The Canadian Occupational Performance Measure
Introduction
Paediatric is a field which comprises of many complex and interesting issues which always related with child development. The development of child that begins from simple to complex that revolves on each of components such as physical, sensory, psychological, cognitive and social issues have always being discuss by many researcher who always doing their studies to understand more about the earliest stage of mankind in the world.
Many researchers have used a lot of approaches and practises to evaluate and understand about the human development. One of the professionals who always take advantage on researching the child is Occupational Therapy. Occupational Therapy is one important professional in the rehabilitation process. In occupational therapy, a lot of efforts have been made to implement and improve client – centred practice which defined as “an approach to providing occupational therapy which embraces a philosophy of respect for, and partnership with, people receiving services” (Eyssen, Beelen, Dedding, Cardol, & Dekker, 2005). The concept is focused on respect for the clients and their families, who have the ultimate responsibility for decisions about daily occupations and who should be provided with information emphasising person-centred communication (Rodger, Braithwaite, & Keen, 2004). This concept can be useful for all client-centred rehabilitation to evaluate and give intervention to the clients. Paediatric rehabilitation seems to focus increasingly on client-centred care. (Verkerk, Jeanne, Wolf, Louwers, Meester-Delver, & Nollet, 2006). Client-centred care implies addressing the problems that an individual experiences (Verkerk, Jeanne, Wolf, Louwers, Meester-Delver, & Nollet, 2006; Law M., 1998; Sumsion, 1999). These problems might concern a broad spectrum of areas, including the performance of daily activities. (Verkerk, Jeanne, Wolf, Louwers, Meester-Delver, & Nollet, 2006; Hendriks, De Moor, Oud, & Franken, 2000). Earlier studies have suggested that a client-centred approach leads to an improvement in client satisfaction, functional outcome and better compliance (Verkerk, Jeanne, Wolf, Louwers, Meester-Delver, & Nollet, 2006).
Due to that, there are similarities that present in the field of researching of the paediatrics with client – centred approach. The similarities make it suitable for the use of Canadian Occupational Performance Measure. This especially design evaluation form from Occupational Therapy is now widely used throughout the world. As the data that this assessment provides are credible, outcome – based and accepted as evidence throughout the world (Pendleton & Schultz-Krohn, 2006). Mainly, it is also can be used by multidisciplinary teams to understand and identifies the needs and priorities of the child and their parents by expanding the focus of the interview (Siebes, Ketelaar, Gorter, & et al., 2007). Although that, there are research done to make COPM have the ability to evaluate child below the range of previous version (Rodger, Braithwaite, & Keen, 2004) to make it more user friendly and sensitive towards the clients situations. Thus, the modified version of COPM is born and refers as Modified COPM which researcher now being extensively done studies on it (Rodger, Braithwaite, & Keen, 2004).
Description
As stated by Law, Baptiste, Carswell, McColl, Polatajko, & Pollock in 2005, the original COPM is an individualized measure that is specially design to detect any changes in client’s self perception on their occupational performance over time as this assessment is based on Canadian Model Of Occupational Performance. It is an Occupational – Based Assessment Model which uses a client – centred approach and have criterion – referenced measure (Pendleton & Schultz-Krohn, 2006). COPM also have its concepts as it emphasized more on its standardizations and its effectiveness. As stated (Pendleton & Schultz-Krohn, 2006), the concepts of COPM are based on:
The primary priority is given towards the client and then later on their condition.
Choices and supports are offered to clients as it directly directed in Occupational Therapy Process.
Client’s needs, satisfactory and importance towards their occupation have to be treated in acceptable, flexible and accessible manner during providence of interventions.
Interventions contextually are given in appropriate and relevance.
It have clear respect on the differences and varieties towards the clients as in Occupational Therapy Process
As stated by Rodger, Braithwaite, & Keen in 2004, Modified COPM have undergoes two major modifications that were made to ensure its avaiability and effectiveness towards assessing children.
First, it relates on working with children (and their parents) by reframing of occupations as the things children need to do, want to do and are expected to do in their daily lives are important. Parents and caregivers are the best to knows on their child performance as they are the most close person thats directly relates with the child. Issues, priorities, abilities, problems and importance towards the child occupational performance are some of the topics that can be share and discuss between parents and multidiciplinary teams to identify the most realistic intervention goals.
Second, the substitution of occupational area ‘Productivity/Work’ with ‘Communication/Behaviour’ have been done as the children from two to four years do not engage and involve in formal school activities. Parents were asked to consider and identify how their child’s communication and behaviour difficulties impacted on the child’s ability to engage in their daily occupations. This to ensure that it can helped parents consider communication, behaviour, play, self-care, routines and transitions, as well as family socialisation among their children.
