Validity and community utility of the Canadian Occupational Performance Measure

The relationship between prognostic factors and patient satisfaction with performance of self-identified goals following interdisciplinary mild traumatic brain injury rehabilitation

BACKGROUND

Individuals with persistent symptoms following a mild traumatic brain injury (mTBI) demonstrate improved satisfaction with their performance of self-identified rehabilitation goals after completing a combined occupational therapy and physiotherapy group intervention. However, the relationship between factors associated with developing persistent symptoms following an mTBI and satisfaction with their performance of self-identified goals after completing an intervention are unknown.

OBJECTIVE(S)

To evaluate whether factors associated with developing persistent symptoms influence satisfaction with the performance of self-identified goals after completing a combined occupational therapy and physiotherapy group intervention.

METHODS

During intake assessments, individuals with persistent mTBI symptoms completed the satisfaction section of the Canadian Occupational Performance Measure (COPM-S), the Rivermead Post-Concussion Symptom Questionnaire (RPQ), and the Generalized Anxiety Disorder Seven-Item Scale (GAD-7). Participants re-rated their satisfaction with performance of self-identified goals using the COPM-S during their discharge assessment. The influence of age, sex, days since injury, education, mechanism of injury, baseline COPM-S, GAD-7, and RPQ scores on goal satisfaction ratings were analyzed using a binomial logistic regression.

RESULTS

One hundred and ninety-eight individuals (44.7 ± 13.6 years old) were included in this study, and 92% experienced a clinically important improvement in their goal satisfaction ratings after completing the intervention. Neither age, sex, days since injury, education, mechanism of injury, baseline COPM-S, GAD-7, or RPQ scores significantly influenced satisfaction with performance of self-identified goals.

CONCLUSIONS

Factors associated with developing persistent symptoms following an mTBI did not influence goal satisfaction after completing a combined physiotherapy and occupational therapy group intervention.

Validity and reliability of the Turkish version of "The Occupational Circumstances Assessment Interview and Rating Scale" in rheumatic diseases

Introduction

Rheumatic diseases significantly impact daily activities, emphasizing the need to understand their occupational profiles. Identifying these profiles using the Occupational Circumstances Assessment Interview and Rating Scale can aid in tailoring treatment approaches. This study aimed to evaluate the validity and reliability of the Turkish version of Occupational Circumstances Assessment Interview and Rating Scale in rheumatic diseases.

Method

The scale's internal construct validity was examined using the Rasch measurement model. Convergent validity of Turkish version of Occupational Circumstances Assessment Interview and Rating Scale was evaluated through Spearman's correlation coefficient, assessing associations with the Community Integration Questionnaire, World Health Organization Disability Assessment Schedule, Second Version and Canadian Occupational Performance Measure.

Results

Correlation analyses demonstrated a positive correlation between Turkish version of Occupational Circumstances Assessment Interview and Rating Scale Rasch-transformed scores and Canadian Occupational Performance Measure total (r = 0.208; p = 0.009), along with negative correlations with Community Integration Questionnaire (r = -0.210; p = 0.008) and World Health Organization Disability Assessment Schedule, Second Version (r = -0.539; p < 0.000).

Conclusion

Findings confirm Turkish version of Occupational Circumstances Assessment Interview and Rating Scale as a valid and reliable tool for assessing the occupational profiles of individuals with rheumatic diseases. It can guide treatment plans and help develop effective strategies to enhance daily life participation.

Perspectives on Airway Protection: A Mixed Methods Investigation in People With Parkinson's Disease

PURPOSE

Disordered airway protection, including both disordered swallowing (dysphagia) and disordered cough (dystussia), is highly prevalent among persons with Parkinson's disease (pwPD). A comprehensive understanding of the perspectives of pwPD as it relates to airway protection is currently lacking and is necessary to provide relevant, person-centered care. Therefore, this study used a parallel-convergent mixed methods design to quantitatively and qualitatively investigate pwPD's perspectives on airway protection.

METHOD

Thirteen pwPD were consecutively recruited from a cough training trial. Quantitative data (obtained from the Swallowing Quality of Life questionnaire [SWAL-QOL] and the modified Canadian Occupational Performance Measure [mCOPM]) and qualitative data (obtained from semistructured interviews) were integrated to define participant knowledge, perceived importance, perceived performance, and psychosocial implications of airway protective deficits.

RESULTS

All participants reported basic knowledge about airway protection, which centered around four themes-physiology, the interconnectedness between bulbar functions, danger, and impaired airway protection as a consequence of PD. All participants believed that airway protection was important (median mCOPM score = 10), with three primary themes related to importance-survival, anticipated future decline, and maintaining oral intake. We identified a split between participants who perceived themselves to have "a swallowing problem" and those who did not, with three themes relating to perceived impairment-use of eating strategies, unpredictable and inconsistent symptom experience, and vigilance required to mitigate symptoms. Psychosocial ramifications centered on three key themes that aligned with three SWAL-QOL domains-overall burden, fear of future decline, and social embarrassment.

CONCLUSION

The integration of quantitative and qualitative data in this study highlights the importance of considering unique patient perspectives to develop personalized and relevant management plans for each unique pwPD that integrate objective and clinical findings with patient priorities and needs.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28489280.

Cognitive Orientation to Daily Occupational Performance (CO-OP) in Parkinson's: Randomized Trial Findings

BACKGROUND

People with Parkinson's disease (PwPD) experience increasing disability due to progressive motor and non-motor symptoms. Comprehensive rehabilitation approaches are needed to maximize their daily functioning. CO-OP targets daily functioning and has established efficacy in populations with similar symptom profiles.

PURPOSE

To explore the potential of CO-OP for PwPD, a feasibility randomized controlled trial (RCT) was conducted.

METHODS

Consenting PwPD (n = 20) were recruited to a parallel group, assessor masked RCT. Following baseline assessment, participants were randomized to CO-OP (20 sessions:10-weeks) or a waitlist control (WLC; 0 sessions: 10 weeks). Goal attainment, functional and cognitive status, quality of life, self-efficacy, transfer, and maintenance were measured. Data were analyzed using descriptive statistics and multiple regression analysis.

RESULTS

Effort (M = 3.02/5) and enjoyment (M = 3.15/5) ratings; homework completion (M = 91%) and protocol adherence (M = 82%) indicate that CO-OP is feasible. CO-OP was superior to the WLC on Canadian Occupational Performance Measure (COPM) performance (p=<.001), COPM satisfaction (p=<.001), and Performance Quality Rating Scale (PQRS; p=<.001) but not the Goal Attainment Scale (GAS; p = .123).

CONCLUSIONS

Addressing a critical gap in Parkinson's disease management, findings suggest that CO-OP is implementable, feasible, and potentially beneficial for PwPD. Further research is warranted to further establish efficacy.

