Enhancing a Client-Centred Practice with the Canadian Occupational Performance Measure

First Step to empowering change: enhancing self-efficacy, energy management, and physical activity in patients with sleep apnea

Introduction

Fatigue often leads to a sedentary lifestyle, negatively impacting health, mortality, and quality of life. Engaging in physical activity can be challenging for individuals experiencing fatigue, particularly those with sleep apnea. This study's objective was to assess the "First Step" concepts' usability in constructing and implementing different interventions through qualitative data. The intervention targets patients with sleep apnea, focusing on individualized energy distribution and meaningful engagement in physical activity.

Methods

Two programs were developed based on the First Step concept, a rehabilitation program and a patient education program. Initially, 13 patients were recruited, split between the groups, with two dropping out. Primarily evaluated through qualitative data, patients in both groups attended group interviews. For one of the programs supplementary quantitative data were collected through the 6-min walk test (6MWT), Sit-to-Stand test, and Canadian Occupational Performance Measure (COPM). Patients in the rehabilitation program also monitored daily step counts using activity trackers.

Results

Patients found the energy management education enlightening, enabling them to make conscious changes in their daily lives. They reported the program's positive reception, with social interaction playing a crucial role in its success. Of the six patients who completed the rehabilitation program, significant improvements in 6MWT scores were observed, indicating enhanced walking endurance. While no changes were seen in the Sit-to-Stand test, COPM results showed notable improvements in performance and satisfaction with chosen activities.

Discussion

The incorporation of the First Step concept empowered patients with sleep apnea to manage fatigue, conserve energy, engage in meaningful activities, and improve their wellbeing. Merging occupational therapy and physiotherapy interventions effectively addressed daily challenges while promoting physical activity. Adaptations to the program, guided by patient feedback, suggest a preference for longer, more personalized sessions. This approach offers a promising pathway to improving quality of life for individuals with chronic conditions.

Conclusion

Our study highlights the usability of the First Step concept, integrating occupational therapy and physiotherapy, to address challenges in individuals with sleep apnea. The tailored, multidisciplinary intervention prioritizes meaningful activities, focuses on energy distribution and physical exercise, yielding improved satisfaction and performance. Further research is warranted to enhance this salutogenic approach for chronic conditions.

Practice, play, repeat - individualized outcomes after the "intensity matters!"-program for children with disabilities - a descriptive multicase study

PURPOSE

To examine and categorize individual outcomes after the "Intensity matters!"-program, a new, cross-professional intensive intervention for children with disabilities across Norway.

MATERIALS AND METHODS

84 children and their parents/legal guardian were enrolled in this multicase study. Participants were active in defining goals, and hereby the content of the intervention. The pre-settled goals were grouped into the categories of body functions and structure, activities and participation inspired by the components of the International Classification of Functioning, Disability, and Health (ICF). The pre-settled goals were assessed pre- and post-intervention by using The Canadian Occupational Performance Measure (COPM). A clinically important change was predefined as a change ≥2 points.

RESULTS

1004 pre-settled goals were categorized into focus areas, where 62.4% were categorized as activity; functional mobility (n = 626). Post-intervention assessment of the COPM ratings of child performance and satisfaction showed a mean change of 3.7 (range -0.25;8.5) and 3.8 (range 0.25;10), respectively.

CONCLUSION

The majority of participants in the "Intensity Matters!"-program had a clinically important change in their individual goals after only three weeks of intervention. This study supports the use of client-centered measures in rehabilitation for children with disabilities, but a further examination of long-term outcome is warranted.

Immersive participatory design of assistive robots to support older adults

Assistive robots have the potential to support independence, enhance safety, and lower healthcare costs for older adults, as well as alleviate the demands of their care partners. However, ensuring that these robots will effectively and reliably address end-user needs in the long term requires user-specific design factors to be considered during the robot development process. To identify these design factors, we embedded Stretch, a mobile manipulator created by Hello Robot Inc., in the home of an older adult with motor impairments and his care partner for four weeks to support them with everyday activities. An occupational therapist and a robotics engineer lived with them during this period, employing an immersive participatory design approach to co-design and customise the robot with them. We highlight the benefits of this immersive participatory design experience and provide insights into robot design that can be applied broadly to other assistive technologies.

Quantifying patient experiences with therapeutic neurorehabilitation technologies: a scoping review

PURPOSE

Neurorehabilitation technologies are a novel approach to providing rehabilitation for patients with neurological conditions. There is a need to explore patient experiences. This study aimed; 1) To identify available questionnaires that assess patients' experiences with neurorehabilitation technologies, and 2) where reported, to document the psychometric properties of the identified questionnaires.

MATERIALS AND METHODS

Four databases were searched (Medline, Embase, Emcare and PsycInfo). The inclusion criteria were all types of primary data collection that included neurological patients of all ages who had experienced therapy with neurorehabilitation technologies and completed questionnaires to assess these experiences.

RESULTS

Eighty-eight publications were included. Fifteen different questionnaires along with many self-developed scales were identified. These were categorised as; 1) self-developed tools, 2) specific questionnaire for a particular technology, and 3) generic questionnaires originally developed for a different purpose. The questionnaires were used to assess various technologies, including virtual reality, robotics, and gaming systems. Most studies did not report any psychometric properties.

CONCLUSION

Many tools have been used to evaluate patient experiences, but few were specifically developed for neurorehabilitation technologies and psychometric data was limited. A preliminary recommendation would be use of the User Satisfaction Evaluation Questionnaire to evaluate patient experience with virtual reality systems.

Occupational performance one to five years after aneurysmal subarachnoid haemorrhage: a cohort study

OBJECTIVE

To report on the self-perceived occupational performance of patients with aneurysmal subarachnoid haemorrhage and examine the associations between aneurysmal subarachnoid haemorrhage characteristics, socio-demographic factors and self-perceived problems.

