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.

Information bias in the Canadian occupational performance measure: A qualitative study

Purpose

The Canadian Occupational Performance Measure (COPM) is designed to measure outcomes from client-centred occupational therapy. We explored clients’ views and experiences of participating in an initial COPM assessment in order to examine the potential information bias which may influence COPM scores.

Material and methods

We used qualitative methods to analyse semi-structured interviews (qualitative thematic analysis) on clients at a typical Japanese rehabilitation hospital, to examine the potential information bias affecting their scores in their initial COPM assessment.

Results

19 of 20 clients (13 men; 7 women, aged 19–84 years) demonstrated potential sources of information bias in their COPM scores. We identified 15 sources of information bias, grouped into three domains: (1) bias during the selection of occupational areas (Misunderstanding client-centeredness, Misunderstanding meaningfulness, Misunderstanding occupation, and Composite occupations), (2) bias during the scoring of performance and satisfaction (Imaginary scores, Confusing scores of performance or satisfaction with importance, Ambiguous scores, Hopeful scores, Target scores, Emotional scores, Considerate scores and Humbleness scores) and (3) bias interfering future scoring (Changes in selected occupation, Forgotten scores, Ceiling effects).

Conclusion

This study identifies potential sources of bias affecting COPM scores, and taking account of this result would facilitate better collaboration with clients through COPM.

The Occupational Experience Helps to Express the Clients' Occupational Needs in Goal Setting: A Retrospective Study in Subacute Care Setting

This study investigates whether reflection on occupational experience during assessment and intervention would help clients express their occupational needs in goal setting. Sixty-two participants who were not able to express their occupational needs in the initial assessment process were either allocated to the occupational experience group who undertook occupation-based assessment and intervention, or the physical training group who engaged in physical training only. The ratio of participants who expressed their occupational needs in each group was 67% (30/45) and 12% (2/17) respectively. Reflection on occupational experience during assessment and intervention to help clients express their occupational needs would have significant implications for practice, as it may encourage clients to reflect on their performance more easily.

Behaviour Change Domains Likely to Influence Occupational Therapist Use of the Canadian Occupational Performance Measure

INTRODUCTION

Occupational therapists have shown low adoption rates for many evidence-based practices. One such practice is the limited uptake of standardized outcome measures such as the Canadian Occupational Performance Measure. Use of this measure has not consistently translated into practice despite decades of encouragement. Theory-based approaches to understanding healthcare provider behaviour change are needed if we are to realize the goal of attaining practice that is in keeping with evidence. This study utilized the Theoretical Domains Framework, a theory-based approach for understanding barriers to evidence-based practice, in order to increase our understanding of the limited uptake of the Canadian Occupational Performance Measure in occupational therapy practice.

METHODS

Theoretical Domains Framework methods were followed. First, primary data was collected from occupational therapists through semistructured interviews that focused on key behaviour change domains as they related to the use of the Canadian Occupational Performance Measure. Two independent researchers coded interview data into domains, derived belief statements from the data, and used belief strength, conflict, and frequency to determine the more and less influential domains for using the Canadian Occupational Performance Measure.

RESULTS

Interviews with 15 practicing occupational therapists across a range of practice areas yielded six key behaviour change domains for increasing the use of the Canadian Occupational Performance Measure. The more relevant domains were Social influences, Social professional role and identity, Beliefs about consequences, Beliefs about capabilities, Skills, and Behavioural regulation). The other eight domains were found to be less relevant.

CONCLUSION

We identified important domains and beliefs that influence the use of the Canadian Occupational Performance Measure by occupational therapists. Results inform our understanding of the use of this measure in practice and identify potential targets for behaviour change interventions.