Effects of Integrating Pain Coping Strategies into Occupational Therapy After Total Knee Arthroplasty: A Parallel Mixed-Method Study

Background/Objectives: This study aimed to evaluate whether integrating coping strategies into occupational therapy (OT) enhances functional recovery and psychological adaptation after total knee arthroplasty (TKA). Methods: Twenty-eight patients who underwent TKA were equally assigned to an intervention and control group. Both groups received standard goal-oriented OT, while only the intervention group underwent structured training in pain coping strategies using the "Coping List". Treatment effects were assessed using Canadian Occupational Performance Measure (COPM), pain, anxiety, depression, and pain-related disability scores. Results: A total of 210 coping strategies were identified, with the intervention group adopting an average of 15.1 additional strategies per patient. Strategies were categorized into six domains: physical, psychological and cognitive, social support, relaxation, daily activities, and medication management. The intervention group showed significantly greater improvements in COPM performance scores (7.6 ± 1.7 vs. 5.5 ± 2.6; p = 0.048) and COPM satisfaction scores (7.9 ± 2.0 vs. 5.6 ± 2.8; p = 0.049) compared to the control group. Conclusions: The findings suggest that individualized coping strategies integrated with physical rehabilitation can help patients achieve postoperative goals, enhance recovery, and improve overall well-being. Incorporating such strategies into OT appears to be effective in early-postoperative rehabilitation. Clinical trial number: This study's clinical trial registration information is available online at UMIN (UMIN000050536).

Benefits of the Global Integration Method (Método de Integração Global - MIG) in functional priorities of parents of Brazilian children and adolescents with autism spectrum disorder

BACKGROUND

Understanding the priorities of parents of children and adolescents with autism spectrum disorder (ASD) is crucial for implementing evidence-based programs. This study aims to identify the functional priorities of parents of Brazilian children and adolescents with ASD, analyze variations in priorities according to the levels of support and age groups of the participants, and categorize the goals according to the categories of the International Classification of Functioning, Disability, and Health (ICF). Additionally, this study aimed to evaluate changes in parents' performance and satisfaction with functional priorities after intervention with the Global Integration Method (Métodode Integração Global - MIG).

METHODS

A total of 241 children/adolescents with ASD (mean age, 6.92 ± 3.61 years) were recruited from different regions of Brazil. 76% (76%) were male, and 40.7% were classified as having support level 2. The Canadian Occupational Performance Measure was administered to parents/caregivers to identify their priorities for their children and to assess changes in performance and satisfaction with priorities after intervention with MIG. The MIG protocol consisted of functional task training in a naturalistic environment (City of Tomorrow) combined with the use of a flexible therapeutic suit (MIG Flex) and was conducted for 3 months, five times a week, for 3-4 h per day. Descriptive statistics were used to provide the priority profile. Pre- and post-intervention data were analyzed using paired t-test.

RESULTS

Parents established 1,203 functional priorities. Activities of daily living, behavioral difficulties, communication, play, and social interactions were the main functional priorities in the perception of parents/caregivers. The profiles of functional priorities were similar between the different levels of support and age groups. Approximately 64% of the priorities were classified in the activity domain of the ICF. In general, the MIG program resulted in significant improvements in performance and satisfaction for the majority of functional priorities (p < 0.05).

CONCLUSION

Activities of daily living appear to be the main priority of parents of children and adolescents with ASD, regardless of the level of support or age group. The MIG program has been associated with improvements in performance and satisfaction across several of the functional priorities identified by parents.

Family Perspectives on Functional Priorities for Brazilian Children and Adolescents with Cerebral Palsy

This study aimed to identify the functional priorities of parents/guardians of Brazilian children and adolescents with cerebral palsy (CP) and to examine possible variations in priorities concerning different age groups and functional classifications. This cross-sectional study included 171 children with CP (mean age: 7.68 ± 3.32 years). The Canadian Occupational Performance Measure was administered to the families to identify functional priorities. Among the 740 functional priorities identified, activities of daily living (ADLs) were the most frequent, followed by priorities related to body functions, motor skills, and play. The functional priorities were similar across different functional levels and age groups.

Role of Meaningful Social Participation and Technology Use in Mitigating Loneliness and Cognitive Decline Among Older Adults

IMPORTANCE

Community social participation aids dementia prevention and alleviates loneliness among older adults. Incorporating occupational therapy using information and communications technology (ICT) could potentially delay dementia onset and reduce loneliness.

OBJECTIVE

To quantify how meaningful social participation, participation frequency, ICT use, and expanded social networks influence cognitive function and loneliness among socially active older Japanese adults.

DESIGN

Cross-sectional exploratory study using structural equation modeling.

SETTING

Meetings organized by older adults at seven community gathering places in Osaka Prefecture, Japan.

PARTICIPANTS

One hundred thirteen healthy older adult cohort members.

MEASURES

Cognitive function assessed via Mini-Cog; loneliness assessed via the condensed UCLA Loneliness Scale.

RESULTS

The final model demonstrated excellent fit, χ2(23) = 28.291, p = .205 (root mean square error of approximation = .045, 90% confidence interval [.000, .094]; confirmatory factor index = .995; Tucker-Lewis Index = .993). ICT use directly affected social networks (β = 0.472), which directly influenced participation frequency (β = 0.324) and meaningful social participation (β = 0.381). The indirect effect of meaningful participation significantly improved cognitive function (β = 0.237). The only indirect effect of meaningful interpersonal participation was a reduction in loneliness (β = -0.235).

CONCLUSIONS AND RELEVANCE

ICT use contributes to the expansion of social networks among elderly people. Furthermore, the frequency of social participation and the meaningfulness of such participation are related to reduction in loneliness and maintenance of cognitive function. Although the frequency of social participation was not directly related to these outcomes, the results suggest that meaningful social participation may play an important role in reducing loneliness and maintaining cognitive function. Plain-Language Summary: The promotion of social participation among older people is a global phenomenon, driven by the recognition of its positive relationship with cognitive function and the alleviation of loneliness. Nevertheless, older people's social participation is constrained by a combination of physical and social factors. To address this issue, there has been a push to promote social participation based on information and communications technology (ICT). However, no specific study has been conducted on occupational therapists' perspective in capturing social participation and the use of ICT. The findings of this study show that using ICT has the potential to enhance opportunities for social interaction for older adults, thereby improving the quality and quantity of social participation. The quality of social participation was identified as the sole factor that had a positive impact on cognitive function and loneliness. This study suggests the need for occupational therapists to consider means of facilitating the use of ICTs among older adults as well as interventions that use occupational therapy theory to enhance the meaningfulness of existing social participation opportunities.

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.

Evaluating the Feasibility, Acceptance, and Beneficial Effects of Online Occupational Therapy for Post-COVID-19 Condition: Protocol for a Randomized Controlled Trial (ErgoLoCo Study)

BACKGROUND

Post-COVID-19 syndrome (PCS; also known as "long COVID") is a relatively novel disease comprising physical, psychological, and cognitive complaints persisting several weeks to months after acute infection with SARS-CoV-2. Approximately 10% of patients with COVID-19 are affected by long-term symptoms. However, effective treatment strategies are lacking. The ErgoLoCo (Occupational Therapy [Ergotherapie] for Long COVID) study was designed to develop and evaluate a novel occupational therapy (OT) concept of online delivery of therapy for long COVID.

OBJECTIVE

The primary study objective is to assess the feasibility of the online OT intervention in PCS. Secondary aims include the evaluation of online OT concerning cognitive problems, occupational performance, and social participation.

METHODS

This randomized controlled interventional pilot study involves parallel mixed methods process analyses and a realist evaluation approach. A total of 80 clients with PCS aged at least 16 years will be recruited into two interventional groups. The control cohort (watch and wait) comprises 80 clients with long COVID. Treatment is provided through teletherapy (n=40) or delivery of prerecorded videos (n=40) using the same standardized OT concept twice weekly over 12 weeks. Analyses of quantitative questionnaires and qualitative interviews based on the theoretical framework of acceptability will be performed to assess feasibility. Focus group meetings will be used to assess how acceptable and helpful the intervention was to the participating occupational therapists. Standardized tests will be used to assess the initial efficacy of the intervention on neurocognitive performance; limitations in mobility, self-care, and everyday activities; pain; disabilities; quality of life (QoL); social participation; and anxiety and depression in PCS, and the possible effects of online OT on these complaints.