DESIGN

A single-centre cohort study design was combined with a cross-sectional analysis.

SUBJECTS/PATIENTS

All patients with aneurysmal subarachnoid haemorrhage who were capable of performing activities of daily living before discharge from hospital were included.

METHODS

The assessment of the patient's occupational performance followed a patient-reported outcome measure 1 to 5 years after the subarachnoid haemorrhage. Secondary outcomes comprised scores from the Glasgow Outcome Scale, modified Rankin Scale, Fisher Scale, World Federation of Neurological Societies grading system, vasospasm, and hydrocephalus.

RESULTS

Of the 62 patients included in the study (66% female, mean age 55 years), 79% reported experiencing issues with occupational performance, most frequently with regard to leisure and productivity. The problems reported were significantly associated with vasospasm (p  =  0.021) and the Glasgow Outcome Scale score (p = 0.045).

CONCLUSION

Even patients who have had aneurysmal subarachnoid haemorrhage with a favourable outcome may encounter occupational performance difficulties for several years. It is vital to use patient-reported outcome measures to identify these issues. This research enhances our comprehension of aneurysmal subarachnoid haemorrhage patients' self-perceived occupational performance and the factors that affect their performance.

Occupational therapy in the management of haemophilia patients: A scoping review

BACKGROUND

Haemophilia is a haematological disease, although most haemorrhages occur in the locomotor system. Patients are physically disabled from an early age and have a poorer perception of quality of life. In the day-to-day lives of patients and their families, psychosocial well-being, the disease's physical, personal, and social impact, as well as work-related problems are the most complicated aspects of the disease that need to be addressed.

OBJECTIVE

To identify the role of occupational therapy in managing patients with haemophilia and to analyse the therapeutic potential of occupational therapy in treating these patients.

METHODS

A scoping review was conducted to identify the role of occupational therapy in managing patients with haemophilia and to analyse the therapeutic potential of occupational therapy in treating these patients. The review was registered in the international registry PROSPERO (Id: CRD42022319637). The databases consulted were SCOPUS, PubMed, PsycINFO, Web of Science and Science Direct, including all studies published until 14 August 2023.

RESULTS

No single study was found that specifically developed an occupational therapy intervention for patients with haemophilia. Measurement instruments have been identified, specific for patients with haemophilia and generic, that can be useful for the functional evaluation of these patients in the occupational therapy approach. Different studies showed the importance of multidisciplinary treatment, including occupational therapy.

CONCLUSIONS

The use of occupational therapy could be effective in improving autonomy and quality of life in haemophilia patients. Therefore, it is of paramount importance to conduct research studies within the field of occupational therapy.

Exploring Goals and Functional Changes in Reablement for People with Fractures and People with Dizziness and Balance Problems

Background

Although older people often have challenges with fractures and dizziness/balance problems, knowledge concerning the impact of reablement of people with these conditions is limited.

Aim

To explore functional changes in reablement for older home-dwelling people with fractures and dizziness/balance problems regarding 1) occupational performance and satisfaction with performance, 2) physical function and 3) health-related quality of life, and 4) which occupations they prioritize as rehabilitation goals.

Material and Methods

The sample is derived from a nationwide clinically controlled trial in Norway consisting of 149 participants with fractures and 113 with dizziness/balance problems who participated in a four to 10-week reablement program. Data were collected at baseline and at 10-week, 6-month, and 12-month follow-up and were analyzed with paired t-tests and analysis of covariance. Occupational priorities were categorized into sub-areas of occupation.

Results

Both groups had significant short-, mid-, and long-term improvements in occupational performance and satisfaction with performance. Except for balance from baseline to 12-month follow-up, the fracture group showed significant improvements in physical function and health-related quality of life at all follow-ups. The results varied more in the group with dizziness/balance problems in physical function and health-related quality of life. Functional mobility was the highest prioritized occupational sub-area in both groups.

Conclusion

The findings of this study provide extended knowledge about goals and functional changes in people with fractures and dizziness/balance problems following a reablement program.

Significance

Tailoring and individual adjustments according to diagnosis may be important in person-centered care in reablement.

Clinical practices, challenges, and job satisfaction of occupational therapists working in Community Mental Health Centers in Turkey

Introduction:

Occupational therapists have been involved in Community Mental Health Centers (CMHCs) since 2016 in Turkey. To the best of our knowledge, no data about occupational therapists’ practices in CMHCs is available in the extant research literature. Therefore, this study aimed to investigate the clinical practices, challenges, and job satisfaction of occupational therapists working for CMHCs in Turkey.

Method:

We conducted a cross-sectional survey study in which 28 volunteer occupational therapists working in CMHCs participated. The participants filled out the Sociodemographic and Professional Experience Information Form and the Job Satisfaction Scale.

Results:

Occupational therapists were experienced practitioners implementing various occupational therapist practices in community mental health and they were generally satisfied with their job. The challenges facing Occupational therapists were communicating with caregivers, motivating the client, enabling the client to perform occupational participation. Collaborative teamwork and participation in training about community mental health were found as the important factors contributing to occupational therapist professionals’ job satisfaction.

Conclusion:

Investigating the professional behaviors of Occupational therapists, an emerging health profession in Turkey, is important for the development of the profession. The education and supervision specially adapted for community mental health and the supportive teamwork seem to be significant for the job satisfaction of community mental health Occupational therapists.

Systematic review of measurement properties of the Canadian Occupational Performance Measure in geriatric rehabilitation

PURPOSE

The Canadian Occupational Performance Measure (COPM) is used to inventory problems experienced by the patient to set goals and evaluate treatment. We aimed to make a systematic overview of measurement properties for people in geriatric rehabilitation.