Purposes
Mainly, COPM is used to identify problems in clients performance area with regards to their occupational performance, to gives rates on client’s priorities towards their occupational performance, to evaluate performance and satisfactory levels that is related with their occupational performance problems area, measuring the changes in client’s perception of their occupational performance over the courses of occupational therapy intervention programmes and its mainly to measure any changes in client’s self – perception of occupational performance which have variety of disabilities comprises of all developmental stages.
Suitable Condition For Using COPM
Pervasive Developmental Disorders which are Asperger’s Syndrome and Autism Spectrum Disorder (Phelan, Steinke, & Mandich, 2009).
Congenital Syndrome And Deformities (Verkerk, Jeanne, Wolf, Louwers, Meester-Delver, & Nollet, 2006)
Developmental Delayed (Rezze, VirginiaWright, Curran, Campbell, & Macarthur, 2009)
Acquire Brain Injury (Rezze, VirginiaWright, Curran, Campbell, & Macarthur, 2009)
Cerebral Palsy (Nijhuis, et al., 2008).
This is due to the requirement of these children towards their needs and problems in order to achieve their goal in their rehabilitation programmes. The studies done by Nijhuis, et al. in 2008 shows there is no optimal of the integration of child with their rehabilitation programmes.
Note that, COPM have been accepted and approved its effectiveness on these conditions as these conditions have the most obvious proof by researcher. COPM can still be use to all disability groups and conditions (Law, Baptiste, Carswell, McColl, Polatajko, & Pollock, 2005). This is refers to the Canadian Model of Occupational Performance as stated in Law, Baptiste, Carswell, McColl, Polatajko, & Pollock on 2005 which shows that the results between interaction of persons, environment and occupation will affect their occupational performance.
Domains
The test consists of three divided area which have been further subdivided as follows:
Occupational Performance
Self care, Functional Mobility, and Community Management
Productivity/Work
Paid/Unpaid work, household Management, Play/School
Leisure
Quite recreation, active recreation, socialization
While the Modified COPM comprises of Self – Care, Communication/Behaviours, and Leisure. The domain for Modified COPM (Rodger, Braithwaite, & Keen, 2004):
Communication: To ask before going to the fridge. To increase ability to make needs known. To communicate need for toilet. Requesting food and toys. Responding to ‘come here’.
Social Interaction: To improve eye contact. To join in more with Mum and siblings. To share and take turns with sibling. To improve tolerance of others engaging in play.
Behaviour: To express frustration in appropriate ways. To reduce the frequency of unusual behaviour. To sit down for snack time at kindy. To react calmly when mess/spills made. To reduce amount of time spent selfstimulating.
Play: To stay beside parents when walking in open spaces. To play by him/herself for five minutes. To play with nominated friend for five minutes. To play calmly alongside sibling. To engage in functional play with a doll. To increase play skills with other children.
Self-care: To tolerate hair-brushing (tolerate parting and bunches) To sit on toilet for five minutes. To tolerate sitting on toilet properly. To establish a regular toilet routine
Age Range
The minimum age range of person who can be assessing with COPM is 8 years old. But, according to Law, Baptiste, Carswell, McColl, Polatajko, & Pollock, 2005, the age can be as young as 5 years old to 6 years old as during this age, the child are able to be self assessing, self awareness and self understanding. In other words, the children are able to express their feelings and thoughts towards their occupations (Case-Smith & O’Brien, 2010). But if the child is unable to be assessing by their own, parents and caregivers can help therapist to assess their child. The recognition of family roles in the development of child with respect to the child occupational goal outcomes during early intervention should be implemented and concentrated on (Rodger, Braithwaite, & Keen, 2004).
Procedures and Scoring
The administration of COPM is following on 4 major steps which important on obtaining the correct, reliable, valid and understandable data. The steps are:
Problem Definition
Rating Importance
Scoring
Reassessment
COPM Cover Page
The cover page consist of Client’s Name, Age, Gender, Identification Number, Respondent (if assessment is done with people who relate with client), Date of Assessment, Planned date of Reassessment, Date of Reassessment, Therapist Name, Facility or Agency the Therapist situated, and Program that offers to the client.
Therapist should complete the cover page as it used for identifying the client or the respondent as well as to provide some demographic information with respect to the rehabilitation that administered to the client. Other than that, some therapist use this initial information gathered from client to encourage and help clients to discuss issues relates with their disabilities and the effects towards their daily functioning. Law M. , Baptiste, Carswell, McColl, Polatajko, & Pollock in 2005, are encouraging therapist to performing these interviews as it can assist in the COPM interview process and the back page of the COPM can also be used to record the information that gathers at the COPM.
Step 1: Problem Definition
The first step is essential as COPM is relatively unstructured assessment process. The steps are begins with interview the clients about their latest occupational performance with regards to their disability or current conditions. Intensive skills of interviewing, probing for the full response of client, validating assumptions and motivates the clients or respondent is the most essential skills that therapist have to care most as it requires to obtain the most thorough and comprehensive assessment.
