Canadian Occupational Performance Measure Satisfaction Research Articles

Personal digital assistants as cognitive aids for high school students with autism: Results of a community-based trial

Objective: The purpose of this study was to examine the efficacy of personal digital assistants (PDAs) as task management tools in a sample of transition-age high school students with autism. Method: The group included twenty-two high school students selected from locales across the Commonwealth of Virginia, all of whom carry a diagnosis of autism and exhibit difficulties in performing everyday tasks due to cognitive-behavioral problems. Participants were trained by an occupational therapist to use PDAs as task management tools and participants and their parents completed self-assessments of occupational performance (using the Canadian Occupational Performance Measure (COPM)) before training and eight weeks after training concluded. At the post-assessment, PDAs were examined for recorded appointments and other entries, as evidence of participants' usage, and participants were asked to demonstrate programming the PDA for reminder alarms and other functions, as a measure of their retention of training. Results: Eight weeks after completion of training, the group demonstrated statistically significant improvement on COPM occupational performance and satisfaction with occupational performance scores, all PDA calendars showed reminder alarms scheduled for each day of the week across the eight week post-training period and all participants demonstrated the ability to respond to reminder alarms appropriately. Also, eight weeks after training, most participants (18 of 22 or 82%) were able to program device software, as trained, demonstrating retention of training and suggesting everyday use of the device. All participants attested to everyday device use and said that the device had improved their independence in performing functional activities. Conclusion: A brief training intervention utilizing PDAs as cognitive aids is associated with improved self-ratings of performance and satisfaction in everyday life tasks among a group of high school students with autism. This group also demonstrated retention of training when reassessed eight weeks later, and their devices showed calendar entries across the eight weeks that suggest everyday use.

Repeat botulinum toxin‐A injections in the upper limb of children with hemiplegia: a randomized controlled trial

To test the effectiveness of repeat botulinum toxin A (BoNT-A) injections in the affected arm of 22 children with hemiplegic cerebral palsy (19 males, three females), aged 1 year 10 months to 4 years 10 months (mean 3y 8mo, SD 9mo) in a randomized controlled trial. Children received either three series of BoNT-A injections plus twice-weekly occupational therapy (OT) or OT alone in 16-week cycles. Muscles targeted at each injection cycle in the 11 children receiving BoNT-A+OT were the adductor pollicis (n=9), flexor pollicis longus (n=5), flexor digitorum superficialis (n=8), flexor digitorum profundus (n=8), flexor carpi radialis (n=2), flexor carpi ulnaris (n=6), pronator teres (n=10), and biceps brachii (n=11). Parental perception of treatment efficacy was assessed using the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scale (GAS), quality of movement using the Quality of Upper Extremity Skills Test (QUEST), fine motor skills using the Peabody Developmental Motor Scale - Fine Motor (PDMS-FM), and spasticity using the Modified Tardieu Scale (MTS). Between-group differences at 12 months were analysed using independent-sample t-tests. All children were at Gross Motor Function Classification System levels I (BoNT-A+OT n=6; OT n=8) or II (n=5 and n=3 respectively) and were too young to be classified using the Manual Ability Classification System. The BoNT-A+OT group had higher COPM performance scores (mean difference -0.8, 95% confidence interval [CI] -1.5-0.0) and higher GAS T scores (mean difference -6.9, 95% CI -13.8 to -0.1]). No significant difference was found for the COPM satisfaction, PDMS-FM, or QUEST scores. The BoNT-A+OT group showed progressive reduction in spasticity compared with the OT group. At study completion MTS mean difference was 50.0 degrees (95% CI 22.4-77.6) for pronators and 20.9 degrees (95% CI 2.4-39.4) for wrist flexors. Repeat BoNT-A injections in the upper limb combined with OT resulted in progressively reduced spasticity and improved parental perception of performance.

Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy

Work disability is a serious consequence of rheumatoid arthritis (RA). We conducted a 6-month, prospective randomized controlled trial comparing assessments of function, work, coping, and disease activity in employed patients with RA receiving occupational therapy intervention versus usual care. Employed patients with RA with increased perceived work disability risk were identified by the RA Work Instability Scale (WIS; score >or=10). Patients were stratified into medium- (score >or=10 and <17) and high-risk (>or=17) groups, then randomized into occupational therapy or usual care groups. Assessments were conducted at baseline and 6 months. The primary outcome was the Canadian Occupational Performance Measure (COPM), a standardized patient self-report of function. Other outcomes included the disability index (DI) of the Health Assessment Questionnaire (HAQ); Disease Activity Score in 28 joints (DAS28); RA WIS; EuroQol Index; visual analog scales (VAS) for pain, work satisfaction, and work performance; and days missed/month. Independent sample t-tests and Mann-Whitney U tests were used. We recruited 32 employed patients with RA. At baseline the groups were well matched. At 6 months the improvement in the occupational therapy group was significantly greater than that in the usual care group for all functional outcomes (COPM performance P < 0.001, COPM satisfaction P < 0.001, HAQ DI P = 0.02) and most work outcomes (RA WIS [P = 0.04], VAS work satisfaction [P < 0.001], VAS work performance [P = 0.01]). Additionally, Arthritis Helplessness Index (P = 0.02), Arthritis Impact Measurement Scales II pain subscale (P = 0.03), VAS pain (P = 0.007), EuroQol Index (P = 0.02), EuroQol global (P = 0.02), and DAS28 (P = 0.03) scores significantly improved. Targeted, comprehensive occupational therapy intervention improves functional and work-related outcomes in employed RA patients at risk of work disability.

Individualized Outcome Measures for Evaluating Life Skill Groups for Children with Disabilities

The challenge of evaluating life skill groups is the need to assess skills reflecting the priorities and abilities of the individuals as well as the program focus. This study describes the feasibility and utility of goal menus and individualized outcome measures in two life skill groups for children with disabilities. Eleven children were evaluated at baseline and 5 weeks post-program using a modified Canadian Occupational Performance Measure (COPM) and modified Goal Attainment Scaling (mod-GAS). COPM satisfaction median scores across all goals increased post-program by 3.0 points (P=0.001) and performance scores by 1.0 point (P=0.002). Mod-GAS scores for all participants were at least -1 (partial achievement), and 55% of participants achieved their functional goal (Mod-GAS = 0) with carryover into their community environments. This study supports the positive contribution of individualized measures to evaluate outcomes within life skill programs for children with disabilities.

Outcomes of an Occupational Therapy School-Based Consultation Service for Students with Fine Motor Difficulties

This paper reports on a study that was conducted to address the perceived occupational performance changes among school-aged children who received occupational therapy services for fine motor difficulties. It also addressed teacher awareness and the degree of implementation of occupational therapy recommendations by teachers. The study sample included 91 school-aged children referred for occupational therapy services for fine motor difficulties. The children were assessed, before and after intervention. Outcome measures used were the Canadian Occupational Performance Measure (COPM) and the Teacher Awareness Scale (TAS). Significant change scores in both scales of the COPM were (Performance = 1.50, p < 0.001; Satisfaction = 1.92, p < 0.001). Regression analyses showed that lower teacher ratings of the students'performance and satisfaction of performance on the initial COPM resulted in significantly greater COPM change scores in the students'performance and satisfaction of performance at reassessment. The greater the degree of implementation of occupational therapy strategies by the teacher, the greater the COPM performance and satisfaction change scores. The greater the degree of teacher awareness of students'special needs resulted in greater COPM performance change scores. Teachers may benefit from more education regarding fine motor difficulties in children and how the implementation of occupational therapy strategies are helpful to improve children's fine motor difficulties.

Satisfaction with Daily Occupations: Construct validity and test–retest reliability of a screening tool for people with mental health disorders

Background/Aim: In occupational therapy research and in clinical practice there is a need for valid, reliable and easily administered measures. For research and screening purposes, the Satisfaction with Daily Occupations (SDO) instrument was developed. It addresses work, leisure, domestic tasks and self‐care and generates a satisfaction and an activity level score. This study investigated its construct validity, internal consistency and test–retest reliability in 55 clients visiting occupational therapists in outpatient mental health care. Methods: The SDO was administered on two occasions with a 1‐week interval, and data on the Canadian Occupational Performance Measure (COPM), psychosocial functioning and self‐rated health were collected on the first of these occasions. Results: In contrast to what was expected, the relationships between the SDO scores and the COPM scores were low. The strongest relationship between the SDO satisfaction score and any other variable was to psychosocial functioning. These variables shared 23% of the variance. Internal consistency for the satisfaction score was acceptable, alpha = 0.75 on the second occasion, and the test–retest reliability was good; rs = 0.84 for the satisfaction score and rs = 0.92 for the activity level.Conclusions: The results indicated that the SDO has satisfactory reliability. The instrument targets a specific construct, as compared to the COPM and the measurements of self‐rated health and psychosocial functioning. Thus, the SDO and the COPM satisfaction scale seem to assess different phenomena, probably because the SDO has predefined items, not specifically targeting a certain client's problematic occupations, whereas the COPM is based on self‐defined problems. The instruments may therefore supplement each other.