METHODS

Seven electronic databases were searched for psychometric studies investigating content validity, construct validity, responsiveness, or reliability of the COPM in geriatric rehabilitation populations aged ≥ 60 years. Two reviewers independently abstracted data and assessed methodological quality from included studies.

RESULTS

Of 292 identified articles, 13 studies were included. The COPM showed good test-retest reliability (two studies), moderate inter-rater reliability (one study), and good content validity (one study with some risk of bias). Four studies with minimal risk of bias showed good construct validity as their hypotheses were confirmed. Responsiveness was moderate in three studies with adequate methodological quality.

CONCLUSION

All measurement properties have been studied in geriatric rehabilitation populations, and indicate that the COPM gives relevant information for geriatric rehabilitation, and scores can be assessed reliably and are responsive to change. Although there were many studies on construct validity, authors had different opinions on what exactly COPM-scores tell us, as they used a variety of comparator instruments and different hypotheses. Consensus on exact interpretation of the scores is needed.

Short-Term Outcome of Rehabilitation Program with Hybrid Assistive Limb after Tendon Lengthening in Patients with Cerebral Palsy

In this study, we aimed to evaluate the short-term outcomes of a rehabilitation program with the Hybrid Assistive Limb® after soft tissue lengthening in young patients with cerebral palsy. We assessed six patients with cerebral palsy who underwent soft tissue surgery followed by gait training using the Hybrid Assistive Limb®. Clinical assessments were conducted preoperatively, before, immediately after, and at 1, 2, and 3 months after gait training. Gross Motor Function Measure was improved 5.93 ± 6.11% (mean ± standard deviation, p < 0.05), Canadian Occupational Performance Measure performance was improved 3.12 ± 1.53 points, and satisfaction was improved 3.80 ± 2.14 points (p < 0.05). The knee extension strength on the operated side was changed 7.75 ± 4.97 Nm after the intervention (p = 0.07). In ambulatory patients, gait speed was changed 8.37 ± 1.72 m/min, stride length was changed 10 ± 6.16 cm, and 6 min walking distance was changed 52 ± 16 m after the intervention. Training with the Hybrid Assistive Limb® may improve walking ability and clinical outcomes in young patients with cerebral palsy after soft tissue lengthening.

Occupational priorities and needs of blind and partially sighted people entering the labor market in Slovenia

BACKGROUND: People with vision impairment are a growing group of clients for occupational therapists, particularly those working in vocational rehabilitation. OBJECTIVE: To examine the occupational priorities and performance issues of blind and partially sighted people entering vocational rehabilitation in Slovenia. Possible differences between priorities and issues among diagnostic groups and in relation to the rehabilitation outcome were explored. METHODS: Records of 42 clients referred to vocational rehabilitation at the University Rehabilitation Institute in Ljubljana between 2007 and 2019 were reviewed. Information on self-perceived occupational priorities and issues was obtained from the Canadian Occupational Performance Measure (COPM). RESULTS: Household and other unpaid work was identified the most frequently (20%) as a priority, followed by job-seeking (19%) and community mobility (15%). Job-seeking was the top performance issue (43%), followed by community mobility (21%) and household management (19%). On the 1–10 scale, the average occupational performance and satisfaction scores were 6.7 and 6.5, respectively; no statistically significant differences in relation to the diagnosis or the rehabilitation outcome were observed. CONCLUSION: The results highlight the client-identified occupational priorities and issues beside job-seeking that need to be considered in planning occupational therapy and supporting the persons with visual impairments entering the labor market.

Rehabilitation Research in Denmark Between 2001 and 2020: A Scoping Review

The demand for rehabilitation has increased, and evidence is rapidly growing; however, a rehabilitative health strategy receives less attention than treatment. Knowledge of what is being researched, who are the target groups and who contributes to rehabilitation research is deficient. We did not find any reviews mapping rehabilitation research regarding the research questions. The objective was to identify and synthesize existing scientific evidence on rehabilitation research published by Danish institutions between 2001 and 2021. The research questions to be explored were: Among which study groups has rehabilitation research been published?. Which types of studies on rehabilitation have been published?. Which institutions have been involved in rehabilitation research?

Methods

The process was guided according to the Joanna Briggs Institute's (JBI's) scoping review methodology. Four databases were searched. All types of peer-reviewed studies on any target group and rehabilitation setting, with any affiliation to a Danish institution, were eligible to be included. Studies referring to population and the type of design were categorized. Institutions were counted as Danish first authorship.

Results

The search revealed 3,100 studies, and following screening 1,779 were included. A total of 24 broad study groups were identified, mostly diagnosis-based health conditions. Musculoskeletal, cancer, and cardiac had 342, 228, and 174 studies, respectively. A total of 1,545 had a Danish first authorship, most of the Danish publications came from hospitals (56.6%) and universities (28.4%). The publication trend showed an almost linear development, with a 10-15% increase during the period.

Conclusion

Following screening 1,779 studies were included involving 24 broad study groups. Most categories were diagnosis-based; musculoskeletal, cancer, and cardiac health conditions encompassed most studies. All study designs were represented, and 1/10 were secondary studies. The majority (87%) of studies had a Danish first authorship. The majority of first affiliations were among hospitals followed by universities. A few municipalities were presented although they are yet to have research responsibility. Publication trends showed an increase primarily from 2013.

Systematic Review Registration

https://osf.io/, identifier [10.17605/OSF.IO/2AENX].