RESULTS

The German Ministry of Education and Research provided funding for this research in March 2022. Data collection took place from October 2022 to August 31, 2023. Data analysis will be completed by the end of April 2024. We anticipate publishing the results in the fall of 2024.

CONCLUSIONS

Despite the enormous clinical need, effective and scalable treatment options for OT clients who have PCS remain scarce. The ErgoLoCo study will assess whether online-delivered OT is a feasible treatment approach in PCS. Furthermore, this study will assess the effect of the intervention on cognitive symptoms, QoL, and occupational performance and participation in everyday life. Particular emphasis will be placed on the experiences of clients and occupational therapists with digitally delivered OT. This study will pave the way for novel and effective treatment strategies in PCS.

TRIAL REGISTRATION

German Clinical Trial Registry DRKS00029990; https://drks.de/search/de/trial/DRKS00029990.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50230.

Response Shifts in the Canadian Occupational Performance Measure: A Convergent Mixed-Methods Study

IMPORTANCE

A response shift (RS) is a phenomenon in which there is an individual perceptual gap between pre and post assessments. RS effects were not considered in the Canadian Occupational Performance Measure (COPM) development process.

OBJECTIVE

To detect the effects of RS on the COPM.

DESIGN

Convergent mixed-methods research.

SETTING

Subacute rehabilitation hospital in Japan.

PARTICIPANTS

Nineteen adult patients with a range of neurological and musculoskeletal conditions recruited from a subacute rehabilitation hospital.

OUTCOMES AND MEASURES

In the qualitative analysis, patients' perceptions regarding occupation identified by the COPM were compared between the initial assessment (Time 1 [T1]) and a reassessment (Time 2 [T2]). In the quantitative study, patients were asked to re-rate the occupations in which the RS had occurred, giving feedback on their perceptions at T1 (T2'). The difference between T2 and T2' was calculated to clarify the magnitude of the RS.

RESULTS

Of the 19 patients, 18 had an RS in at least one occupation. The RS effects were classified into five categories: Replacing, Adding, Reducing, Unspecified, and Embodiment. Ninety occupations were extracted from all the patients, and 46 (51.1%) were affected by RS. The percentages of occupations for which the change in score due to RS exceeded the minimal clinically important difference (±2 points) was 26.1% (12 of 46) for COPM-Performance scores and 30.4% (14 of 46) for COPM-Satisfaction scores.

CONCLUSIONS AND RELEVANCE

Diverse RS effects have been identified in the COPM, which also affect score interpretation. Plain-Language Summary: The Canadian Occupational Performance Measure has a potential measurement bias that is due to a response shift in which there is an individual perceptual gap between pre and post assessments. The results of this study reveal a need to establish more accurate measurement methods to reduce the impact of response shifts on COPM scores.

Use of a dynamic arm support to drive a power wheelchair: a case report

PURPOSE

Dynamic arm supports (DAS) can assist individuals with severe upper limb disabilities who use a wheelchair to accomplish their daily activities. The objective of this case series was to assess the potential of a DAS to improve power wheelchair (PWC) control in real-life contexts and to describe the integration process. A secondary objective was to explore factors that may influence the DAS integration process.

METHODS

This case series includes four participants fitted with the Kinova DAS O110. A one-year follow-up was planned for each participant with qualitative and quantitative data collection to assess DAS outcomes. Assessment methods were selected to cover the three vantages of assistive technology outcomes assessment: effectiveness, subjective well-being, and social significance.

RESULTS

Among the four participants, one used the DAS to help with his wheelchair control for at least 12 months (successful integration). For him, the DAS led to significantly improved wheelchair skills and an important positive psychosocial impact. He was, however, only able to use the DAS for PWC control (no effects on other daily activities), and could not use it in some contexts because the device increased his PWC width. As for the other participants, they stopped using the DAS for different reasons, including a DAS-related adverse event.

CONCLUSION

This study demonstrated that a wheelchair-bound DAS has the potential to improve PWC use, but successful integration requires specific factors. The service delivery process and the environmental accessibility are crucial for the successful integration of such a device and to avoid safety issues.IMPLICATIONS FOR REHABILITATIONNo study deeply assessed the impacts of dynamic arm support on power wheelchair control, and the associated facilitators and obstacles.A wheelchair-bound dynamic arm support has the potential to improve power wheelchair control for individuals with upper limb disabilities and to lead to positive psychosocial impacts if some conditions conductive to successful integration are met.The service delivery process and the environmental accessibility appear as crucial aspects for the successful integration of a new device, such as dynamic arm support and avoiding safety issues.

Efficacy and Feasibility of the CO-OP Approach in Parkinson's Disease: RCT Study Protocol

Background. Parkinson's disease (PD) leads to cognitive dysfunction which limits participation and occupational performance. Cognitive Orientation to Daily Occupational Performance (CO-OP) approach is effective in other adult neurological populations and warrants investigation in PD. Purpose. To describe a study protocol evaluating the preliminary efficacy and feasibility of CO-OP approach in PD. Method. A randomised controlled trial (RCT) with adults with PD was assigned to either: CO-OP training-intensive (CO-OP-I, 20 sessions) or waitlist control (WLC) followed by CO-OP-standard (CO-OP-S, 10 sessions). Outcomes. Occupational performance and satisfaction of adults with PD in chosen goals. Measures will be obtained at baseline, post-intervention, and 3-month follow-up. Implications. As the first RCT focused on CO-OP in PD, this trial will provide evidence for the potential of this approach in PD and lay the groundwork for future large-scale trials. Trial Registration. Australian New Zealand Clinical Trials registry, ACTRN12621001483842. Registered November 1, 2021; retrospectively registered 3 months after commencement.

Available Assistive Technology Outcome Measures: Systematic Review

BACKGROUND

The World Health Organization claimed that measuring outcomes is necessary to understand the benefits of assistive technology (AT) and create evidence-based policies and systems to ensure universal access to it. In clinical practice, there is an increasing need for standardized methods to track AT interventions using outcome assessments.

OBJECTIVE

This review provides an overview of the available outcome measures that can be used at the follow-up stage of any AT intervention and integrated into daily clinical or service practice.

METHODS

We systematically searched for original manuscripts regarding available and used AT outcome measures by searching for titles and abstracts in the PubMed, Scopus, and Web of Science databases up to March 2023.

RESULTS

We analyzed 955 articles, of which 50 (5.2%) were included in the review. Within these, 53 instruments have been mentioned and used to provide an AT outcome assessment. The most widely used tool is the Quebec User Evaluation of Satisfaction with Assistive Technology, followed by the Psychosocial Impact of Assistive Technology Scale. Moreover, the identified measures addressed 8 AT outcome domains: functional efficacy, satisfaction, psychosocial impact, caregiver burden, quality of life, participation, confidence, and usability. The AT category Assistive products for activities and participation relating to personal mobility and transportation was the most involved in the reviewed articles.

CONCLUSIONS

Among the 53 cited instruments, only 17 (32%) scales were designed to evaluate specifically assistive devices. Moreover, 64% (34/53) of the instruments were only mentioned once to denote poor uniformity and concordance in the instruments to be used, limiting the possibility of comparing the results of studies. This work could represent a good guide for promoting the use of validated AT outcome measures in clinical practice that can be helpful to AT assessment teams in their everyday activities and the improvement of clinical practice.

