Administration of the Canadian Occupational Performance Measure: effect on practice

Feasibility of Increasing Occupation-Based Assessment Using the Knowledge to Action Framework

The Assessment of Motor and Process Skills (AMPS) is a standardized occupation-based measure; however, barriers often limit use in practice. The Knowledge to Action Framework (KTA) is one of the most widely used implementation approaches to induce practice change. The objective of the study is to examine the feasibility and acceptability of a KTA-informed intervention to increase the use of the AMPS. AMPS-trained occupational therapists were recruited through convenience sampling. Interventions included workshops, action planning, goal setting, peer support, and organizational resources. Recruitment and retention were tracked. Pre- and post-survey results of interventions' helpfulness, AMPS behaviors, and motivational changes informed acceptability. Participants (n = 5) rated 7/7 (100%) intervention strategies as helpful, reported decreased barriers and increased frequency of AMPS administration, increased resources for AMPS implementation, and improved compatibility with practice. Implementation of a KTA-informed intervention to increase AMPS practice was feasible and supported by environmental changes and peer support in a physical rehabilitation setting.

Education leads to increased adherence to the 'Australian Competency Standards for Occupational Therapy Driver Assessors'

BACKGROUND

Occupational therapy competency standards provide an evidence-base to inform clinical best practice, however it is not known whether education about competency standards will increase occupational therapists' adherence to their use.

AIMS/OBJECTIVES

To investigate if education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' leads to increased adherence to the competency standards in the clinical practice of occupational therapy driver assessors.

MATERIALS AND METHODS

A mixed methods multiple case study design was used to evaluate 5 occupational therapy driver assessors' adherence to the competency standards. An audit of 25 client files and interviews were conducted to evaluate practice against the competency standards prior to an education session, followed by an audit of a further 25 files, interview and feedback after education.

RESULTS

Qualitative and quantitative analyses suggest that education about the 'Australian Competency Standards for Occupational Therapy Driver Assessors' was associated with increased adherence to the competency standards in clinical practice. The results also support the use of competency standards in clinical practice.

CONCLUSIONS AND SIGNIFICANCE

Competency standards can be used to inform and guide clinical practice, and individualised education and feedback of practice against the competency standards can increase occupational therapists' adherence to these standards.

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.

Knowledge Translation Research to Promote Behavior Changes in Rehabilitation: Use of Theoretical Frameworks and Tailored Interventions: A Scoping Review

OBJECTIVE

To describe knowledge translation (KT) research as a means of changing practice behaviors in rehabilitation. We specifically aimed to explore how theories, models, and frameworks (TMFs) are used to guide KT, guide methods to tailor KT interventions, and evaluate outcomes. We hypothesized these methods would have increased over the past 10 years.

DATA SOURCES

We identified articles through searches conducted using databases Cumulative Index to Nursing and Allied Health, MEDLINE, PubMed, Academic Search Premier, and previous reviews from January 2000 to April 2020. Search terms included physical therapy, occupational therapy, speech-language pathology, knowledge translation, and knowledge-to-action (KTA).

STUDY SELECTION

Two authors interpedently screened titles, abstracts, and full-text articles. Studies were included if behavior change of rehabilitation practitioners was measured. Systematic reviews, protocols, and capacity-building interventions were excluded.

DATA EXTRACTION

Three authors extracted information on study design, theoretical frameworks, intervention strategies, and outcome evaluation.

DATA SYNTHESIS

Fifty-six studies were included in the review. Sixteen (29%) reported the use of a theoretical framework to guide the KT process. Since 2013, the KTA framework was used 35% of the time. Twenty-two studies (39%) reported barrier assessments to tailor interventions, and 82% were published after 2013. However, barrier assessment in the local context was only conducted 64% of the time. Outcomes of tailored interventions were most frequently measured using chart audits (50%) and questionnaires (41%). Further, the link between KT theory, specific barriers, and selection of intervention strategies was not consistently described.

CONCLUSIONS

Over the past 7 years, there has been an increase in the use of KT TMFs and tailored interventions. Recommendations for future research include the use of TMFs to guide local barrier assessment, KT strategy selection, intervention development, and overall KT process and mapping barriers to selected intervention strategies.

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.

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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.