Centredness in health care: A systematic overview of reviews

Introduction

The introduction of effective, evidence‐based approaches to centredness in health care is hindered by the fact that research results are not easily accessible. This is partly due to the large volume of publications available and because the field is closely linked to and in some ways encompasses adjoining fields of research, for example, shared decision making and narrative medicine. In an attempt to survey the field of centredness in health care, a systematic overview of reviews was conducted with the purpose of illuminating how centredness in health care is presented in current reviews.

Methods

Searches for relevant reviews were conducted in the databases PubMed, Scopus, Cinahl, PsychINFO, Web of Science and EMBASE using terms connected to centredness in health care. Filters specific to review studies of all types and for inclusion of only English language results as well as a time frame of January 2017–December 2018, were applied.

Results

The search strategy identified 3697 unique reviews, of which 31 were included in the study. The synthesis of the results from the 31 reviews identified three interrelated main themes: Attributes of centredness (what centredness is), Translation from theory into practice (how centredness is done) and Evaluation of effects (possible ways of measuring effects of centredness). Three main attributes of centeredness found were: being unique, being heard and shared responsibility. Aspects involved in translating theory into practice were sufficient prerequisites, strategies for action and tools used in safeguarding practice. Further, a variety and breadth of measures of effects were found in the included reviews.

Conclusions

Our synthesis demonstrates that current synthesized research literature on centredness in health care is broad, as it focuses both on explorations of the conceptual basis and the practice, as well as measures of effects. This study provides an understanding of the commonalities identified in the reviews on centredness in healthcare overall, ranging from theory to practice and from practice to evaluation.

Patient or Public Contribution

Patient representatives were involved during the initiation of the project and in decisions about its focus, although no patient or public representatives made direct contributions to the review process.

The responsiveness of the Danish version of the Canadian Occupational Performance Measure

Introduction

To establish the responsiveness of the Danish version of the Canadian Occupational Performance Measure (COPM-DK).

Method

A cross-sectional study was performed in three Danish settings, including 88 clients, 40 men, aged 16–90 years, with a variety of diagnoses. To determine construct responsiveness, the mean changes of the COPM performance and satisfaction score (COPM-P/S) were compared and correlated with the mean changes in the five-item World Health Organization (WHO) Well-Being Index (WHO-5) and the EuroQol–five domains–five levels questionnaire (EQ-5D-5L). To determine the responsiveness, data were analysed with ROC curves to establish the optimal cut-point values for the COPM-DK scores. Minimal important change (MIC) was assessed in relation to anchor-based questions.

Results

The mean change for COPM-P/S was 3.1 and 3.0, respectively. Small positive correlations were found between the COPM-DK scores and the WHO-5 and EQ-5D-5L scores. The AUC were 0.76 and 0.75, respectively. The optimal cut-point values for the COPM-P/S-scores based on either all positive answers or to the two highest, were 1.2 or 4.20 (COPM-P) and 1.67 or 5.80 (COPM-S), respectively

Conclusions

The capability of the COPM to detect changes in perceived occupational performance issues is supported. We recommend an MIC on 3.5 points on both scales.

Learning, translating, and applying the perceive, recall, plan, perform system of task analysis assessment to practice: Occupational therapists’ experiences

Introduction

This study explored occupational therapists’ experiences of embedding the Perceive, Recall, Plan, Perform System of Task Analysis (PRPP) assessment in practice and gained understandings of the clinical utility.

Methods

Qualitative interpretive description research using data from semi-structured interviews with 11 New Zealand registered occupational therapists and a focus group with two Māori occupational therapists. Thematic data analysis was used to develop themes.

Results

Five themes emerged: Resonating with practice as it should be, Translating to practice, Communicating assessment findings using an occupational performance focus on cognition, Validating the practice fit and Cultural application. Participants described the PRPP assessment as a flexible tool, which was applied in different ways in varied practice settings, with clients performing a range of culturally specific occupations. Embedding the assessment in practice was an involved process that challenged many participants’ existing assessment procedures and included managing team expectations to perform cognitive-based assessments.

Conclusions

The PRPP assessment added value to occupational therapists’ practice. Effective implementation of the assessment required a secure occupation-focused perspective and client-centred culturally responsive communication skills. Commitment was needed to both adopt a new assessment process and to communicate occupation-based assessment results. Participants connected as social learners to address practice challenges post-training.

Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis

STUDY DESIGN

This is a longitudinal, observational, multicenter, cohort study.

INTRODUCTION

Thumb carpometacarpal (CMC) osteoarthritis (OA) is associated with more pain and restrictions than other hand OA. The use of patient-identified occupational performance goals to guide hand therapy treatment and to measure clinical outcomes is fundamental for a patient-centered intervention. The COPM enables subjects to identify goals for hand therapy and engage in a subject-specific therapeutic process.

PURPOSE OF THE STUDY

The purpose of this study is to evaluate the convergent validity and responsiveness of the COPM to evaluate the relationship between the patient's self-perception and satisfaction of performance in everyday living and pain intensity, upper limb function, and manual ability.

METHODS

Eligible participants to multiple hand therapy centers were recruited. Outcomes measures (VAS scale, QuickDASH, MAM-36, and the COPM questionnaire) were measured at the baseline and 3 months after.

RESULTS

One hundred forty-five (n = 145) consecutive patients for five different hand rehabilitation centers with symptomatic thumb CMC OA were screened for eligibility criteria. COPM-P and COPM-S were the most responsive instruments, with an area under the curve of 0.88 (95% CI 0.79-0.96) and 0.88 (95% CI 0.80-0.96), respectively.

CONCLUSIONS

Although more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions for thumb OA. The COPM focuses on function and occupation and, in comparison with others upper limb scales, does not require the use of another complementary scale for addressing both satisfaction and ADL status. COPM is an instrument with a good convergent validity and responsiveness to evaluate the relationship between the patient's self-perception and satisfaction in thumb CMC OA.