Putting Youth in Charge: Exploring a Multi-Year Interagency Community Engagement Experiential Programme for Youth with Disabilities and Their Families

This paper outlines a qualitative exploration of the experiences of Youth in Charge (YiC), a 3-year pilot programme. YiC was designed to promote early, immersive community participation for students with physical disabilities, and was co-developed/co-hosted by three agencies (hospital, community rehabilitation, school board). To better understand the experiences of the youth, parents, and staff involved in this broad intervention, observation of 10 programme sessions and annual semi-structured interviews with youth (n = 5), parents (n = 4) and staff (n = 6) were undertaken. Qualitative results comprise six themes based in the two major thematic areas of participation-related experiences and programme considerations. Results indicate the need for community-based experiences, measured risk-taking, long-term engagement, parental involvement, and greater interagency collaboration and integration.

Responsiveness of the patient-specific Canadian occupational performance measure and a fixed-items activity limitations measure in patients with dupuytren disease

BACKGROUND

Patients with Dupuytren disease experience various activity limitations. Treatment aims to reduce finger joint contractures to improve hand function and activity performance. For assessing improvement different patient-centered measures have been used. The Canadian Occupational Performance Measure (COPM) was developed as an interview-based outcome measure to detect changes over time in patients' perception of their performance and satisfaction in self-identified activity issues. The 11-item disabilities of the arm, shoulder and hand (QuickDASH) scale consists of fixed items that ask patients to rate the difficulty in performing specific daily activities. Few studies have compared the responsiveness of these two types of patient-reported measures in Dupuytren disease.

PATIENTS AND METHODS

We included 30 patients with Dupuytren disease enrolled in a prospective cohort study of collagenase injection. We used the COPM (score range 1-10), the QuickDASH (score range 0-100) and measurement of finger joint contracture before and 5 weeks after treatment.

RESULTS

Using the COPM the patients identified 107 activity problems (55 in self-care, 19 in productivity and 33 in leisure). The two most common activity problems were to wash self (21 patients) and to don gloves (19 patients). A clinically important improvement with 3 points or greater from baseline to 5 weeks was seen for performance in 77 activities (72%). The median COPM performance score improved from 4.4 at baseline to 9.0 at 5 weeks and the median QuickDASH score improved from 13.6 to 2.5. Responsiveness (Cohen's d) for the COPM performance was 2.6 (95% CI 1.9-3.3) and for the QuickDASH 0.6 (95% CI 0.1-1.1).

CONCLUSION

The COPM had about 6-fold larger responsiveness than the QuickDASH, which supports use of an individualized measure when assessing treatment effects in Dupuytren disease.

A Clinically Significant Difference on the COPM: A Review

Background. The Canadian Occupational Performance Measure (COPM) assists occupational therapists to identify occupational performance problems using a client-centred approach. Since its first publication in 1991, there has been abundant evidence of the ability of the COPM to detect a statistically significant difference as an outcome measure. There has also been a tacit understanding that a difference of 2 points from pre-test to post-test on either Performance or Satisfaction COPM score represents a clinically significant difference. There is however, some confusion about the origins of this claim. Purpose. To ascertain empirical evidence for the claim that a clinically significant difference is a change score ≥2 points. Method. We conducted a scoping review of peer-reviewed literature (1991-2020) for intervention studies using the COPM as an outcome measure and examined intervention type and change scores. Findings. One hundred studies were identified. The COPM was used to assess effectiveness of eight types of occupational therapy interventions. The common belief, however, was not empirically supported that clinical significance can be asserted on the basis of a two-point change in COPM scores. Implications. Further research is needed to test alternative approaches to asserting clinical significance or a minimal clinically important difference.

Improving Participation among Youth with Disabilities within Their Unique Socio-Cultural Context during COVID-19 Pandemic: Initial Evaluation

BACKGROUND

Participation in meaningful activities is important for quality of life among youth with disabilities; yet participation is often restricted during adverse times. This study aimed to explore the effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention among ultra-Orthodox Jewish Israeli youth with disabilities during the COVID-19 pandemic.

METHODS

A 20-week single-subject research design with multiple baselines measuring participation goals/activities was employed with two youths (15 and 19 years old) combining quantitative and qualitative descriptive data. Changes in participation levels were measured biweekly using the Canadian Occupational Performance Measure; COPM; participation patterns were measured using the Participation and Environment Measure-Children and Youth; PEM-CY pre- and post-intervention; parents' satisfaction was measured using the Client Satisfaction Questionnaire, CSQ-8. Semi-structured interviews were conducted post-intervention.

RESULTS

Both participants significantly improved participation in all selected goals and participation patterns, and were highly satisfied with the intervention. The interviews revealed additional information on personal and environmental barriers, factors supporting intervention, and intervention effects.

CONCLUSIONS

The results indicated that an environment-centered and family-centered approach can potentially improve the participation of youths with disabilities within their unique socio-cultural context, during adverse times. Flexibility, creativity, and collaboration with others also contributed to intervention success.

Occupational performance problems in people with depression and anxiety

BACKGROUND

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Practitioner-led, peer-group sports intervention combined with a context-focused intervention for children with cerebral palsy: a protocol of a feasibility randomised clinical trial

BACKGROUND

There is a need to investigate relevant, acceptable and feasible approaches that promote participation in leisure-time physical activity for children with cerebral palsy (CP). The aim of this study is to assess the feasibility of a randomised controlled trial comparing a peer-group intervention focused on improving physical literacy (Sports Stars) with the combination of Sports Stars and a context-focused intervention (Pathways and Resources for Engagement and Participation, PREP) for ambulant children with CP in Brazil.

METHODS

In this feasibility trial, 18 ambulant children (aged 6-12 years) with CP will be randomised into two groups (nine per group): (1) Sports Stars and (2) Sports Stars plus PREP. The Sports Stars group will receive 8 weekly group sessions, focusing on developing the physical, social, cognitive and psychological skills required to participate in popular Brazilian sports. The combined Sports Stars and PREP group will receive Sports Stars in addition to eight individual PREP sessions focused on overcoming environmental barriers to participation. The primary outcome will include feasibility measures: willingness to participate in an RCT, eligibility and recruitment rates, maintenance of evaluator blinding, acceptability of screening procedures and random allocation, feasibility of evaluating outcomes, contamination between the groups, intervention adherence, treatment satisfaction, understanding of the intervention and implementation resources. Additional instruments will be applied to obtain data related to leisure-time physical activity participation goals, overall participation (home, school and community), physical literacy, level of physical activity and family empowerment. Outcomes will be assessed before, after and 12 weeks after intervention.

ETHICS AND DISSEMINATION

This feasibility trial has been approved by ethical Federal University of Minas Gerais' Ethics Review Committee (CAAE: 33238520.5.0000.5149). All potential subjects will provide written informed consent. The results of this study will be published in peer-reviewed journals and be presented at academic conferences.

TRIAL REGISTRATION NUMBERS

RBR-4m3b4b6, U1111-1256-4998.

Feasibility of Customized Pillboxes to Enhance Medication Adherence: A Randomized Controlled Trial

OBJECTIVE

To test the (1) feasibility of an assistive technology based pillbox intervention on medication adherence; (2) feasibility of trial procedures; and (3) preliminary effectiveness of the pillbox intervention on medication adherence.

DESIGN

A single-blinded randomized controlled clinical trial was conducted during 2-4 weeks.

