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

Going beyond Activity and Participation: Development of the DIF-CHUM-A patient-reported outcome measure for individuals with Dupuytren's contracture

STUDY DESIGN

This is a cross-sectional clinical measurement.

INTRODUCTION

There are currently no Dupuytren's contracture (DC)-specific, patient-reported outcomes (PROs) that can provide a thorough clinical portrait of the patients' perceptions with regard to the execution of regular activities.

PURPOSE OF THE STUDY

The purpose of this study was to present the development of the Dupuytren's contracture Impact on Function-Centre Hospitalier de l'Université de Montréal (DIF-CHUM), a DC-specific PRO.

METHODS

The development process involved consultation of 45 individuals with DC and 7 health professionals, existing literature, and DC-specific PRO.

RESULTS

The DIF-CHUM is composed of 2 sections: section 1, Activity and Participation includes 8 items per hand, scored on Difficulty and Change scales; section 2, General Impact includes up to 18 items, scored on Difficulty, Importance, Change and Satisfaction scales. Preliminary evidence suggests that the DIF-CHUM demonstrates good content validity.

DISCUSSION

The DIF-CHUM is designed to be a patient-centered measure of Activity and Participation and Functional Competence for individuals with DC that will provide hand therapists with a unique perspective of the impact of DC on patients' lives.

CONCLUSION

Further validation of the DIF-CHUM, including its scoring, is under way.

Clinical utility of the Danish version of the Canadian Occupational Performance Measure

BACKGROUND

The Canadian Occupational Performance Measure (COPM) is intended to help clients identify and evaluate their occupational performance issues. As it enhances client-centred practice (CCP), more frequent use of the COPM might fulfill the political agenda of patient involvement in Denmark. However, in a study translating the COPM into Danish, challenges were found highlighting the need to study its clinical utility.

AIM

To examine the clinical utility of the Danish version of the COPM (COPM-DK) and help determine whether to recommend a more routinely use.

METHODS

Data gathered during qualitative interviews with 16 occupational therapists (OTs) from various settings were subjected to a qualitative content analysis.

RESULTS

The COPM-DK appeared to have clinical utility, especially regarding the meaning and relevance of the information obtained, and seemed to facilitate an occupational lens and CCP. The OTs' difficulties and concerns when using the COPM and their personal and environmental commitment to the COPM seemed associated with how they performed the COPM. Thus, training was recommended to facilitate a valid and reliable use.

CONCLUSION

Given the benefits and the perceived utility of the COPM-DK, a more routinely use, to place OTs and CCP in the center of Danish healthcare system, is recommended.Key MessagesThe utility of the Danish version of the Canadian Occupational Performance Measure is supported, according to Danish occupational therapists in various rehabilitation settings and hospitals.Using the Canadian Occupational Performance Measure seems to enhance a client-centred practice with collaborative goals and helps to establish partnership, being of value to the interdisciplinary team, too.The utility and acceptability of the Canadian Occupational Performance Measure seemed to be linked to the occupational therapists' experience and understanding of the Canadian Occupational Performance Measure's content and form, thus an introduction course is recommended to avoid a use that affects the assessment's validity and reliability.

Goal-setting in geriatric rehabilitation: a systematic review and meta-analysis

Objective:

To explore the effect of goal-setting on physical functioning, quality of life and duration of rehabilitation in geriatric rehabilitation compared to care as usual.

Data sources:

Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from initiation to October 2018.

Methods:

We included randomized controlled trials (RCTs), controlled before–after studies and studies using historic controls of older patients (mean age ⩾55 years) receiving rehabilitation for acquired disabilities. Our primary outcome was physical functioning; secondary outcomes were quality of life and rehabilitation duration. Cochrane guidelines were used to assess the risk of bias of the studies and extract data. Only RCT data were pooled using standardized mean difference (SMD).

Results:

We included 14 studies consisting of a total of 1915 participants with a mean age ranging from 55 to 83 years. Ten out of the 14 studies had a randomized controlled design, 7 of which could be pooled for the primary outcome. The risk of bias was judged high in several domains in all included studies. The meta-analysis showed no statistically significant differences between goal-setting and care as usual for physical functioning (SMD −0.11 (−0.32 to 0.10)), quality of life (SMD 0.09 (−0.56 to 0.75)) and rehabilitation duration (MD 13.46 days (−2.46 to 29.38)).

Conclusion:

We found low-quality evidence that goal-setting does not result in better physical functioning compared to care as usual in geriatric rehabilitation. For quality of life and duration of rehabilitation, we could not exclude a clinically relevant effect.

A critical discourse analysis of the attitudes of occupational therapists and physiotherapists towards the systematic use of standardised outcome measurement

PURPOSE

To investigate discourses relating to the implementation of standardised outcome measurement within rehabilitation practise.

METHOD

It is a critical discourse analysis of texts in professional occupational therapist (OT) and physiotherapist (PT) journals, along with transcriptions from three focus group interviews with 25 OTs and PTs in local rehabilitation settings.

RESULTS

Although positive attitudes towards outcome measurement were expressed in the professional journals, OTs and PTs in local settings had professional reservations about standardisation of the rehabilitation practise. The therapists were caught in what they considered to be a dilemma between taking a holistic approach and performing standardised practise. Systematic outcome measurement challenged the core values of their practise. Therapists often felt that 'it did not make sense' to use outcome measurement and this became a barrier to its implementation.

CONCLUSION

If the use of standardised outcome measurement is to be increased, reflection is needed on how the measurements can be integrated to provide a meaningful contribution to individual rehabilitation processes. To optimise implementation, it is essential to make use of research in knowledge translation and adapt it to fit with the ways in which new ideas and recommendations are implemented in local rehabilitation contexts. Implications for Rehabilitation Successful implementation of standardised outcome measurements depends on whether occupational therapists and physiotherapists have an experience of the measurements as being meaningful. Enforcement of standardised outcome measurements must be done by means of more than a few isolated arguments, if professional acceptance is to be gained. To reject established dogmas on, e.g. standardisation, deliberate and conscious reflections in local settings are needed. It is necessary to go beyond normal and familiar professional reflections. To this end, newcomers' opinions are valuable.

Comparing and Using Occupation-Focused Models

As health care moves toward understanding the importance of function, participation and occupation, occupational therapists would be well served to use occupation-focused theories to guide intervention. Most therapists understand that applying occupation-focused models supports best practice, but many do not routinely use these models. Barriers to application of theory include lack of understanding of the models and limited strategies to select and apply them for maximum client benefit. The aim of this article is to compare occupation-focused models and provide recommendations on how to choose and combine these models in practice; and to provide a systematic approach for integrating occupation-focused models with frames of reference to guide assessment and intervention.