The Canadian Occupational Performance Measure (COPM) as Routine Practice in Community-Based Rehabilitation: A Retrospective Chart Review

Objective

To investigate whether patients experienced improved functional outcomes as a result of their admission to rehabilitation and to identify whether the service provided effective, patient-centered and goal-directed rehabilitation.

Design

Retrospective chart review of admission and discharge data from patients accessing the service between 2011 and 2019.

Setting

Community-based interdisciplinary rehabilitation service.

Participants

Consecutive patients (N=612) admitted to the service.

Interventions

Routine care delivered with a median duration of 181 days and an interquartile range of 120-261 days.

Main Outcome Measures

The Canadian Occupational Performance Measure (COPM) administered on admission and discharge and an improvement ≥2 in the COPM subscales of performance and satisfaction.

Results

Of 612 participants, 96% had the COPM administered at admission (baseline) and 68% again at discharge. Performance and satisfaction were measured in 584 patients at admission, 406 at discharge, and 404 at both time points. For performance, 243 patients (60%) experienced an improvement (≥2), with an average of 2.2 points. For satisfaction, 268 patients (66%) experienced an improvement (≥2), with an average of 2.8 points. Factors influencing outcomes, differed. For each 10 year increase in patient age, the average improvement in satisfaction was 0.26 points lower (95% confidence interval, 0.07-0.45) after adjusting for sex, duration, completion, and health condition.

Conclusions

Irrespective of patient-related factors and regardless of age, sex, health condition, or discharge plan, the majority of patients reported a positive functional outcome in COPM Performance and satisfaction as a result of time spent in the community-based rehabilitation service. This service provided equitable care and patient-centered, goal-focused, and outcome-based therapy that enabled patients to improve their functional capacity.

The reliability of the Danish version of the Canadian Occupational Performance Measure

Introduction

This study aims to assess the reliability of the Danish version of the Canadian Occupational Performance Measure (COPM).

Method

151 clients, 42.4% male, mean age 66.9 years ( SD: 14.4, range: 16–90), from two hospitals and two rehabilitation centres were interviewed twice with the COPM over a ten-day mean interval ( SD: 4.9, range: 2–27) either by the same (intra-rater) or two different occupational therapists (inter-rater). Data were analysed with intra-class correlation coefficients, coefficient of repeatability, and Bland–Altman plots.

Results

823 occupational performance issues were prioritized of which 41%, 338 occupational performance issues (95% CI: 37.7–44.5), were mentioned in both interviews. The intra-class correlation coefficients were 59.8 (95% CI-intra-class correlation coefficients: 49.3–69.5) (COPM), 73.5 (95% CI intra-class correlation coefficients: 65.5-80.2) (COPM-Performance), and 71.8 (95% CI intra-class correlation coefficients: 63.4–78.8) (COPM-Satisfaction). The limits of agreement were −2.83 to 3.05 for the COPM-Performance and −3.50–3.53 for the COPM-Satisfaction. The COPM-Importance scores were highest when obtained by two raters, but opposite for the scores of the COPM-Performance and COPM-Satisfaction. The coefficient of repeatability roughly showed a change in +/- three points (COPM-Importance: 2.67; COPM-Performance: 2.94; and COPM-Satisfaction: 3.52). Correspondingly, Bland–Altman plots showed limits of agreement for the mean values of −2.71 and 3.53, respectively.

Conclusions

The intra-rater and inter-rater reliability of the COPM were moderate across settings, clients and rater experiences.

The Effectiveness of Client-Centered Intervention With Telerehabilitation Method After Total Knee Arthroplasty

There is known to be a decrease in quality of life and perceived occupational performance and satisfaction following total knee arthroplasty (TKA). This study was planned to examine the effectiveness of a client-centered (CC) intervention with the telerehabilitation (TR) method on the quality of life, perceived occupational performance, and satisfaction after TKA. A total of 38 patients who had undergone TKA were randomly assigned to the CC and control groups. A 12-day intervention program was applied to the CC group. The Nottingham Health Profile (NHP) and Canadian Occupational Performance Measure (COPM) were applied before and after intervention. The 12-day intervention showed a strong effect on all parameters in the CC group (p<.001). In the postintervention comparisons, a significant difference was found in favor of the CC group (p < .001). CC interventions with the TR method can be used in post-TKA interventions.

The Person-Centered Rehabilitation Model: Framing the concept and practice of person-centered adult physical rehabilitation based on a scoping review and thematic analysis of the literature

OBJECTIVE

To develop a cross-professional model framing the concept and practice of Person-Centered Rehabilitation (PCR) in adult populations, based on a scoping review and thematic analysis of the literature.

DATA SOURCES

Key databases (PubMed, Scopus, CINAHL), snowballing searches, and experts' consultation were the data sources for English-language empirical or conceptual papers, published from January 2007 to February 2020.

STUDY SELECTION

Two independent reviewers selected adult-based papers addressing at least one of the six categories of PCR-related content, a priori specified in the published review protocol. From 6527 unique references, 147 were finally included in the analysis. Of those, 26 were exclusively conceptual papers.

DATA EXTRACTION

Two independent reviewers extracted textual data on what PCR entails conceptually or as a practice. No quality appraisals were performed as is typical in scoping reviews.

DATA SYNTHESIS

A thematic analysis produced thematic categories that were combined into an emergent model (the PCR Model), which was reviewed by five external experts. PCR was framed as a way of thinking about and providing rehabilitation services "with" the person. PCR is embedded in rehabilitation structures and practice across three levels: 1) the person-professional dyad, 2) the micro-system level (typically an interprofessional team, involving significant others) and 3) a macro-system level (organization within which rehabilitation is delivered). Thematic categories are articulated within each level, detailing both the conceptual and practice attributes of PCR.