SETTING

Researchers recruited a convenience sample to participate in this university laboratory-based study.

PARTICIPANTS

English-speaking consumers of 2 or more daily medications (N=15) participated in the study. Individuals with cognitive impairment or who did not manage their own medications were excluded.

INTERVENTIONS

Participants were randomized to 1 of 3 pillbox interventions: (1) standard-of-care pillbox; (2) customized off-the-shelf pillbox; or (3) customized 3-dimensional (3D) printed pillbox.

MAIN OUTCOME MEASURES

Outcome measures were divided among the 3 goals of the study. In addition to feasibility metrics, the Adherence to Refills and Medications Scale was used to measure the primary outcome measure, medication adherence. The Quebec User Evaluation of Satisfaction with Assistive Technology was used to measure pillbox satisfaction.

RESULTS

Researchers successfully administered 6 standard-of-care, 5 custom off-the-shelf, and 4 custom 3D printed pillboxes. Compared with the standard-of-care pillboxes, customized 3D printed pillboxes had large (d=1.04) and customized off-the-shelf pillboxes had medium (d=0.67) effects on medication adherence.

CONCLUSIONS

Prescription of customized pillboxes using a manualized and novel assistive technology approach that leverages 3D printing is feasible.

Perceived Support Needs of School-Aged Young People on the Autism Spectrum and Their Caregivers

With increasing demands for health, disability and education services, innovative approaches can help distribute limited resources according to need. Despite an increased focus on support needs within the clinical pathway and policy landscape, the body of research knowledge on this topic is at a relatively early stage. However, there appears to be a sense of unmet support needs and dissatisfaction with the provision of required support following an autism diagnosis amongst caregivers of young people on the spectrum. The primary aim of this study was to explore the perceived support needs of Australian school-aged young people on the spectrum and their caregiver(s). This was achieved using a phenomenographic Support Needs Interview conducted by occupational therapists during home-visits with caregivers of 68 young people on the spectrum (5-17 years). Qualitative data analysis resulted in two hierarchical outcome spaces, one each for young people and their caregivers, indicating interacting levels of support need areas that could be addressed through a combination of suggested supports. These support needs and suggested supports align with almost all chapters within the Body Functions, Activities and Participation and Environmental Factors domains of the International Classification of Functioning, Disability and Health. The overall goals of meeting these complex and interacting support needs were for the young people to optimize their functioning to reach their potential and for caregivers to ensure the sustainability of their caregiving capacity. A series of recommendations for support services, researchers and policy makers have been made to position support needs as central during the assessment, support and evaluation phases.

Clinical Utility of Patient-Reported Outcome Measures Used for Tendon and Nerve Transfers for Tetraplegia in New Zealand

Purpose

This study determines the clinical utility of patient-reported outcome measures used to measure outcomes of upper extremity (UE) reconstructive procedures in individuals with tetraplegia. The patient-reported outcome measures are the Canadian Occupational Performance Measure, the Capabilities of Upper Extremity Questionnaire (CUE-Q), and the Personal Wellbeing Index.

Methods

Retrospective data of 43 individuals with spinal cord injury (SCI) levels C4-C7 tetraplegia, and American Spinal Injury Association Impairment Scale grades A-D who had upper limb reconstructive surgery were reviewed. Participants were grouped according to their SCI level and resultant surgical procedures into higher SCI severity and lower SCI severity groups.

Results

The mean age of participants was 26.3 years (SD 13.4; range 13-64 years). The higher-severity SCI group required elbow and hand reconstruction surgery, whereas the lower-severity group only required hand reconstruction surgery. Important differences in Canadian Occupational Performance Measure priorities were identified between the higher and lower SCI severity groups. Question redundancy was evident with the CUE-Q. The self-report Personal Wellbeing Index captures the possible impacts of improved UE function on an individual's perceived sense of personal wellbeing.

Conclusions

In this patient-reported outcome measure analysis, we found that the level of impairment influences patient priorities. Functional measures ought to consider UE impairment and personal wellbeing as a construct in this population, given the demands of surgery.

Type of Study/Level of Evidence

Prognostic II.

Hand surgery and hand therapy clinical practice guideline for epidermolysis bullosa

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Epidermolysis bullosa (EB) causes blistering and scarring of the hands resulting in contractures fused web spaces and altered function. Surgery is needed to release contractures and web spaces and hand therapy is essential to maintain results, approaches for both differ. WHAT DOES THIS STUDY ADD?: These guidelines aim to provide information on the surgical and conservative therapeutic hand management of children and adults diagnosed with EB. They are based on available evidence and expert consensus to assist hand surgeons and therapists in decision making, planning and treatment. They highlight the importance of a holistic multidisciplinary team (MDT) approach, where patient priorities are paramount.

An Evaluation of the Overall Utility of Measures of Functioning Suitable for School-Aged Children on the Autism Spectrum: A Scoping Review

A diagnosis of an autism spectrum condition (autism) provides limited information regarding an individual's level of functioning, information key in determining support and funding needs. Using the framework introduced by Arksey and O'Malley, this scoping review aimed to identify measures of functioning suitable for school-aged children on the autism spectrum and evaluate their overall utility, including content validity against the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets for Autism. The overall utility of the 13 included tools was determined using the Outcome Measures Rating Form (OMRF), with the Adaptive Behavior Assessment System (ABAS-3) receiving the highest overall utility rating. Content validity of the tools in relation to the ICF and ICF Core Sets for Autism varied, with few assessment tools including any items linking to Environmental Factors of the ICF. The ABAS-3 had the greatest total number of codes linking to the Comprehensive ICF Core Set for Autism while the Vineland Adaptive Behavior Scales (Vineland-3) had the greatest number of unique codes linking to both the Comprehensive ICF Core Set for Autism and the Brief ICF Core Set for Autism (6-16 years). Measuring functioning of school-aged children on the spectrum can be challenging, however, it is important to accurately capture their abilities to ensure equitable and individualised access to funding and supports.

Exploring Patient Outcomes After Participation in an Inpatient Occupation-Based Group: A Longitudinal Observational Cohort Study

IMPORTANCE

Occupation-based interventions are used during inpatient rehabilitation, and group models may enhance intervention delivery. However, little is known about the impact of occupation-based groups on patient outcomes.

OBJECTIVE

To examine the effect of an occupation-based group on patient outcome measures of instrumental activities of daily living (IADL) skills over time and explore demographic differences among patients.

DESIGN

Longitudinal observational cohort study with four time points: preintervention, postintervention, 30-day follow-up, and 90-day follow-up.

SETTING

Tertiary hospital general rehabilitation ward.

PARTICIPANTS

Inpatient adults age 18 or older recruited using consecutive sampling from those referred to the group.

INTERVENTION

The LifeSkills group, which focused on repetitive practice of meaningful occupation-based activities.

OUTCOMES AND MEASURES

Demographic data were obtained, and the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling, Lawton IADL scale, and a self-efficacy scale were administered at each data point.

RESULTS

Thirty people (21 women, 9 men; ages 35-91 yr) participated, with 5 lost to follow-up. A statistically significant increase in scores postintervention occurred on all measures and was also seen at 90-day follow-up for COPM occupational performance, satisfaction, and self-efficacy scores. Lawton IADL scale scores at follow-up were lower than those at preintervention and statistically significant. No significant differences were found for age and diagnosis.