A multifaceted continuing professional development intervention to move stroke rehabilitation guidelines into professional practice: A feasibility study

INTRODUCTION

Rehabilitation post-stroke is critical for maximizing patient outcomes. This study assessed the feasibility of implementing and evaluating a continuing professional development (CPD) intervention aimed at increasing the uptake of stroke best practice guidelines among physiotherapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) in six university-affiliated stroke rehabilitation centers in Quebec, Canada.

METHOD

Twelve stroke best practice recommendations with reflective tools were sent weekly by e-mail. Participants' eligibility criteria included: a) profession; b) practicing more than 1 year in a stroke rehabilitation program; c) fluency in French or English; and d) basic computer literacy. Feasibility (operationalized via participation, satisfaction and relevance), cognitive impact, perceived application in practice and expected patient outcomes were measured over 24 weeks using three questionnaires and analyzed using descriptive statistics.

RESULTS

The sample totaled 62 of 133 eligible (47%) clinicians. Satisfaction, relevance and cognitive impact of delivered information varied across disciplines and recommendations. Agreement with the recommendations was high across disciplines. On average, three-interdisciplinary recommendations (related to post-stoke depression, post-stoke fatigue and patients' and caregivers' learning needs) were rated as the most relevant for at least one patient. The majority of clinicians would use the recommendations for a specific patient and expected health benefits by applying those recommendations.

CONCLUSION

This study demonstrated the feasibility of assessing the impact of a CPD intervention in stroke rehabilitation uptake and informed the design of a research program aimed at increasing the use of stroke evidence-based rehabilitation interventions.

Evaluating the Effect of Functional Electrical Stimulation Used for Foot Drop on Aspects of Health-Related Quality of Life in People with Multiple Sclerosis: A Systematic Review

BACKGROUND

Multiple sclerosis (MS) is a common degenerative neurologic condition resulting in walking difficulties. Foot drop is a common walking impairment in MS that can affect health-related quality of life (HRQOL). Functional electrical stimulation (FES) can improve walking in people with MS, but its effect on HRQOL is not well established. This review investigated the effect of FES used for foot drop on HRQOL in adults with MS.

METHODS

A systematic search was performed using CINAHL, MEDLINE, Cochrane Library, PubMed, and PEDro online databases. Inclusion and exclusion criteria were applied to select eligible studies. Data were extracted, and two reviewers independently rated the quality of the studies using the Effective Public Health Practice Project assessment tool.

RESULTS

Eight studies were eligible for review; seven were of moderate-to-strong methodological quality and one was weak. Seven studies demonstrated significant positive effects of FES on different aspects of HRQOL as measured by the 29-item Multiple Sclerosis Impact Scale, 36-item Short Form Health Status Survey, Canadian Occupational Performance Measure, and Psychosocial Impact of Assistive Devices Scale.

CONCLUSIONS

This review provides preliminary evidence that FES has a positive effect on aspects of HRQOL in people with MS; however, the variety of HRQOL outcomes used makes it difficult to determine definitive conclusions. Future larger-scale randomized studies with long-term follow-up are recommended to better understand the effect of FES on HRQOL. This will inform prescribing decisions and support compliance with FES over the longer-term.

Does training in a top-down approach influence recorded goals and treatment plans?

BACKGROUND.

Five stroke rehabilitation teams were supported in the implementation of Cognitive Orientation to daily Occupational Performance (CO-OP) as part of a knowledge translation (KT) project called CO-OP KT. Medical record auditors noted there was occasionally a disconnect between client goals and treatment plans, revealing a need to better understand the characteristics of each and their relationship to each other.

PURPOSE.

This study aimed to examine the characteristics of goals and treatment plans in occupational therapy before and after CO-OP KT.

METHOD.

A descriptive secondary analysis of medical record data was employed.

FINDINGS.

Post intervention, there was a change in goal specificity (p = .04) and therapist-client goal alignment (p = .05). Occupation-based goals were often paired with a bottom-up, impairment-based treatment. Top-down treatments, when present, lacked the same detail given to bottom-up plans.

IMPLICATIONS.

CO-OP KT seemed to lead to more specific goals, but matching top-down treatment plans were not found.

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

BACKGROUND

The active participation of clients is an important aspect of rehabilitation quality as conceptualized in client-centred practice (CCP). A recommended outcome measure for enhancing CCP is the Canadian Occupational Performance Measure (COPM). However, the relationship between COPM use and CCP enhancement has not been documented.

AIM

The aim of this study was to examine whether the use of the COPM enhanced CCP.