CONCLUSION

The PCR model can inform both clinical and service organization practices. The PCR Model may benefit from further developments including obtaining wider stakeholders' input, determining relevance in different cultural and linguistic groups, and further operationalization and testing in implementation projects.

The influences of the environment and information on the complications of diabetes on patient outcomes

This letter was written to address two concerns about the results of the paper published by Zeynep et al. (BMC Health Qual Life Outcomes 18:265, 2020). First, the differences between the two groups in the environment with or without occupation may strengthen the primary outcome results. Second, lack of information on the complications and treatments of diabetes makes interpretation of the results difficult.

Use of a technology-based system to motivate older adults in performing physical activity: a feasibility study

Background

Maintaining or initiating regular physical activity (PA) is important for successful aging. Technology-based systems may support and stimulate older adults to initiate and persevere in performing PA. The aim of the current study was to assess to which extent a customised Kinect system is 1) a credible tool to increase PA in older adults, 2) motivating to perform PA by older adults, and 3) easy to be used in older adults.

Methods

A mixed-method cross-sectional feasibility study was performed in 5 aged care facilities in Flanders, Belgium. Aged participants were asked to perform a 20–30 min test with the intelligent Activity-based Client-centred Training (i-ACT) system. After the test, the ‘Credibility and Expectancy Questionnaire’ (CEQ), the ‘Intrinsic Motivation Inventory’(IMI), the System Usability Scale (SUS), and semi-structured interviews were conducted in the older adults. Feedback was gathered using the thinking aloud method in both aged participants and healthcare professionals.

Results

A total of 48 older adults (20 males and 28 females, mean age = 81.19 (SD = 8.10)), were included. The scores pertaining to system credibility and expectancy, system usability, and motivation towards use were moderate to good. Participants reported that they liked using the i-ACT system, but that the context could be more attractive by adding more visualisations. Twelve professionals stated that they observed involvement in older adults but think that i-ACT is better used in day care centres.

Conclusions

This study indicates that i-ACT is a usable and motivational system to engage older adults to perform PA and therefore supports successful aging. Future research is necessary to investigate the efficacy of i-ACT to perform PA and the transfer to regain and/or maintain engagement in ADLs that older adults find meaningful and purposeful at an older age. Also, further development of i-ACT is advisable to adapt the i-ACT system towards implementation at the home of older adults.

Trial registration

ClinicalTrial.gov ID NCT04489563, 23 July 2020 - Retrospectively registered.

Quality of life and occupational performance of children with cancer in the era of the COVID-19 pandemic in terms of rehabilitation

PURPOSE

This study was designed to determine the changes in the quality of life (QOL) and occupational performance of children with cancer and to examine their rehabilitation needs during the pandemic period in Turkey.

METHODS

60 children with cancer and their families participated in the study. The first and second assessments were carried out in April and September 2020, respectively. The pediatric quality of life inventory parent proxy-report was used to evaluate the QOL, and the Canadian occupational performance measurement was used to evaluate children's occupational performance and satisfaction. A qualitative interview was planned to determine the impact of the pandemic on children with cancer alongside their families and therefore determining the rehabilitation needs of the children.

RESULTS

While there is no statistically significant change in the pain-related conditions of the children in the first six months of the pandemic (p > 0.05), procedural and treatment anxieties of the children increased during the treatment. Their QOL including cognitive state, perceived physical appearance and communication skills also showed a statistically significant decrease (p < 0.05). Both the occupational performance and satisfaction scores decreased significantly, covering the pre-pandemic and pandemic era (p < 0.01). In the qualitative interview parents expressed their children's need for physical, psychological and social participation support. Also, they emphasized the need for time management.

CONCLUSIONS

During the COVID-19 pandemic, the QOL and occupational performance level of children with cancer decreased significantly. Holistic rehabilitation approaches complying with pandemic conditions are likely to benefit these children.

Client-centred practice in occupational therapy after stroke: A systematic review

Background: Client-centred practice aims to involve the person in making decisions during the therapeutic intervention process, giving him or her a central and active role.Objectives: To analyze the effects of client-centred practice in occupational therapy on issues related to occupational performance and participation among people with stroke and traumatic brain injury.Material and methods: A systematic review of randomized clinical trials examining the effects of a client-centred practice carried out by occupational therapists in patients with stroke or traumatic brain injury aged over 18 years was conducted. PubMed, Web of Science, Scopus, OT Seeker, PsycINFO and EBSCO were used to retrieve potentially eligible publications.Results: Eight studies, from 294 identified, were included. The extracted data showed that the application of client-centred practice in occupational therapy improved satisfaction with occupational performance compared to conventional interventions. However, client-centred practice and conventional intervention had similar effects on functionality (Activities of Daily Living), life satisfaction and burden on caregivers.Conclusions and significance: Client-centred practice has the effect of achieving greater satisfaction with occupational performance. This suggests that client-centred practice in occupational therapy helps patients to accept the new limitations on their occupational performance. Further studies are needed to determine the effects of client-centred practice on other aspects.

Effects of Home-visit Occupational Therapy Using a Management Tool for Daily Life Performance on Severe Mental Illness: A Multicenter Randomized Controlled Trial

AIM

Effective intervention is necessary for improving the social functioning of patients with severe mental illness (SMI). We examined the effects of home-visit occupational therapy (OT) using a Management Tool for Daily Life Performance (MTDLP) that was designed to support patients in completing their desired daily life activities. The control group were treated by home-visit OT without using MTDLP.

