Occupational Performance Goals Research Articles

The effect of cognitive orientation to daily occupational performance in children with attention deficit hyperactivity disorder: A pilot randomized controlled study

This single-blind randomized controlled trial (RCT) study was planned to examine the effect of the Cognitive Orientation to Daily Occupational Performance (CO-OP) intervention on occupational performance and executive functions through daily routines children with attention deficit hyperactivity disorder (ADHD). Using a simple random method, the children were divided into two groups: n = 15 in the CO-OP group (4 girls, 11 boys) and n = 15 in the control group (3 girls, 12 boys). CO-OP intervention included 12 sessions (2 sessions per week, each lasting 1 hour, 6 weeks in total) focusing on teaching cognitive strategies to improve daily living activities. These sessions involved personalized goal setting, performance analysis, and the application of cognitive strategies to enhance executive function and occupational performance in children with ADHD. The data were collected by assessing the children with the Canadian Occupational Performance Measure, Goal Attainment Scaling, and Executive Functions and Occupational Routines Scale at the beginning and end of the study. When comparing the pre- and post-evaluations of the CO-OP group, statistically significant improvements were noted in occupational performance and satisfaction (p < 0.001), occupational performance goals (p < 0.001), and executive functions through daily routines (p < 0.05). Test results for differences in posttest scores between the two groups showed that the CO-OP group had significantly better activity performance and satisfaction (p < 0.001), as well as gains in social routines for executive skills (p < 0.05), compared to the control group. The findings suggest that the CO-OP approach represents a promising and effective method for facilitating skill acquisition in various activities among children diagnosed with ADHD. Trial registration: This research was registered to clinical trials with the code NCT05125120.

Timepoint for return to occupations post-burn injury using the Canadian Occupational Performance Measure (COPM).

The Canadian Occupational Performance Measure (COPM) was implemented at a state-wide burns service to ensure compliance with current best evidence as outlined by the Australian and New Zealand Burns Association 'burn trauma rehabilitation: allied health practice guidelines'- Chapter 7 Measuring Post-Burn Recovery, as a standard outcome measure for individuals with an admission time greater than 24 h. The primary aim of this study is to determine if individuals have a minimal important change in performance and satisfaction with activities that were identified as problematic on the COPM prior to their acute discharge. Previous research confirmed the feasibility of using the COPM in the acute burn ward and recommended the most appropriate timepoint for re-measurement be confirmed, which is the secondary objective of this study. The benefits of confirming this timepoint include ensuring efficient use of clinicians' time without compromising the accuracy of the assessment and ensuring effective translation of the guidelines' recommendation. A prospective longitudinal study was undertaken, where all individuals who previously completed a COPM prior to acute discharge were sought to complete a re-assessment while accessing outpatient services. Time frames for re-assessment were open. Only individuals who were actively receiving occupational therapy outpatient services were included. COPM assessments were completed in person where possible, particularly for participants who required an interpreter, with phone and video calls also used when needed. A total of 37 participants were included, with the timeframe between initial and post-COPM assessment ranging from 2 to 643 days. Outcomes plateaued at approximately 12 months (365 days) post-initial measurement (prior to discharge from acute ward). The most common occupational performance goals that participants identified were returning to work, sport, and driving. 86.5% of participants increased their satisfaction with these activities. The results of this study demonstrate improvements across the domains of performance and satisfaction occur for individuals with burns at approximately 3 months and 12 months post-injury. Based on this study, it is suggested that when using the COPM assessment in a tertiary burn setting, re-measurement be completed no earlier than 3months and later than 12 months from burn injury, or upon discharge from the service. The findings from this study will be translated into clinical practice at this facility.

CO-OP helps children and young people with executive function deficits achieve their occupational performance goals.

This commentary is on the original article by Lebrault et al. on pages 501–513 of this issue.

Cognitive Orientation to daily Occupational Performance to improve occupational performance goals for children with executive function deficits after acquired brain injury.

To determine the effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach in improving the occupational performance goals of children and young people with executive function deficits after acquired brain injury (ABI) (e.g. etiologies such as stroke, encephalitis, brain tumor, and traumatic brain injury). A replicated single-case experimental study using a randomized multiple baseline design across participants and goals was used. Three clusters of four participants (12 participants, nine males and three females, aged 8-16 years) were included. The intervention consisted of 14 individual CO-OP sessions. Each participant chose four goals; three goals were trained during the intervention sessions and a fourth goal served as the control. The Goal Attainment Scale (GAS) was used as a repeated measure to determine goal achievement while the Canadian Occupational Performance Measure (COPM) was used to identify the perceived goal achievement of children, young people, and their parents. For 26 of the 35 trained goals, the intervention led to statistically significant improvements in the GAS. Perceived occupational performance and satisfaction improved significantly for the trained goals (30 out of 35 goals for the COPM performance and satisfaction of participants; 26 out 31 goals for the COPM performance of parents; 24 out of 31 goals for the COPM satisfaction of parents) and were maintained at the follow-up. Almost all COPM control goal results were significant, but these changes were not supported by the GAS measures or the statistical analysis. The generally positive results of this study provide evidence of the benefits of using the CO-OP approach with this population.