METHODS

We performed a scoping review in five steps: (1) identifying a search strategy with inclusion and exclusion criteria; (2) screening relevant databases for published and unpublished studies by using selected keywords and by manually scrutinizing reference lists; (3) agreeing on eligible papers between authors in terms of inclusion and exclusion criteria; (4) charting included data; and (5) analysing data using qualitative content analysis.

RESULTS

Twelve studies were included in the review. The results indicated enhanced CCP in two themes when using the COPM. These themes appeared to influence each other; therefore, the first theme, Conditions for enhancing CCP when using the COPM, represented the circumstances needed for the second theme, Enhancing CCP when using the COPM, to be fulfilled.

CONCLUSION

The use of the COPM seems to enhance CCP if certain conditions are present.

Cognitive Orientation to daily Occupational Performance (CO-OP): A New Approach for Children with Cerebral Palsy

AIMS

The results of a small single-case study series suggested that Cognitive Orientation to daily Occupational Performance (CO-OP) may be a successful approach for children with cerebral palsy (CP). Therefore a pilot randomized controlled trial was conducted with the following research questions-is CO-OP a feasible approach to use with children with CP, what are the effects of CO-OP when compared to usual practice, and is a larger study warranted?

METHODS

18 children between age 7 and 12 (nine in CO-OP group and nine in Current Usual Practice Approach (CUPA) group) received ten 1-hour sessions of intervention on average once per week at home. Primary outcome measures were the Canadian Occupational Performance Measure and the Performance Quality Rating Scale (PQRS). PQRS assessors were blind to group allocation and timing of assessment.

RESULTS

All children in the CO-OP group were able to learn the strategies and achieve their chosen goals, thus demonstrating the feasibility of the approach. Both approaches equally promoted skill acquisition and skill maintenance at follow-up. Effect sizes suggest that CO-OP may show some advantage for transfer and maintenance.

CONCLUSION

Based on these initial findings, further research is warranted.

The clinical utility of the Canadian Occupational Performance Measure in vocational rehabilitation: A qualitative study among occupational therapists in Slovenia

BACKGROUND

Few studies exist on the clinical utility of the Canadian Occupational Performance Measure (COPM) in vocational rehabilitation.

OBJECTIVE

The aim of this study was to explore how Slovenian occupational therapists working in vocational rehabilitation, perceived the usefulness of the COPM in their everyday practice.

METHODS

A qualitative study using two focus group discussions was conducted. The meaning condensation method was applied to analyze the data.

RESULTS

Analysis revealed the following key themes: (1) the COPM facilitates collaboration with the client; (2) the COPM is a source of evidence and empowerment for occupational therapists; (3) the challenges that arise when using the COPM; (4) the use of COPM requires training; and (5) using the COPM results and understanding their meaning.

CONCLUSIONS

The study reveals new insights into using the COPM results in occupational therapy, especially into the contextual factors that influence the meaning and importance of work for clients in vocational rehabilitation.

Personal Care Participation Assessment and Resource Tool: Clinical utility for inpatient rehabilitation

Background.

Evidence supports validity of the Personal Care Participation Assessment and Resource Tool (PC-PART), but clinical utility remains unverified.

Purpose.

This study aimed to investigate occupational therapists’ perceptions about the PC-PART’s clinical utility for inpatient rehabilitation.

Method.

Using mixed methods, occupational therapists who had used the PC-PART as part of a research study in an inpatient rehabilitation setting completed a questionnaire ( n = 9) and participated in a focus group ( n = 6) to explore their perspectives about its clinical utility. Quantitative data were summarized and qualitative data analyzed using inductive thematic analysis.

Findings.

Quantitative data highlighted both positive and negative aspects of the PC-PART’s clinical utility. Five themes emerged from the qualitative data: nature of information gathered; familiarity with the instrument; perceived time and effort; item phrasing, interpretation, and presentation; and external influences on clinical use.

Implications.

The PC-PART was perceived to support gathering of clinically useful information, helpful to intervention and discharge planning. Recommendations for improving some item phrasing, operational definitions, and instructions were identified. Although standardized assessments were valued, use in routine practice was challenging, requiring a knowledge translation strategy.

A systematic review of interventions to increase the use of standardized outcome measures by rehabilitation professionals

OBJECTIVE

To determine the types and effectiveness of interventions to increase the knowledge about, attitudes towards, and use of standardized outcome measures in rehabilitation professionals.