METHOD

In this multicenter randomized controlled trial, 60 participants included adults aged 18-65 with an ICD-10 diagnosis of F2 (i.e., schizophrenia, schizotypal and delusional disorders) or F3 (i.e., mood [affective] disorders) and who utilized one of the 20 psychiatric outreach teams in Japan. Participants were randomly assigned into two groups: MTDLP (n = 29), control (n = 31). Home-visit OT was provided to both groups, once a week, for four months. A repeated-measures analysis of variance was conducted to compare changes in participants' social functioning using the Global Assessment of Functioning (GAF) and the Social Functioning Scale (SFS).

RESULTS

The GAF scores of the MTDLP group improved significantly greater than those of the control group. No significant change in SFS total scores was found between the groups; however, the Employment/Occupation scores (an SFS subscale) of the MTDLP group significantly improved compared to the controls.

CONCLUSION

These findings suggest that MTDLP can increase the social functioning of people with SMI more so than controls. Thus, home-visit OT using MTDLP that is intensively focused on the patient's desires and implemented in the real-world environment appears to contribute to improvements in social functioning.

The Impact of the Quantity and Quality of Social Support on Patients with Chronic Pain

PURPOSE OF REVIEW

Social support is an important yet often overlooked aspect of chronic pain management. Understanding the impact of social support on patients with chronic pain and determining if a relationship exists between a patient's perceived social support and their perceived quality of life is a crucial component to completely treating a pain patient. We sought to develop an intervention for patients with chronic pain that addresses the different types of social support, barriers to using social support, and ways to improve the quality of their social support.

RECENT FINDINGS

A retrospective review of a prospectively collected database was utilized in an Outpatient Chronic Pain Rehabilitation Program with 23 patients with a chronic pain diagnosis who participated in a 3-week comprehensive pain rehabilitation program. Evaluation, intervention, and discharge were evaluated utilizing The American Chronic Pain Association's Quality of Life Scale and The Canadian Occupational Performance Measure (COPM). The intervention phase comprised a 45-min group session. At discharge, the occupational therapist followed up with the patient regarding the results of their social survey. Overall, the results indicated an underutilization of social support among patients with chronic pain. Out of the four questions asked on the social support survey, patients scored their use of tangible support (Q2) as the lowest. No significant positive correlation (0.27) was found between social support and quality of life which can be attributed to the wide variety of patients seen at the PRC. Social support is an essential part of chronic pain treatment and should be addressed throughout all stages of pain management.

Occupational performance goals and outcomes of time-related interventions for children with ADHD

BACKGROUND

Children with attention deficit hyperactivity disorder (ADHD) have difficulties with occupational performance, related to difficulties with time-processing ability.

AIMS

To examine the outcome of a multimodal time-related intervention designed to support children aged 9-15 years with ADHD, to achieve their occupational performance goals and improve satisfaction with occupational performance. A further aim was to compare the children's ratings of outcome with their parents' ratings and to analyse the occupational performance goals.

MATERIAL AND METHODS

A pre-post design was used. Participants were 27 children, aged 9-15 years. Children and parents rated occupational performance and satisfaction at baseline and follow-up, after 24 weeks, using the Canadian Occupational Performance Measure (COPM). The intervention consisted of time-skills training and time-assistive devices (TADs). Descriptive and non-parametric statistics were used.

RESULTS

Significant improvements were found in reported performance and satisfaction. Children's were higher than those of their parents. Most goals were about carrying out daily routines, knowing the duration of an activity and knowing what will happen in the near future.

CONCLUSION AND SIGNIFICANCE

The study contributes to knowledge about suitable interventions for children with ADHD who have time-related difficulties. Occupational therapy interventions, including TADs and time-skills training, resulted in significantly improved occupational performance.

Cognitive Assessments Used in Occupational Therapy Practice: A Global Perspective

This exploratory study was aimed at evaluating the current status of global occupational therapy practice on the use of assessments for clients with cognitive impairments and providing recommendations for ongoing evidence. We targeted international occupational therapy clinicians working with clients experiencing neurocognitive impairments. 323 occupational therapists from a wide range of clinical practice areas participated in the study. A large number of therapists used noncognitive specific assessments with a focus on functional approaches. The most commonly used standardized assessments were the COPM (56.7%), followed by MMSE (54.2%) and MoCA (45.5%), while the nonstandardized assessments were clinical observation (38.4%) and generic ADL assessment (34.1%). The use of main assessments was significantly different across world regions (p < 0.05), as were the reasons for choosing them (p < 0.05). The occupational therapists' use of assessment tools with clients suffering from neurocognitive impairments is inconsistent across the globe. The identification of international best practices for selecting and implementing proper outcome measures is warranted. It is essential to promote the development of an occupational therapy initiative to support the use of appropriate assessments at the international levels to facilitate consistent best practice.

Relationships between executive functions and occupational performance of children with medulloblastoma

Introduction

This study examines executive functions and occupational performances of children with medulloblastoma and children with typical development. The aim was to compare the executive function and occupational performance levels of children with medulloblastoma and children with typical development and to investigate the relationship between the executive function and occupational performance levels of children with medulloblastoma.

Method

Parents of 105 children (6–12 years) completed the Childhood Executive Function Inventory. A total of 105 children were administered the Canadian Occupational Performance Measurement to obtain information on occupational performance areas. Executive functions and occupational performance levels of children with medulloblastoma ( n = 52) and typical development ( n = 53) were compared. Correlation analysis was conducted between the executive functions and occupational performances of children with medulloblastoma.

Results

Executive function and occupational performance levels of children with medulloblastoma were lower than those with typical development. Significant relationships were found between the executive functions and occupational performances of children with medulloblastoma ( p < 0.05, p < 0.001).