CONCLUSIONS AND RELEVANCE

Positive patient outcomes of goal achievement, occupational performance, satisfaction, and self-efficacy were seen at discharge, with evidence of sustainability over time. This could be a resource alternative for addressing skill retraining because people with different diagnoses and in different age groups benefited equally. What This Article Adds: Occupation-based group programs have encouraging application in general inpatient rehabilitation for addressing patient outcomes.

The impact of parent involvement on improving participation of children born preterm: The story in the baseline

Background

Preterm birth continues to be a major public health challenge that has long term consequences on participation into adulthood. However, little is known about effective interventions to improve the participation of children born preterm.

Methods

This study gathered initial evidence on the usefulness of a goal-focused, environmental-based approach (Pathways and Resources for Engagement and Participation (PREP)) in improving the participation of children born preterm, and living in Ireland. Three school-age boys (6–7 years old) with a history of preterm birth participated in the 12-week PREP intervention. A 36-week single-subject AB design was employed and replicated across 3 different participation goals within each child and across 3 children. Activity performance was measured repeatedly, through parental involvement, using the Canadian Occupational Performance Measure (COPM), providing 9 individual outcome trajectories. Visual inspection and mixed-effects segmented regression were used.

Results

Goals were selected from various participation domains and settings. Throughout the baseline phase, once goals were set, significant improvements in activity performance were observed for all participants (t = 14.06, p < 0.001). Further clinically significant improvements (2.58 on the COPM) for all 9 participation goals were seen in overall performance during the intervention phase. These changes remained at follow-up.

Conclusions

Findings support family-centered practice and draw attention to the power of goal setting in improving participation within this context. Challenges with single-subject design with this population were also highlighted. Results demonstrate the potential impact of parent involvement when using an environmental-based approach to improve the participation of this underserved population.

•

Improvement in participation in children born preterm, without physical disabilities.

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Challenges of single-subject design with this population.

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Environmental-based strategies show effectiveness in addressing participation goals.

•

Environmental-based strategies may promote capacity building in parents.

•

Studies focusing on the impact of goal setting and parental involvement are needed.

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.

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

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

Canadian Occupational Performance Measure: Benefits and Limitations Highlighted Using the Delphi Method and Principal Component Analysis

Introduction

The objective of this study was to establish a baseline of current use in practice of the Canadian Occupational Performance Measure (COPM) by consulting 33 expert French occupational therapists, who trained in this method between 2012 and 2017 and use of the COPM with their clients. The areas of health intervention are pediatrics, psychiatry, neurology, and geriatrics. An email invitation to participate in the research was therefore sent to 113 occupational therapists. We received 33 responses.

Methods

A novel mixed method study combined a Delphi method with a lexical analysis of experts' responses and principal component analysis (PCA).

Results

In the last Delphi round, the consensus of the expert group was attained on 31 benefits and 1 limitation, confirming the generally positive influence of the COPM in French health services. Discussion. The COPM was clearly identified as a tool that supports occupational therapy clinical reasoning, facilitates team decision-making for care pathways, and enables people with disabilities and health conditions to make decisions for their care.

Conclusion

The Delphi study revealed that the COPM appears to be well adapted to French culture and should be widely incorporated into preregistration training.

Cognitive orientation to daily occupation group in the adult day rehabilitation setting: A feasibility study

Introduction

The Cognitive Orientation to daily Occupational Performance (CO-OP) ApproachTM is a leading approach in occupational therapy. Implementing the CO-OP ApproachTM in a group format in day rehabilitation has not yet been explored.

Method

In day rehabilitation, a barrier to implementing the CO-OP ApproachTM is the group model. To address these challenges, this feasibility study involved the development, implementation, and evaluation of a CO-OP group for adults. Four patients participated in six group sessions. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM) and the Assessment of Motor and Process Skills (AMPS). Subjective data were collected to reflect the participant's experiences during the group.

Results

80% of participants recruited completed the group. All participants demonstrated improvement in goals addressed within the group and goals not addressed within the group on the COPM. AMPS findings were inconclusive. Subjective findings indicated participants appreciated the group learning environment, valued the CO-OP process, were motivated to participate, and would have liked more groups.

Conclusion

To our knowledge, this is the first adult CO-OP group in a clinical setting. Results support the feasibility of a CO-OP group in day rehabilitation and the need for further examination of the effectiveness of this intervention.

Comparative effects of community-based family-child-centered care and conventional pediatric rehabilitation for cerebral palsy

BACKGROUND

While the transdisciplinary-based rehabilitation provided ample evidence on improving impairment (body structure and functions) levels, the therapeutic effects on the international classification of functioning, disability, and health (ICF) domains are unknown in cerebral palsy (CP).

OBJECTIVE

To compare the effects of the community-based family-child-centered care (CFC) and conventional pediatric rehabilitation (CPR) on the physical, cognitive, sensory, and social integration domains in children and adolescents with CP.

METHODS

Twenty-six participants with CP (mean age = 9.37±5.24, 14 females) were assigned into either CPR or CFC groups. Clinical outcomes included gross motor function measure (GMFM-66), Pediatric Balance Scale (PBS), fine motor area of Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Functional Independence Measure (FIM) cognition area, Short Sensory Profile (sSP), COPM, Pediatrics Quality of Life (PedsQL) questionnaire, Short Falls Efficacy Scale (sFES), and Dynamic Postural Instability (DPI). An analysis of variance (ANOVA) and an analysis of covariance (ANCOVA) was conducted at P < 0.05.

RESULTS

ANOVA revealed the superior effects of CFC in GMFM-66, PBS, BOT-2, FIM, and PedsQL compared to CPR (P < 0.05). ANCOVA showed the superior effects of CFC in Z-axis of DPI than CPR (P < 0.05).

CONCLUSIONS

Our results provide novel, promising clinical evidence that CFC was more effective than CPR at improving impairment, activity, as well as participation levels in participants with CP.

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

IMPORTANCE

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

OBJECTIVE

To evaluate the measurement properties of the COPM.

DATA SOURCES

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

FINDINGS

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

CONCLUSIONS AND RELEVANCE

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

Effectiveness of interactive augmented reality-based telerehabilitation in patients with adhesive capsulitis: protocol for a multi-center randomized controlled trial

Background

As the primary treatment for adhesive capsulitis, intensive and accurate home exercise is as important as physical therapy in hospitals. Augmented reality (AR)-based telerehabilitation has been implemented recently in various musculoskeletal conditions to increase patient compliance and enable patients to exercise with the correct posture. The objective of this study is to present a protocol for investigating the additive effect of interactive AR-based telerehabilitation in comparison with the usual care for patients with adhesive capsulitis.

Methods

This study presents the protocol of a prospective, multi-center, single-blinded, two-armed randomized controlled trial (RCT). One hundred patients with stage I or II adhesive capsulitis will be recruited at the physical medicine and rehabilitation clinic. Patients will be randomly divided into two groups with 1:1 allocation. The intervention group will receive 3 months of hospital-based physical therapy in conjunction with home-based telerehabilitation. The control group will receive 3 months of hospital-based physical therapy in conjunction with a home-based exercise described in a brochure provided by the hospital. The primary outcome will be the change in passive range of motion (ROM) of the affected shoulder joint from baseline to 12 weeks after baseline assessment. The secondary outcomes will be active ROM, pain measured with the numeric rating scale, shoulder pain and disability index, 36-Item Short Form Survey, EuroQoL-5D-5L, and Canadian Occupational Performance Measure.