DATA SOURCES

An electronic search using Medline, EMBASE, PsycINFO, CINAHL, Ergonomics Abstracts, Sports Discus. The search is current to February 2016.

STUDY SELECTION

All study designs testing interventions were included as were all provider and patient types. Two reviewers independently conducted a title and abstract review, followed by a full-text review.

DATA EXTRACTION

Two reviewers independently extracted a priori variables and used consensus for disagreements. Quality assessment was conducted using the Assessment of Quantitative Studies published by the Effective Public Health Practice Group.

DATA SYNTHESIS

We identified 11 studies involving at least 1200 providers. Nine of the studies showed improvements in outcome measure use rates but only three of these studies used an experimental or quasi-experimental design. Eight of the studies used an educational approach in the intervention and three used audit and feedback. Poor intervention description and quality of studies limited recommendations.

CONCLUSIONS

Increased attention to testing interventions focused on known barriers, matched to behavior change techniques, and with stronger designs is warranted.

Translating knowledge in rehabilitation: systematic review

BACKGROUND

Clinicians are faced with using the current best evidence to make treatment decisions, yet synthesis of knowledge translation (KT) strategies that influence professional practice behaviors in rehabilitation disciplines remains largely unknown.

PURPOSE

The purposes of this study were: (1) to examine the state of science for KT strategies used in the rehabilitation professions (physical therapy, occupational therapy, speech-language pathology), (2) to identify the methodological approaches utilized in studies exploring KT strategies, and (3) to report the extent that KT interventions are described.

DATA SOURCES

Eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, and CENTRAL) were searched from January 1985 to May 2013 using language (English) restriction.

STUDY SELECTION

Eligibility criteria specified articles evaluating interventions or strategies with a primary purpose of translating research or enhancing research uptake into clinical practice.

DATA EXTRACTION

Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. The published descriptions of the KT interventions were compared with the Workgroup for Intervention Development and Evaluation Research's (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions.

DATA SYNTHESIS

Of a total of 2,793 articles located and titles and abstracts screened, 26 studies were included in the systematic review. Eighteen articles reported interventions that used a multicomponent KT strategy. Education-related components were the predominant KT intervention regardless of whether it was a single or multicomponent intervention. Few studies used reminders or audit and feedback intervention (n=3). Only one study's primary outcome measure was an economic evaluation. No clear delineation of the effect on KT strategies was seen.

LIMITATIONS

Diverse studies were included; however, the heterogeneity of the studies was not conducive to pooling the data.

CONCLUSIONS

The modest-to-low methodological quality assessed in the studies underscores the gaps in KT strategies used in rehabilitation and highlights the need for rigorously designed studies that are well reported.

Patient-reported outcomes: state-of-the-art hand surgery and future applications

Patient-reported outcome measures (PRO) can provide reliable and valid estimates of patient status and response to interventions to complete the final step in an evidence-based patient interaction. A variety of PRO are relevant to upper extremity surgery and rehabilitation outcomes. PRO provide feasible tools for clinical research or practice, although use in clinical decision making lags behind research applications. Recent trends in clinical measurement include better integration of International Classification of Functioning, Disability and Health in content validation, more modern methods of evaluating scaling properties (Rasch analysis), consensus exercise on establishing core measures, electronic data collection, and computer-adaptive testing.

Proving the Effectiveness of Community Occupational Therapy in the Equipment and Adaptation Setting Using the Canadian Occupational Performance Measure

The Community Occupational Therapy Service (Equipment and Adaptations) at Worcestershire Health and Care National Health Service Trust, Redditch and Bromsgrove Locality identified the need to find an outcome measure that would determine its effectiveness. The Canadian Occupational Performance Measure was chosen as a client-centred, reliable, and validated outcome measure that was integrated within existing paperwork. The process followed is outlined in this practice analysis.

The service completed 1,869 Canadian Occupational Performance Measure scores, which showed a statistically significant increase in client ratings of performance and satisfaction in 90% of clients, illustrating the effectiveness of the service. The aim of this practice analysis is to explain the process that this service followed to integrate the Canadian Occupational Performance Measure into practice and, thus, share the benefit of using it as an outcome measure with colleagues who work in a similar setting. The authors highlight the importance of continuing with the Canadian Occupational Performance Measure and look to develop its use further.