Feasibility of Augmenting Cognitive Strategy Training With Non-Invasive Brain Stimulation.

Many individuals post-stroke have difficulty identifying if or how they can continue performing meaningful daily life tasks. The objective of this study was to evaluate the feasibility of metacognitive strategy training (MCST) and transcranial direct current stimulation (tDCS) in chronic stroke. A case series design was used. Participants completed 12 intervention sessions over 4 weeks consisting of 20 min of tDCS and 45 min of MCST to address occupational performance goals. Feasibility outcomes of acceptability and safety/tolerability were evaluated and measures of occupational performance were administered pre- and post-intervention. Participants perceived the intervention to be highly acceptable and relevant to their needs. Large improvements were observed for performance and satisfaction with goals trained (Hedge's g = 2.07 and 2.11, respectively) and untrained (Hedge's g = 1.25 and 1.43, respectively) within the intervention. An intervention combining MCST with tDCS was feasible to administer and positively received by stakeholders; further research is warranted.

Individualized Goal Setting for Pediatric Intensive Care Unit-Based Rehabilitation Using the Canadian Occupational Performance Measure.

The Canadian Occupational Performance Measure (COPM) is a client-centered outcome measure that facilitates the prioritization of individualized interventions. Given the rising emphasis on individualized intervention in pediatric intensive care units (PICUs), this cross-sectional study aimed to explore caregivers' perspectives on their children's functional goals within PICUs. From 1 September 2020 to 26 June 2022, caregivers of 41 children aged 1-18 years completed the COPM within 48 h of PICU admission. The study also explored the clinical variables predicting a high number of occupational performance goals (≥4/5). Out of 190 goals proposed by caregivers, 87 (45.8%) pertained to occupational performance, while 103 (54.2%) were related to personal factors. Among the occupational performance goals, the majority were associated with functional mobility (55; 28.9%), followed by personal care (29; 15.2%) and quiet recreation (3; 1.6%). Among personal goals, physiological factors (68; 35.8%) were most common, followed by physical factors (35; 18.4%). We found caregiver anxiety, measured by the State-Trait Anxiety Inventory-State, to be a significant predictor of the number of occupational performance goals. These findings underscore the importance of caregiver psychological assessment in the PICU to facilitate personalized goal setting and improve rehabilitation outcomes.

Linking Prioritized Occupational Performance in Patients Undergoing Spasticity-Correcting Upper Limb Surgery to the International Classification of Functioning, Disability, and Health.

Background Spasticity is generally caused by damage to the spinal cord or the areas of the brain that controls movements, which poses significant limitations in occupational tasks. Objectives The aims of the study were to (I) describe prioritized occupational performance problems (POPP) among patients who underwent upper limb spasticity-correcting surgery and map them to the International Classification of Function, Disability, and Health (ICF); (II) assess outcomes postsurgery; (III) assess whether the results are influenced by the diagnosis, gender, and residual muscle function; and (IV) assess correlation between changes in COPM and gains in grasp ability and grip strength. Methods In this retrospective study, assessments occurred pre- and postsurgery, including the Canadian Occupational Performance Measure (COPM), grip strength, and grasp ability. POPP were transformed to prioritized occupational performance goals (POPG) during subsequent rehabilitation. Results 60 patients with a history of spinal cord injury (SCI) (n = 42; 59%), stroke (n = 25; 34%), traumatic brain injury (TBI) (n = 4; 6%), and reason unknown (n = 1; 1%) were included, with a mean age of 57 (±13) years. Of those, 11 had bilateral surgery, generating 71 COPM forms and 320 POPG. The POPG were mapped to the ICF activity and participation chapter, most often to self-care (n = 131; 41%), domestic life (n = 68; 21%), and mobility (n = 58; 18%). COPM scores were significantly increased postsurgery, irrespective of diagnosis, gender, and muscle function. No clear correlation between COPM improvement and hand function gains was shown. Conclusion Patients who underwent spasticity-correcting upper limb surgery identified difficulties with a wide range of occupational tasks that they considered as important to regain. Treatment-induced gains in occupational performance were significant but had no clear correlation with gains in grasp ability and hand strength. Independent of diagnosis, gender, and residual muscle function, it seems important to address the activity- and participation-specific aspects in the assessment and rehabilitation of patients.