Quality of Life in Depression: Predictive Models

The purpose of this study was to examine the predictive factors of quality of life for inpatients with depressive disorders. Eighty-three patients (mean age 44; 73% female) with depressive disorders were recruited from the psychosomatic ward of a medical center in the northern part of Taiwan. The predictive models of this study were established by encompassing three constructs: clinical variables, demographics, and perceived competence. The outcome variables of this study included an overall quality of life score and four domains' scores of the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Stepwise regression analysis was used to identify significant factors related to the outcome variables. The results showed that there were five distinct models for the various domains of the quality of life. The predictive variables of the final model for overall quality of life included: the Beck Anxiety Inventory, the Canadian Occupational Performance Measure-satisfaction, and the Occupational Self Assessment-self. For the physical domain of the quality of life model, the adjusted Beck Depression Inventory-II, the Beck Anxiety Inventory, and the Activity of Daily Living Inventory were the significant predictors. In the psychological domain, the adjusted Beck Depression Inventory-II and age were the predictive factors. The adjusted Beck Depression Inventory-II, the Beck Anxiety Inventory and the Occupational Self Assessment-environment were the predictors for the social domain of quality of life. Finally, the adjusted Beck Depression Inventory-II, age, and the Occupational Self Assessment-environment were the predictors for the environmental domain of quality of life. The significance of the perceived competence variables in the quality of life of patients with depression indicates that occupational therapy intervention is warranted.

Can Individualized Rehabilitation Improve Functional Independence in Elderly Patients With COPD?

The aims of this study were to establish whether pulmonary rehabilitation (PR) improves domestic function and daily activity levels in COPD and whether individually targeted exercise is more effective than general exercise. Prospective randomized, controlled trial. Outpatient PR program in secondary care. One-hundred eighty patients (mean [+/-SD] age, 68.3 +/- 8.6 years; FEV1, 0.95 +/- 0.4 L; FEV1/FVC ratio, 0.51 +/- 0.15; 111 male patients; 69 female patients) with stable COPD. One hundred twenty-one patients completed the study. Patients were randomized to a conventional 7-week general exercise program ([GEP] n = 90) or an individually targeted exercise program ([ITEP] n = 90). Daily activity was measured using ambulatory activity monitors (Z80 -32k V1 Int; Gaehwiler Electronics; Hombrechtikon, Switzerland). These were lightweight devices, which contained a uniaxial accelerometer. Domestic function was assessed by the Canadian Occupational Performance Measure (COPM). Exercise performance was assessed by the incremental shuttle walk test (ISWT) and the endurance shuttle walk test and health status by the chronic respiratory questionnaire-self-reported. Activity monitor counts increased by 29.18% (95% confidence interval [CI], 3.19 to 55.17; p = 0.03) for the GEP and 40.63% (95% CI, 7.42 to 73.83; p = 0.02) for the ITEP. Mean COPM performance scores increased by 1.71 (95% CI, 1.37 to 2.05; p = 0.0001) for the GEP and 1.46 (95% CI, 1.05 to 1.87; p = 0.0001) for the ITEP. Mean COPM satisfaction scores increased by 2.27 (95% CI, 1.74 to 2.81; p = 0.0001) for the GEP and 2.04 (95% CI, 1.56 to 2.52; p = 0.0001) for the ITEP. ISWT scores increased by 81.72 m (range, 63.83 to 99.62) for the GEP and by 85.52 m (range, 67.62 to 103.42) for the ITEP. No statistically significant difference was found between the general exercise group and the individually targeted exercise group for any outcome measure. Pulmonary rehabilitation improves domestic function and physical activity. This study also demonstrates that general exercise training is as effective as individually targeted training.

The Use of Canadian Occupational Performance Measure (COPM) in Clients with an Acute Stroke

Occupational therapy (OT) focuses on enabling individuals to participate in occupations of their choice. The aim of this study was to introduce a client-centred practice approach with clients who had experienced an acute stroke. Eighty consecutive clients who were referred to OT participated in the study. The Canadian Occupational Performance Measure (COPM) was administered to 29 clients. COPM is a semi-structured interview, designed to measure a clients’ perceptions of their occupational performance over time. The client identifies activities that are difficult to him or her and rates his or her performance and level of satisfaction in these activities. All COPM scores on satisfaction and performance have improved. The average score of improvement on performance was 2, and improvement on satisfaction was 2. Analysis of the changes on the COPM using Wilcoxon signed rank tests demonstrated that the changes were not statistically significant for both the COPM performance and satisfaction scores. We were able to assess and follow clients priorities in 36.25 % of acute stroke clients referred to OT.