Discussion

This will be the first RCT study protocol to investigate the effect of telerehabilitation in patients with adhesive capsulitis. The result of this RCT will determine whether AR-based telerehabilitation is more effective than a brochure-based home exercise program and will provide evidence of the usefulness of “telerehabilitation” using hardware (IoT) and software (monitoring platform) technologies to develop “digital therapeutics” for the future.

Trial registration

This trial was retrospectively registered at the Clinicaltrials.gov website on 20 March 2020, with the identifier NCT04316130.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04261-1.

Clinical Utility of the Canadian Occupational Performance Measure in Older Adult Rehabilitation and Nursing Homes: Perceptions among Occupational Therapists and Physiotherapists in Spain

INTRODUCTION

Scientific evidence that supports the psychometric properties of the COPM as a tool to enable personalized care has been repeatedly shown. However, there is a lack of studies about its utility within the Spanish research community.

AIM

This qualitative study seeks to ascertain the perceptions of professionals from social health centers, nursing homes, and Spanish rehabilitation services about the clinical utility of the COPM as a standardized instrument.

METHODS

Thirty occupational therapists and physiotherapists in four focus groups discussed the experience of applying the COPM. The interpretative phenomenological analysis (IPA) incorporated a multidimensional model of clinical utility based on the components of acceptable, appropriate, accessible, and practicable by the clients, professionals, and institutions. Results and Discussion. The results of the utility study showed that the COPM helped professionals and clients to gain significant involvement in the treatment process. The COPM contributed to the process of further goal setting, occupation-based, and client-centered, thus achieving considerable satisfaction from the clients that had treatment. The professional training and adaptation to the geriatric population were vital to this process.

CONCLUSION

The COPM is a useful and viable tool for the institutions that are supportive of a client-centered approach in the Spanish context.

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.

Change in Depression, Confidence, and Physical Function Among Older Adults With Mild Cognitive Impairment

BACKGROUND AND PURPOSE

Nearly a quarter of those in the United States older than 71 years experience mild cognitive impairment. Persons with mild cognitive impairment battle depression and progressive disengagement from daily activities, which contribute to participation restriction and activity limitation. Daily engagement in meaningful activity (DEMA) is a tailored intervention designed to benefit persons with mild cognitive impairment and their caregivers through preserved engagement and supported adjustment to cognitive changes. This secondary analysis was guided by the International Classification of Functioning, Disability and Health (ICF) model. Aims were to (i) explore the extent to which change in self-rated activity performance and physical function can predict change in depressive symptoms, (ii) evaluate for difference in confidence and depressive symptoms at ICF levels of activity and participation, and (iii) quantify the impact of daily engagement at the ICF level of participation on physical function.

METHODS

A secondary analysis was conducted using data from the parent study, which was a 2-group randomized trial involving persons with mild cognitive impairment and their informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N = 20, Information Support N = 20) examined outcomes at posttest and follow-up. Analysis employed linear regression to model the relationship between explanatory and dependent variables and independent t test to examine for difference in confidence, depression, and physical function.

RESULTS AND DISCUSSION

At posttest, change in self-rated performance predicted change in depressive symptoms. Those in the DEMA group who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Although not significant, the control group posttest results showed a mean decrease in confidence.

CONCLUSIONS

Results demonstrate a positive impact of DEMA on depressive symptoms, confidence, and physical function. Change in occupational performance predicted change in depressive symptoms. Confidence significantly improved among those who engaged at the ICF participation level. A larger, randomized controlled longitudinal trial is needed to better assess the impact of DEMA on physical function, activity, participation restriction, and quality of life.

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.

Increasing Meaningful Occupation for Women Who Provide Care for Their Spouse: A Pilot Study

Caregiving for a loved one can be difficult and negatively affect health and quality of life. This pilot mixed-method study explored an intervention to increase participation in meaningful occupation for women who care for their spouse. Participants completed the World Health Organization Quality of Life: Brief Version (WHOQOL-BREF) and Canadian Occupational Performance Measure (COPM). The 4-week intervention consisted of an activity log (Daily Experiences of Pleasure, Productivity, and Restoration Profile) and a reflective journal (Journal of Activities and Experiences). Researchers analyzed data from the reflective journal using content analysis. Preliminary findings showed an increase in the physical health domain (p < .05), and satisfaction with meaningful activities had clinical significance. Qualitative themes included caregiving is a demanding role, writing down experiences helped caregivers take action, and caregivers reorganized daily activities. Although preliminary results showed a positive trend, the intervention was brief, and more research is needed to determine whether greater gains are possible, and can be sustained.

Effect of postoperative pneumatic compression after volar plate fixation of distal radial fractures: a randomized controlled trial

We investigated the difference between postoperative rehabilitation with or without adjunctive intermittent pneumatic compression therapy following distal radial fracture treated with volar plating. A total of 115 patients were randomized to a control or to an experimental group. After 4 weeks of immobilization the experimental group received intermittent pneumatic compression therapy in addition to conventional postoperative rehabilitation. Primary outcome up to 1 year postoperatively was assessed using the Canadian Occupational Performance Measure. No significant differences between groups were found. There were no clinically relevant differences regarding the secondary outcome measures swelling, strength, pain and flexibility. We conclude that postoperative intermittent pneumatic compression treatment had no major benefits. The results of the present study do not support general use of intermittent pneumatic compression initiated 4 weeks following volar plating surgery for distal radial fracture.

LEVEL OF EVIDENCE

I.

The effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention: improving participation of adolescents with physical disabilities

AIM

This study examined the effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention in improving the participation of adolescents in community-based activities.

METHOD

Twenty-eight adolescents (14 males, 14 females), aged 12 to 18 years (mean 14y 6mo, SD 21.6mo) with moderate physical disabilities participated in a 12-week PREP intervention. An interrupted time series design with multiple baselines was employed, replicating the intervention effect across three chosen activities and all participants. An occupational therapist worked individually with adolescents and parents to identify and implement strategies to remove environmental barriers that impede participation in selected activities. Activity performance was repeatedly measured using the Canadian Occupational Performance Measure (COPM) at baseline, intervention, and follow-up (20wks). For each activity, the trajectory representing change in performance was analyzed descriptively. Segmented regression combined with a mixed-effects modeling approach was used to statistically estimate the overall effectiveness of the intervention within and across 79 activities.

RESULTS

A statistically significant improvement (B=2.08, p<0.001) was observed across all activities, 59 per cent of which also indicated a clinically significant change of more than 2 points on the COPM scale. Levels of performance were maintained during follow-up with an additional increase of 0.66 points on the COPM scale (t=3.04, p=0.004). Intervention was most effective for males and those with a higher number of functional issues.

INTERPRETATION

Findings illustrate that participation can be improved by changing the environment only. Such evidence further supports emerging therapeutic approaches that are activity-based, goal-oriented, and ecological in nature.

WHAT THIS PAPER ADDS

Environment-based intervention strategies, guided by the Pathways and Resources for Engagement and Participation, are effective in improving and maintaining adolescent participation. Intervention was most effective for males and those with a higher number of functional issues. The study design serves as an example for future pragmatic studies accounting for individual-based changes and contexts.

Home-based bimanual training based on motor learning principles in children with unilateral cerebral palsy and their parents (the COAD-study): rationale and protocols

BACKGROUND

Home-based training is considered an important intervention in rehabilitation of children with unilateral cerebral palsy. Despite consensus on the value of home-based upper limb training, no evidence-based best practice exists. Promoting compliance of children to adhere to an intensive program while keeping parental stress levels low is an important challenge when designing home-based training programs. Incorporating implicit motor learning principles emerges to be a promising method to resolve this challenge.