Group coaching intervention with parents of children with autism spectrum disorder in Brazil – a pilot study

Introduction: Caring for children diagnosed with autism spectrum disorder (ASD) entails changes in family dynamics. In Brazil, the journey from diagnosis to treatment is characterized by several barriers. Families and their children can be empowered to achieve occupational performance goals through parental coaching interventions. There is, however, limited national evidence on coaching interventions designed to support this population. Aim: This pilot study examines the effects of a coaching intervention program on the occupational performance of Brazilian children with ASD and their families. Methods: A single-subject experimental design was used to conduct group coaching sessions with 16 caregivers over ten weekly sessions. The intervention was designed following the principles of Occupational Performance Coaching (OPC) and was conducted in a group setting to address the economic constraints of the Brazilian health system. The assessment tools adopted were the Canadian Occupational Performance Measure (COPM) and the Developmental History Questionnaire, developed by the authors. During group coaching intervention sessions, occupational performance in the home environment and the efficacy of strategies developed in collaboration with caregivers were observed and discussed. Ultimately, the COPM goals were reassessed by the participants. Results: The average difference for COPM performance and satisfaction scores indicated significant changes, demonstrating that the group coaching intervention improved the participants' occupational performance. Caregivers reported a broader understanding of ASD and its implications for their children's daily lives. In addition, they have enhanced problem-solving skills and reported increased sense of self-efficacy and competence. Application and Conclusion: This pilot study has contributed to the literature on using group coaching interventions to increase the occupational performance of participating children and their families. Our findings indicate that the use of OPC principles is promising in Brazil. These initial findings can encourage further research in this emerging intervention approach and support family-centred interventions in paediatric occupational therapy in Brazil.

Community Transition Goal Setting for Adults in Long-Term Prison: Reentry Needs of People Sentenced as Juveniles to Life Without the Option of Parole

Abstract Date Presented 04/02/2022 OT is an emerging practice area in criminal justice and rarely applied with people sentenced to life as juveniles, who have served more than 25 years and have new potential for parole. A review of 21 OT evaluations revealed 85 different occupational performance goals and related barriers (n = 18) and facilitators (n = 12) to preparing for release. The complexities of setting goals to address prison-to-community transition are explored, along with implications for OT needs in prison reentry services. Primary Author and Speaker: Lisa Jaegers Additional Authors and Speakers: Christine Picker, Jessica Neff, Mackenzie Murphy, Serena Blank, Grace Kanary, Natalie Schur Contributing Authors: Karen Barney

ICF linking of patient-reported therapy goals for children with acquired upper extremity impairment

BackgroundPatient reported outcome measures are used to evaluate hand therapy outcomes. Yet, limited evidence is available regarding the outcomes children desire from hand therapy. PurposeTo determine the desired treatment outcomes of children with acquired upper extremity impairments. Study designDescriptive case series MethodsTwo raters independently applied International Classification of Function, Disability and Health (ICF) linking rules to the Canadian Occupational Performance goals of 151 children, age 6-18, receiving occupational therapy for acquired upper extremity impairments. Prevalence of the linked ICF codes was examined using frequency distributions. Kappa and the proportion of positive agreement assessed inter-rater agreement of the linked codes. ResultsFollowing consensus, two independent raters linked 894 meaningful concepts to the study population's 501 goals derived from the Canadian Occupational Performance. Ninety-two unique ICF codes were linked to these 894 meaningful concepts. Twenty-three ICF codes account for 77.2% of the most frequently linked codes. For these top 23 codes, the greatest proportion (51.4%) of ICF codes are in the d4 mobility chapter representing specific constructs of hand and arm use. The second largest proportion (14.2%) of linked codes are in the d9 Community, society and civic life chapter aligning with participation in sports, music, performing arts and play. Within the d5 self-care chapter, the study population's top priorities included hair care, fitness and drinking. The primary concerns within the b body functions domain are reduced pain, improved joint mobility and strength. ConclusionThe study population's top priorities align with specific dimensions of hand and arm use and participation in sports and fitness, performing arts, and play. Further research may elucidate alignment of these patient-desired outcomes and the item banks of commonly used patient reported outcome measurement scales in this population.

