroke patients participated, 11 men and 15 women, aged from 26 to 83 years (mean 68, SD 15). Twenty-four patients were six months, two patients were two months post stroke.

RESULTS

Of the 115 problems identified during the first COPM, 64 (56%) were also identified the second time. Correlation coefficients for the scores were 0.89 (p < 0.001) for performance and 0.88 (p < 0.001) for satisfaction. Of the individual problems identified with the COPM, 25% or less were present in the standardized measures. Correlations between the scores on the COPM and the standardized measures were low and nonsignificant, while all standardized measures correlated significantly with each other.

CONCLUSIONS

Test-retest reliability of the COPM was moderate for the item pool but was good for the performance and satisfaction scores. Discriminant validity was confirmed. Many patient-unique problems identified with the COPM were not evaluated by standardized measures.