METHODS

Here we describe two protocols for home-based bimanual training programs, one based on implicit motor learning principles and one based on explicit motor learning principles, for children with unilateral spastic cerebral palsy aged 2 through 7 years. Children receive goal-oriented, task-specific bimanual training in their home environment from their parents for 3.5 h/week for 12 weeks according to an individualized program. Parents will be intensively coached by a multidisciplinary team, consisting of a pediatric therapist and remedial educationalist. Both programs consist of a preparation phase (goal setting, introductory meetings with coaching professionals, design of individualized program, instruction of parents, home visit) and home-based training phase (training, video-recordings, registrations, and telecoaching and home visits by the coaching team). The programs contrast with respect to the teaching strategy, i.e. how the parents support their child during training. In both programs parents provide their child with instructions and feedback that focus on the activity (i.e. task-oriented) or the result of the activity (i.e. result-oriented). However, in the explicit program parents are in addition instructed to give exact instructions and feedback on the motor performance of the bimanual activities, whereas in the implicit program the use of both hands and the appropriate motor performance of the activity are elicited via manipulation of the organization of the activities.

DISCUSSION

With the protocols described here, we aim to take a next step in the development of much needed evidence-based home-based training programs for children with unilateral cerebral palsy.

The influences of client-centered therapy on the level of performance, the level of satisfaction of activity of daily living, and the quality of life of the chronic stroke patients

[Purpose] The purpose of this research is to take a look at the influences of client-centered therapy on the level of everyday life performance, the level of satisfaction, and the quality of life of the chronic stroke patients. [Subjects and Methods] This research used client-centered therapy with two chronic stroke and hemiplegia patients as subjects. The therapy was carried out once a day, five times a week, for thirty minutes at a time for four weeks. Also, five kinds of training were included in the medical treatment programs which were organized after the initial Canadian occupational performance measure (COPM) evaluations. Evaluations were carried out before and after the mediation. Changes in the level of everyday life performance level of satisfaction were measured using the COPM, and changes in quality of life were measured using the Stroke Specific Quality of Life Scale (SS-QOL). [Results] After the application of medical treatment, both subjects showed positive changes in terms of the level of everyday life performance, level of satisfaction, and quality of life. [Conclusion] Both subjects demonstrated improvements in all aspects of both outcome measurements which implied that a short client-centered therapy program could help chronic stroke patients improve some aspects of their life.

Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded Constraint-Induced Movement therapy

PURPOSE

To evaluate the efficacy of an expanded form of Constraint-Induced Movement Therapy (eCIMT) that renders CIMT, originally designed for treating mild-to-moderate upper-extremity hemiparesis, suitable for treating severe hemiparesis.

METHODS

Twenty-one adults ≥1 year after stroke with severe upper-extremity hemiparesis (with little or no capacity to make movements with the more-affected hand) were randomly assigned to eCIMT (n = 10), a placebo-control procedure (n = 4), or usual care (n = 7). The participants who received usual care were crossed over to eCIMT four months after enrollment. The CIMT protocol was altered to include fitting of orthotics and adaptive equipment, selected neurodevelopmental techniques, and electromyography-triggered functional electrical stimulation. Treatment was given for 15 consecutive weekdays with 6 hours of therapy scheduled daily for the immediate eCIMT group and 3.5 hours daily for the cross-over eCIMT group.

RESULTS

At post-treatment, the immediate eCIMT group showed significant gains relative to the combination of the control groups on the Grade-4/5 Motor Activity Log (MAL; mean = 1.5 points, P < 0.001, f = 4.2) and a convergent measure, the Canadian Occupational Performance Measure (COPM; mean = 2.3, P = 0.014, f = 1.1; f values ≥0.4 are considered large, on the COPM changes ≥2 are considered clinically meaningful). At 1-year follow-up, the MAL gains in the immediate eCIMT group were only 13% less than at post-treatment. The short and long-term outcomes of the crossover eCIMT group were similar to those of the immediate eCIMT group.

CONCLUSIONS

This small, randomized controlled trial (RCT) suggests that eCIMT produces a large, meaningful, and persistent improvement in everyday use of the more-affected arm in adults with severe upper-extremity hemiparesis long after stroke. These promising findings warrant confirmation by a large RCT.

Impact of an Activity-Based Program on Health, Quality of Life, and Occupational Performance of Women Diagnosed With Cancer

OBJECTIVE. We evaluated the impact of a 1-wk activity program on the health, quality of life (QOL), and occupational performance of community-living women diagnosed with cancer.

METHOD. A one-group pretest–posttest repeated-measures design was used. Participants completed a functional health measure (36-Item Short Form Health Survey [SF–36]), a QOL measure (World Health Organization Quality of Life–Brief version [WHOQOL–BREF]), and an occupational performance and satisfaction measure (Canadian Occupational Performance Measure [COPM]) before and 6 wk after program completion. The COPM was also administered on Day 5.

RESULTS. Paired t tests for the SF–36 and WHOQOL–BREF showed no significant differences, except for the WHOQOL–BREF’s Social Relationships subscale (p &lt; .008). Repeated-measures analyses of variance showed a significant difference in COPM performance and satisfaction scores (p &lt; .001).

CONCLUSION. The activity program effectively improved occupational performance and satisfaction and social relationships of community-living women diagnosed with cancer.

Pain, fatigue, function and participation among long-term manual wheelchair users partnered with a mobility service dog

PURPOSE

To assess the effects of a mobility service dog (MSD) on pain, fatigue, wheelchair-related functional tasks, participation and satisfaction among manual wheelchair users over a nine-month period.

METHOD

A longitudinal study with repeated assessment times before and three, six and nine months after intervention was achieved. Intervention consisted in partnering each participant with a MSD. The setting is a well-established provincial service dog training school and participants homes. A convenience sample of 24 long-term manual wheelchair users with a spinal cord injury was involved. Outcome measures were: Wheelchair User's Shoulder Pain Index (WUSPI), Rate of Perceived Exertion (RPE), vitality scale from the SF-36, grip strength, Wheelchair Skills Test (WST), Canadian Occupational Performance Measure (COPM), Reintegration to Normal Living Index (RNLI), Life Space Assessment, Psychosocial Impact of Assistive Devices Scale (PIADS) and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0).

RESULTS

Shoulder and wrist pain as well as fatigue decreased significantly over time with the use of a MSD as evidenced by scores from WUSPI, RPE and SF-36 (feeling less worn out). Manual wheelchair propulsion skills (steep slopes, soft surfaces and thresholds) improved significantly over time as confirmed by the WST. Participation increased significantly over time as revealed by the COPM (for five occupations) and the RNLI (for five items). Satisfaction with the MSD was high over time (QUEST: nine items) and with a high positive psychosocial impact (PIADS: 10 items).

CONCLUSION

MSD represents a valuable mobility assistive technology option for manual wheelchair users. IMPLICATIONS FOR REHABILITATION   For manual wheelchair users partenered with mobility service dog  • Shoulder pain and fatigue significantly decreased and continued to decrease between the third and sixth month and the ninth month.   • Performance with propelling the wheelchair up steep slopes increased from 41 to 88% and on soft surfaces increased from 53 to 100% after 3 months, respectively.   • Occupational performance satisfaction was significantly increased for mobility in relation with the transfers, navigating in a natural environment and picking up objects.   • High satisfaction towards psychosocial competency, psychosocial adequacy and self-esteem were reported at months three, six and nine.

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

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