Occupational performance goals and outcomes of time-related interventions for children with ADHD

Background Children with attention deficit hyperactivity disorder (ADHD) have difficulties with occupational performance, related to difficulties with time-processing ability. Aims To examine the outcome of a multimodal time-related intervention designed to support children aged 9–15 years with ADHD, to achieve their occupational performance goals and improve satisfaction with occupational performance. A further aim was to compare the children’s ratings of outcome with their parents’ ratings and to analyse the occupational performance goals. Material and Methods A pre-post design was used. Participants were 27 children, aged 9–15 years. Children and parents rated occupational performance and satisfaction at baseline and follow-up, after 24 weeks, using the Canadian Occupational Performance Measure (COPM). The intervention consisted of time-skills training and time-assistive devices (TADs). Descriptive and non-parametric statistics were used. Results Significant improvements were found in reported performance and satisfaction. Children’s were higher than those of their parents. Most goals were about carrying out daily routines, knowing the duration of an activity and knowing what will happen in the near future. Conclusion and significance The study contributes to knowledge about suitable interventions for children with ADHD who have time-related difficulties. Occupational therapy interventions, including TADs and time-skills training, resulted in significantly improved occupational performance.

Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis

Study DesignThis is a longitudinal, observational, multicenter, cohort study. IntroductionThumb carpometacarpal (CMC) osteoarthritis (OA) is associated with more pain and restrictions than other hand OA. The use of patient-identified occupational performance goals to guide hand therapy treatment and to measure clinical outcomes is fundamental for a patient-centered intervention. The COPM enables subjects to identify goals for hand therapy and engage in a subject-specific therapeutic process. Purpose of the StudyThe purpose of this study is to evaluate the convergent validity and responsiveness of the COPM to evaluate the relationship between the patient’s self-perception and satisfaction of performance in everyday living and pain intensity, upper limb function, and manual ability. MethodsEligible participants to multiple hand therapy centers were recruited. Outcomes measures (VAS scale, QuickDASH, MAM-36, and the COPM questionnaire) were measured at the baseline and 3 months after. ResultsOne hundred forty-five (n = 145) consecutive patients for five different hand rehabilitation centers with symptomatic thumb CMC OA were screened for eligibility criteria. COPM-P and COPM-S were the most responsive instruments, with an area under the curve of 0.88 (95% CI 0.79-0.96) and 0.88 (95% CI 0.80-0.96), respectively. ConclusionsAlthough more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions for thumb OA. The COPM focuses on function and occupation and, in comparison with others upper limb scales, does not require the use of another complementary scale for addressing both satisfaction and ADL status. COPM is an instrument with a good convergent validity and responsiveness to evaluate the relationship between the patient’s self-perception and satisfaction in thumb CMC OA.

Perceived Occupational Performance in Youth with Eating Disorders: Treatment-Related Changes.

This study examined changes in performance and satisfaction with self-identified occupational performance goals during a specialized day treatment admission in children and adolescents with eating disorders. Weight-related outcomes for underweight youth were also examined. A total of 63 youth participated in the study, with admission and discharge data on ratings of self-identified occupational performance goals (measured with the Canadian Occupational Performance Measure) available for 42 participants. Significant improvements were found in ratings of satisfaction and performance with self-identified goals over the course of treatment. The program was also effective in supporting weight restoration for underweight youth, with a large effect size observed. A symptom-focused day treatment program for paediatric eating disorders led to improvements in perceived occupational performance. Collaborating with youth to develop self-identified goals in the context of eating disorders treatment can foster autonomy and potentially improve treatment engagement.

Saddle Up for Success: Equine-Assisted Activities and Therapy Program Evaluation Survey

Abstract Date Presented 03/26/20 This study conducted a program evaluation survey of an equine-assisted activities and therapy (EAAT) program to gain a deeper understanding of participants’ experiences, thoughts, beliefs, and judgments about progress with occupational performance goals and overall satisfaction. Evidence obtained through this study can be used by stakeholders including OT practitioners to better understand possible benefits from participating in an EAAT program and inform future programming. Primary Author and Speaker: David LeVan Additional Authors and Speakers: Katherine Kiss, Jessica Gaffney, Alexandra LaDuke, Lauren Flint Contributing Authors: Anna Lacy

OT in an Equine Environment for Children With Autism: A Multiple Baseline Single-Case Experimental Design

Abstract Date Presented 04/05/19 Results of this single-case experimental design indicate that children with autism who participated in OT in an equine environment demonstrated improvement in individual occupational performance goals, social motivation, and social communication. Some, but not all, participants demonstrated decreased irritability and hyperactivity. Results suggest that horses and the equine environment can be effectively integrated into OT for children with autism. Primary Author and Speaker: B. Caitlin Peters Contributing Authors: Wendy Wood