The therapist have to make this step crucial during assessing the clients as its can make clients indentify their occupations that they want to do, need to do and expected to do in their daily life. Encouraging the clients to think about a typical day and describe their occupations that they are typically do, also have to be taken care of by therapist. Therapist then asks the clients about their ability and satisfactory towards performing those occupation that they have stated early.
In simpler words; Knows about clients’ needs, performance and satisfaction.
At this stage, it is important for therapist to identify the areas of occupational performance that make difficulties to the client by administering the COPM with as comfortable as therapist and client as can with regards to any style that therapist considers appropriate with the interview.
The test consists of three divided area which have been further subdivided that is simple and helpful for the therapist during interview process that only provide some structure and ensure therapist to covers all the required areas and not put the effort to the clients itself. However, therapist needs to review each area to ensure all occupational performance problems are identified. Follow the client’s lead when deals with different areas as they may response in their own manners of telling during the interview
Note that, not all of the areas have to be cover by therapist as it is use for ensuring the importance of certain occupation for the client have been discussed with them. Some areas may present during reassessment, so, take note on that area too.
Step 2: Rating Importance
This is the important steps in this assessment. Clients have to rate on their occupational problems that they have chosen in previous interview in terms of the occupational importance in their life. The importance is rated on a ten – point scale and enters it on the score sheet at beside of the defined problems. By doing this, it gives immediate understanding on the engagement of the client in the setting of providing and facilitating the intervention and the priorities that should be taking care of.
Example: IMPORTANCE
How important is it to you to be able to do this activity?
Not important at all Extremely Important
1 2 3 4 5 6 7 8 9 10
Step 3: Scoring
Based on step 2, assist client to find and choose the top 5 most problematic and important occupations. Therapist may assist on showing the highest rates on importance of the occupation that they have chosen recently and help to identify and understand the relations of the occupation, problems and issues for intervention the client. This allow client to get opportunities to confirm and agreed with their most important problems or to choose other problems that is less important if they wish to focus on the intervention that relates with the problems.
The top 5 chosen problems is suggested to be enters in the scoring section which will be the basis for the intervention goal that later then implemented towards client. Contrarily, those target goals are not the only outcomes that therapist have to work with. In fact, therapist has to covers beyond the goals to achieve the maximum ability of the client.
Simplify, at this step, the client should have complete their self – evaluation towards their current performance in that area as well as complete their self evaluation towards their satisfaction towards their current performance.
The scoring rating for performance and satisfaction on each problem are easy, but it is not necessarily to do it first and move to the next problem. Gains of at least 2 points on the COPM are considered clinically important (Rezze, VirginiaWright, Curran, Campbell, & Macarthur, 2009).
Example: PERFORMANCE
How would you rate the way you do this activity?
Unable to do at all Extremely Well Do
1 2 3 4 5 6 7 8 9 10
Example: SATISFACTION
How satisfied are you with the way you do this activity?
Not satisfied at all Extremely Satisfied
1 2 3 4 5 6 7 8 9 10
Therapists have to enter the clients’ score in appropriate box. Then, therapist has to follows the rules below:
Total Score=Total Performance Score / Number of Problems
OR
Total Score=Total Satisfaction Score / Number of Problems
The data obtained is then enters on the TOTAL section.
Step 4: Reassessment
Reassessment is done at appropriate time interval such as in between initial assessment and therapeutic intervention. The time interval is varied which depends on the agreement and judgement that have been done by therapist and client.
During reassessment, the Performance and Satisfaction have to be evaluating again by following the previous ways and enters it on reassessment sections.
Then, therapist has to follows the rules below:
Change In Performance=Performance Score 2-Performance Score 1
OR
Change in Satisfaction=Satisfaction Score 2-Satisfaction Score 1
Then, in order to get total change in performance or satisfaction, therapists have to calculate based on rules at below:
Total Change In Performance=Total Performance Score 2-Total Performance Score 1
OR
Total Change in Satisfaction=Total Satisfaction Score 2-Total Satisfaction Score 1
The Administration for Modified COPM also have four steps which is same as the previous, but in this modified version, the steps is mainly refers to interviewing parents and caregivers. The steps are:
Parents asked to identify occupations that were difficult for their son/daughter with regards to self-care, play, rest and relaxation.
Parents rated these difficulties using a 10-point scale to identify priorities for intervention.
Parents rated current performance and satisfaction of their son/daughter on three to five of the priority areas using a 10-point scale.
Parents rated performance and satisfaction post-intervention.
Administration Time
15 minutes to 30 minutes depends on the experience of the therapist to gain information.