Conclusion

It is clear that the executive functions of children with medulloblastoma significantly affect their occupational performance level. Client-centered, occupation-oriented cognitive therapy interventions prepared according to occupational therapy theories and models might be useful to increase the occupational performance level of children with medulloblastoma.

Client-centred practice in Scandinavian contexts: A critical discourse analysis

Background: The concept of client-centred practice is an essential element of occupational therapy (OT), but there is a lack of a clear and shared definition of the concept in Scandinavia (Norway, Sweden and Denmark). This may complicate the articulation, discussion, development and implementation of client-centredness in OT practices.Aim: The purpose of this study was to investigate and discuss current understandings of client-centred practice in Scandinavian contexts.Material and method: The study was based on a social constructivist research approach in which Fairclough's critical discourse analysis was applied. The analysis was based on six documents published in Scandinavian OT journals and four documents published in Scandinavian Journal of OT.Results: In Scandinavian contexts, the concept of client-centred practice was articulated in three overall discourses: a client, collaborative and practice discourse. The practice discourse was the most prominent and the source of the other discourses.Conclusions and significance: Occupational therapists (OTs) in the Scandinavian countries have conceptual understandings of client-centred practice that potentially provide the basis for knowledge sharing and collaboration between OT communities. However, the study also found that client-centred practice may not yet be firmly established in all OT practices in Scandinavia.

Looking into the Content of the Canadian Occupational Performance Measure (COPM): A Danish Cross-Sectional Study

PURPOSE

To examine the content validity of the Danish version of the Canadian Occupational Performance Measure (COPM-DK).

MATERIALS AND METHODS

This cross-sectional study was performed in a hospital and a community rehabilitation centre. The content validity of the COPM was assessed by relating the clients' prioritized occupational performance issues (OPIs) to the conceptual model of the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the levels of the Taxonomic Code of Occupational Performance (TCOP). Six occupational therapy lecturers participated in classifying the OPIs using the TCOP.

RESULTS

A total of 112 clients from a regional and community-based rehabilitation participated. The 56% regional participants came from a hospital's hand and knee surgery department. The remaining 44% participants came from a community-based rehabilitation centre with in- and outpatient departments. There were 44% males, with a mean age of 65.2 years. They prioritized 495 OPIs, of which 40% concerned self-care, 32% productivity, and 28% leisure. The prioritized OPIs were divided into a total of 224 different OPIs. There were significant differences in which areas were prioritized in the various population groups. Of the OPIs, 64.3% could be classified into the TCOP levels of occupation and activity, i.e., 1/3 of the OPIs were related to tasks and actions, and thus beyond the scope of the COPM. The interrater agreement of the OPI classification was only fair (kappa 0.3).

CONCLUSION

The content validity of the COPM seems to depend on how and with which clients it is administered. Caution must be taken to secure OPIs on the higher levels of the TCOP, while maintaining the clients' right to nominate OPI preferences. Therefore, an introductory course and on-going support are recommendable. Bearing this in mind, the COPM seems useful to identify individual clients' prioritized OPIs in a Danish context.

The Validity of the Danish Version of the Canadian Occupational Performance Measure

PURPOSE

To establish the construct validity of the Danish version of the Canadian Occupational Performance Measure (COPM).

METHODS

A cross-sectional study was performed in two settings, a regional hospital and a rehabilitation centre in a community. Including adult clients with a variety of diagnoses, we assessed construct validity by correlating the COPM to the Occupational Self-Assessment (OSA), the five-item World Health Organization Well-Being Index (WHO-5), and the EuroQol-five domain-five level questionnaire (EQ-5D-5L). Further examination of the comparability of the OSA and the COPM was performed in two ways. First, an interrater agreement of the theoretical correlation of the 21 OSA items and the three areas of the COPM was conducted. Secondly, we examined the compliance between the prioritized occupational performance issues (OPIs) and items of the OSA prioritized for change.

RESULTS

The study included a total sample of 112 participants with more than half of the participants (56%) recruited from the hospital. 109 participants had measurements for both COPM and OSA (44% males) with a mean age of 64.7 years (range 16-96 years). All correlations, between the COPM and the OSA, the WHO-5, and the EQ-5D-5L, were low or negligible (r < 0.50). Manual examination confirmed a difference in the constructs of the OSA and the COPM. This was demonstrated by a negligible interrater agreement between the items of the OSA and the areas of the COPM, and differences in the prioritized OPIs and OSA items, even if there were some resemblances, were found.

CONCLUSIONS

This study suggests that the construct of the COPM provides data different to those obtained with the standardized measurements included for comparison. The present study supports the assumption that the COPM can detect unique OPIs that clients want to do, need to do, must do, or are not satisfied with the way they do.

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.

Everyday occupations prioritised by older adults participating in reablement. A cross-sectional study

Background: Little knowledge exists regarding which occupations older adults prioritize as rehabilitation goals in reablement and what factors are associated with their preferences.Objectives: To explore which occupations older people with functional decline find important to improve, which of these they prioritize as their rehabilitation goals, and what factors are associated with these priorities.Materials and methods: A cross-sectional study was undertaken with a sample of 738 older adults from a nationwide trial evaluating the effects of reablement in Norway. The nine occupational sub-areas of the Canadian Occupational Performance Measure were used as a framework for analyses.Results: Participants identified a multitude of occupations as challenging. Functional mobility was the most frequently identified and prioritized sub-area. Significant associations were found between prioritized occupations and health condition, sex, living status, education, walking speed and motivation.Conclusions: This study found both abundance and diversity in the occupational problems and prioritized goals of older adults, with mobility being a key priority regardless of health condition.Significance: It is important that reablement continues to be a person-centered intervention embracing the possibility to choose meaningful occupations. Occupational Therapists and other health professionals should address mobility when improving occupational performance in older adults.