The Canadian Occupational Lisa Knecht - Sabres, MS, OTR/L

Research
Update
Performance Measure: An Outcome Measure
Background client’s scores are
compared against
The expertise of an occupational therapist their own assess-
lies in his/her ability to appreciate the broad range ment scores. Per-
of human occupations and activities that make up formance and Sat-
peoples’ lives (AOTA, 2008). The Occupational isfaction for each
Practice Framework (AOTA, 2002), defines occu- identified problem
pations as activities that: (1) have unique meaning are re-evaluated
and purpose in one’s life; (2) are central to one’s on a 10-point scale
identity; and, (3) influence how one spends time (changes of 2 or
and makes decisions. Since occupational therapy more points on the
practitioners focus on enabling people to engage COPM are clini-
(or re-engage) in the everyday activities which cally important)
bring meaningfulness and purposefulness to their (Law et al., 2005).
lives, the occupational therapy (OT) evaluation There is a
process must include an assessment of the daily ac- plethora of research
tivities the person either needs or wants to perform on the COPM,
(AOTA, 2008). which has repeatedly demonstrated satisfactory
According to the Occupational Practice to excellent reliability, validity, and usefulness of
Framework (AOTA, 2008), the first critical step in the COPM as an outcome measure (Carswell et
any OT evaluation is to obtain an understanding al., 2004). Other benefits of the COPM are that
of the patient’s or client’s occupational profile. In it: helps with goal writing (e.g., goals are focused
other words, it is imperative to gain a deep un- on occupational performance rather than on body
derstanding of the person’s occupational history function); ensures that the client is involved in the
and experiences, patterns of daily living, interests, goal formulation process; helps with team confer-
values, and needs. Thus, it is essential to ascertain ences and ensures that conferences are focused on
the person’s concerns about performing his/her oc- the client’s needs; facilitates intervention planning
cupations and daily life activities, as well as his/her and motivation of the client; facilitates evaluation
priorities for occupational performance. Utilizing of outcomes; and, outcomes are clear and evident
a client-centered approach to evaluate one’s activi- to the client (Carswell et al., 2004).
ties of daily living (ADL’s) and instrumental ac-
tivities of daily living (IADL’s) provides a natural Case Example: Lynda
means for the patient or client to identify his/her
unique circumstances and context (Law, Baum, & Lynda* is a 45 year old married woman
Dunn, 2005). The Canadian Occupational Perfor- who is a mother and works full-time as a teacher.
mance Measure (COPM) (Law et al., 2005) is one Lynda was seen for home health OT after having
of the few OT evaluation tools which evaluates oc- brain surgery to remove an acoustic neuroma. Af-
cupational performance in a client-centered man- ter surgery, Lynda exhibited many neurological
ner. deficits (e.g., dysmetria, ataxia, low muscle tone,
The COPM is a semi-structured interview fatigue, decreased balance, and decreased postural
designed to have the client: (1) identify concerns control), which significantly interfered with her
regarding his/her performance during self-care, occupational performance.
productivity, and leisure activities; (2) evaluate his/ As seen below, Lynda was most concerned
her performance and satisfaction relative to his/her about being able to perform some of her basic
Research Update self-identified problematic occupational perfor- ADL’s, IADL’s, and leisure interests. It was im-
mance areas; and (3) prioritize his/her problems in portant for Lynda to be able to apply her make-up
If you would like to con-
occupational performance in order to determine and style her hair because she wanted to go back
tribute to the Research
areas to focus on during intervention. to work and was concerned about her personal
Update segment or know
Thus, the COPM measures changes in a appearance. Being a wife and mother, it was im-
someone who would,
client’s perception of his/her occupational perfor- portant for her to be able to cook for her family.
please contact Carrie
mance over the course of occupational therapy in- Additionally, Lynda wanted to be able to engage
Nutter at
tervention. Since the COPM was designed as an in her yearly hobby of planting flowers in her yard
[email protected]
outcome measure, the scores are used for compara- and she wanted to be able to join her family on
tive purposes at reassessment. The COPM is an in-
dividualized measure (vs. norm referenced), so the …Continued on Page 11

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 August / September • Issue 4 • 2011

Canadian Occupational Performance Measure (continued from page 4)

weekend bike rides. The chart below represents Lynda’s initial and discharge scores (self-assessment of her performance and satisfac-
tion) on her areas of concern/goals related to her occupational performance.

Initial Evaluation Reassessment

Performance/Satisfaction Performance/Satisfaction
Applying Make-up: 0/0 Applying Make-up: 8/8
Hair Care: 0/0 Hair Care: 8/8
Cooking: 2/2 Cooking: 8/8
Gardening: 0/0 Gardening: 8/8
Riding a Bike: 0/0 Riding a Bike: 5/6

Case Example: David

David* is a 65 year old retired man who had a LCVA which resulted in global aphasia and dense right hemiparesis. David
was seen for home health OT after an intense course of in-patient rehabilitation services. Both David and his wife were concerned
about David’s inability to take care of himself and his apparent “depression” over his inability to partake in his leisure interests. The
chart below represents David’s initial and discharge scores on his areas of concern/goals related to his occupational performance.

Initial Evaluation Reassessment

Performance/Satisfaction Performance/Satisfaction
Toileting: 4/4 Toileting: 8/8
Showering: 4/4 Showering: 8/8
Dressing: 4/4 Dressing: 8/8
Riding a Bike: 0/0 Riding a Bike: 8/8
Date Night: 3/4 Date Night: 6/6

The above two case examples illustrate how the COPM can be used as an outcome measure. Since changes of 2 or more
points on the COPM are considered to be clinically important, this data demonstrates that these two clients made significant im-
provements in their level of satisfaction, as well as their ability to perform their self-identified problematic areas of occupational
performance. Both of these clients were seen for 3-4 weekly OT home health visits which focused on improving occupational per-
formance via remediation, compensation, and adaptation. •

*Please Note: Names have been changed to ensure anonymity of the clients.

References:

American Occupational Therapy Association (2008). Occupational therapy practice framework. Bethesda, MD.
American Occupational Therapy Association (2002). Occupational therapy practice framework. Bethesda, MD.
Carswell, A., McColl, M., Baptise, S., Law, M., Polatajko, H., & Pollock, N. (2004). The Canadian Occupational Performance
Measure: A research and clinical review. The Canadian Journal of Occupational Therapy, 71, 210-219.
Law, M., Baptise, S., Carswell, A., McColl, M., Polatajko, H., & Pollock, N. (2005). Canadian occupational performance
measure (4th ed.). Ottawa, Ontario: CAOT Publications.
Law, M., Baum, C., & Dunn, W. (2005). Measuring occupational performance: Supporting best practice in occupational
therapy. Thorofare, NJ: Slack, Inc

Occupational Therapy and Driving Evaluations (continued from page 8)

very individualized and will vary from person to person. pists also have many presentations on driving geared to either oc-
Individuals must have a current driver’s license or learner’s cupational therapy students, other professionals (case manger, phy-
permit and an order from their physician to participate in the evalu- sician, therapy clinics, etc.), park districts, senior centers, libraries,
ation. YMCA, etc.
For more information please call Alexian Rehabilitation If interested in having one of the occupational therapists
Hospital drivers program at 847-640-3119. The occupational thera- come present, please contact Jodie Auliff at 847-981-3592. •

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