Psychometric Properties
Reliability
Based on the research done by Eyssen, Beelen, Dedding, Cardol, & Dekker, 2005,
The ICC for the mean scores for performance and satisfaction were respectively 0.67 (95% CI 0.54-0.78) and 0.69 (95% CI 0.56-0.79). The limits of agreement for the mean values of performance and satisfaction were in the range of respectively -2.5 to 2.4 (d -0.05, SD 1.2) and -2.3 to 2.7 (d – 0.01, SD 1.4). Cohen’s weighted kappa for each of the five problems ranged from 0.37 to 0.49 for performance scores and 0.38-0.49 for satisfaction scores.
Inter – Rater Reliability
For original COPM, Verkerk, Jeanne, Wolf, Louwers, Meester-Delver, & Nollet, 2006 have stated that,
The comparison between two interview was done which the first COPM interviews identified 392 prioritized problems and the second 390. In the first COPM only two problems were prioritized for one child, four problems for five children and five problems were identified for 74 children, while in the second COPM interview only three problems were prioritized for three children, four problems for four children and five problems for 73 children. Of the 392 prioritized problems identified in the first interview, 290 were prioritized again in the second interview. Of the problems that were prioritized at the first assessment, the median percentage that were also prioritized at the second assessment was 80. No systematic differences were found in the mean scores for performance and satisfaction of the problems that were prioritized in both interviews. The limits of agreement for performance scores were -2.4 to +2.3 (d¯_/0.7, SD 1.2) and for satisfaction scores -2.3 to +2.6 (d¯ 0.18, SD 1.2).
For Modified COPM, Rodger, Braithwaite, & Keen, 2004 shows that,
Inter-rater agreement for goal domain classification was 92.2 per cent. For specific domains, inter-rater agreement was 100 per cent for self-care, 97.3 per cent for communication, 94.7 per cent for behaviour, 91.7 per cent for play, and 69.2 per cent for social interaction. No goals were classified as ‘Other’. Parents identified between three and six goals. The mean number of goals was 4.09. The domain of communication represented the highest priority area of goals identified by parents.
Validity
Construct Validity
Research of Verkerk, Jeanne, Wolf, Louwers, Meester-Delver, & Nollet in 2006 have found that,
For 196 (50%) problems prioritized in the first COPM there was a comparable item in the PEDINL and for 151 prioritized problems (39%) there was a comparable item in the TAP(C)QOL; and 144 (95%) of these corresponding items were also ticked by the parents on the TAP(C)QOL. For 142 (36%) prioritized problems in the COPM no comparable item could be found in either the PEDI-NL or the TAP(C)QOL. These problems concerned a great variety of activities, the majority of which were play activities, preschool skills, outdoor activities and activities which were not formulated specifically enough in the PEDI-NL or the TAP(C)QOL.
Criterion Validity
Verkerk, Jeanne, Wolf, Louwers, Meester-Delver, & Nollet in 2006 also have found that,
A total of 157 (71%) of the 221 problems reported in the replies to the open-ended question matched the prioritized problems reported in the COPM. However, 66 (30%) of the 221 matched problems concerned temperament or impairments and behaviour of the child, but not activities.
Case Study
Client’s Name: MH Jr.
Age: 5 years
Gender: Male
Id #: 123456
Respondent: Mrs. NH (mother)
Date of Assessment: 31st August 2010
Planned Date of Reassessment: September 2010
Date of Reassessment: 14th September 2010
Therapist: Mrs. NB
Facility/Agency: Dept. of Occupational Therapy
Program:
Step 1: Identification of Occupational Performance Issues
Step 2: Rating Importance
Step 1A: Self Care
Personal Care:
Dressing
Feeding
Functional Mobility:
Sitting
Standing
Community Management:
IMPORTANCE
8
8
9
8
Step 1B: Productivity
Paid/Unpaid Work:
Household Management:
Play/School:
Play with peers
Drawing
7
5
Step 1C: Leisure
Quite Recreation:
Active Recreation:
Socialization:
Emotional outburst when play
7
Step 3 and 4: Scoring – Initial Assessment and Reassessment
Initial Assessment:
Reassessment:
Occupational Performance Problems
Performance 1
Satisfaction 1
Performance 2
Feeding
Dressing
Sitting
Standing
Drawing
4
3
5
3
5
2
1
3
3
4
5
4
5
4
6
Scoring:
Total Score =
ΣPerformance @ Satisfaction
# of problems
(4+3+5+3+5)
5
= 4
(2+1+3+3+4)
5
= 2.6
(5+4+5+4+6)
5
= 4.8
Change In Performance =
Performance Score 2 (4.8) – Performance Score 1 (4)
= 0.8
Change in Satisfaction =
Satisfaction Score 2 (5) – Satisfaction Score 1 (2.6)
= 2.4
Additional Notes and Background Information
Initial Assessment:
This child have mild Spastic Cerebral Palsy with affected all four limbs.
Reassessment:
This child have motivation to do the activities provided although may sometime present frustration and emotional outburst.