Abstract 8: Functional and societal limitation and disability outcomes in a randomized control trial of botulinum toxin type a for children with spastic diplegic cerebral palsy.

Objectives: To document the functional and societal limitation and disability level effects (National Center for Medical Rehabilitation Research framework) of gastrocnemius botulinum toxin type A (BTX) injections in children with spastic diplegic cerebral palsy (CP). Design: Randomized double-masked placebo controlled trial. Setting: Tertiary care children’s hospital. Participants: 33 children with spastic diplegic CP, (mean age, 5.5y; range, 3.0–11.9y), of whom 19 were boys (subjects’ Gross Motor Function Classification System levels: level I=12; level II=15; level III=6). Intervention: All participants were randomized to receive either 12U/kg BTX or placebo saline injections. Main Outcome Measures: Functional limitation and disability: Gross Motor Function Measure (GMFM-88, GMFM-66), energy cost index (ECI), and Canadian Occupational Performance Measure (COPM) performance scores were collected at selected weeks postinjection. Societal limitation: COPM satisfaction scores and Goal Attainment Scaling (GAS) were obtained at 12 and 24 weeks. Results: GMFM-88 total score ( P=.00) and the GMFM-66 ( P=.03) significantly increased for the treatment group compared with the placebo group at 24 weeks. No significant group differences were found for the ECI at any follow-up point. The COPM performance scores were significantly greater for the treatment group at 12 weeks ( P=.04) and approached a significant difference at 24 weeks ( P=.06). COPM satisfaction scores and GAS did not differ significantly by group at any follow-up point. Conclusions: The GMFM-88 and -66 scores and COPM performance scores demonstrated a significant difference at 12 weeks, with a diminishing effect noted at 24 weeks. In contrast, satisfaction with performance as measured by the COPM satisfaction scores and performance and importance of goals set as measured by the GAS did not differ significantly between treatment groups. These data documented consistent changes on the functional limitation and disability levels up to 6 months posttreatment, but not on the societal outcome level.

The Canadian Occupational Performance Measure: Is it a Reliable Measure in Clients with Chronic Obstructive Pulmonary Disease?

The Canadian Occupational Performance Measure (COPM) is now a widely used and accepted outcome measure for clients with chronic conditions. The aim of this study was to examine the reproducibility of the COPM in clients with chronic obstructive pulmonary disease (COPD). Test-retest reliability of the performance and satisfaction scores has yet to be established in this population. The reasons for examining reliability are discussed. Fifteen clinically stable clients (eight men and seven women, mean age 67.1 years) were interviewed by an occupational therapist and their COPM performance and satisfaction scores recorded. A reassessment of the performance and satisfaction scores then took place about 7 days later. The scores were analysed using the mean difference, 95% confidence intervals and correlation coefficients. The results were as follows: performance score 1 and performance score 2: mean difference = 0.14 (95% CI: −0.39 to 0.68); and satisfaction score 1 and satisfaction score 2: mean difference = 0.42 (95% CI: −0.18 to 1.01). The intraclass correlation coefficients between test 1 and test 2 were high (r = 0.92 for performance and r = 0.90 for satisfaction). This study indicates that the COPM is a reliable tool in clients with COPD.

The Use of a Simulated Environment (Easy Street) to Retrain Independent Living Skills in Elderly Persons: A Randomized Controlled Trial

Older adults who receive training for functional skills in contextually appropriate environments may show greater functional improvement than persons trained in a traditional environment. Functionally limited older adults receiving training in contextually appropriate environments (simulated home and community settings) may show greater improvement in activities of daily living (ADL) than persons trained in a traditional manner. Eighty-eight patients from a day hospital, aged 65 years or older, were randomized to either receive rehabilitation in a simulated environment (Easy Street) or in a gymnasium setting. Rehabilitation focused on retraining functional skills in a contextually appropriate environment (Easy Street) or in a traditional setting (gymnasium) using motor learning principles for a period of 16 weeks. Outcome measures included the Structured Assessment of Instrumental Living Skills (SAILS), a performance measure with criterion and timed components; a self-report health status questionnaire, the Short Form-36 (SF-36); and the patient-orientated goal-directed Canadian Occupational Performance Measure (COPM). There were no group differences on any of the outcome measures: SAILS (p = .3); the SF-36 physical (p = .83) and mental (p = .51); and the COPM performance scale (p = .94) and satisfaction scale (p = .40). Although we have not excluded benefits of contextually appropriate rehabilitation environments with different intervention approaches, at different stages of rehabilitation or with patients at higher functional levels, our results suggest the appropriateness of a moratorium on these expensive interventions pending demonstration of clear positive effects determined from further study.