Exploring the applicability of occupational therapy transition assessments for students with disabilities

ABSTRACTYoung adults with disabilities often require extensive support and planning to ensure that they have a successful transition from the secondary education setting to the postsecondary work, education/training, and living environment. The purpose of this study was to improve occupational therapy support to transition teams by evaluating feedback from transition team members (teachers, therapists, psychologists, and administrators) about occupational therapist conducted postsecondary transition assessments. These occupational therapist transition assessments were conducted for individuals with developmental disabilities who were preparing to transition from high school to the postsecondary community setting. The occupational therapist conducted 18 transition assessments and collected 71 feedback surveys from the interdisciplinary special education team members during the district’s special education transition programme planning and evaluation process. This study examines the feedback from these special educators about those evaluations. The study results yielded useful information regarding the agreed value that occupational therapy conducted transition assessments bring to the transition team for transition planning. This study also identified four foundational assessment areas that occupational therapists should always consider when conducting a transition assessment. These areas include the student’s sensory processing, occupational performance, vocational interests, and self-determined postsecondary goals.

Goal setting dynamics that facilitate or impede a client-centered approach

Background: Client-centred goal setting is central to the process of enabling occupation. Yet, there are multiple barriers to incorporating client-centred goal setting in practice. We sought to determine what might facilitate or impede the formation of client-centred goals in a context highly supportive of client-centred goal settingMethods: We used conversational analysis to examine goal-setting conversations that took place during a pilot trial of Occupational Performance Coaching for stroke survivors. Twelve goal-setting sessions were purposively selected, transcribed, and analyzed according to conventions for conversation analysis.Results: Two main types of interactions were observed: introductory actions and goal selection actions. Introductory actions set the context for goal setting and involved sharing information and seeking clarification related to goal requirements and clients’ occupational performance competencies. Goal selection actions were a series of interactions whereby the goals were explored, endorsed or dropped.Conclusion: Client-centred occupational performance goals may be facilitated through placing goal-setting in the context of life changes and lifelong development of goals, and through listening to clients’ stories. Therapists may improve consistency in adoption of client-suggested goals through clarifying meaning attached to goals and being attuned to power dynamics and underlying values and beliefs around risk and goal attainability.

Implementation Intentions for Self-Selected Occupational Therapy Goals: Two Case Reports.

We evaluated the feasibility of an intervention combining metacognitive strategy instruction (MSI) with training in implementation intentions for adults with mild traumatic brain injury (mTBI). Implementation intentions are written premade decision statements specifying when, where, and how goal behaviors are to be enacted. Two participants with mTBI received a six-session intervention that included setting a daily implementation intention for an occupational therapy goal. A scoring rubric was used to evaluate the quality of implementation intentions; goal achievement was measured using the Canadian Occupational Performance Measure (COPM) and goal attainment scaling. All implementation intentions received perfect quality scores, suggesting participants learned to correctly craft implementation intentions. Improvements in COPM self-ratings exceeded minimal detectable change values; goal attainment levels indicated better-than-expected goal achievement. An intervention combining MSI and implementation intention training appears to be feasible. As an adjunct to MSI, implementation intentions may contribute to clients' ability to achieve their own occupational performance goals. Further study is needed.

Effectiveness of cognitive orientation to (daily) occupational performance (CO-OP) on children with cerebral palsy: A mixed design

BackgroundCerebral palsy (CP) is the most common cause of physical disabilities during childhood. Therapeutic interventions mainly focus on impairment reduction to address motor-based difficulties. In contrast, Cognitive Orientation to daily Occupational Performance (CO-OP) is a cognitive approach, providing intervention at the level of activity and participation. AimsThis study aims to determine whether the CO-OP approach improves motor skills and achievement in motor-based occupational performance goals in children with CP. Methods and proceduresIn this mixed design research (i.e., a multiple baseline single case experimental design and a one-group pretest-posttest design), five children with CP participated in 12 CO-OP intervention sessions. Repeated measures of motor skills for the multiple baseline single case experimental design were taken using the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP); pre- and post-measures of parent/child perception of performance and satisfaction were identified using the Canadian Occupational Performance Measure (COPM); level of achievement was identified using Goal Attainment Scaling (GAS). Outcomes and resultsAccording to the BOTMP results, all children were able to engage in the CO-OP intervention to improve motor performance. Significant differences after treatment were found in both performance and performance satisfaction ratings using the COPM as rated by parents and children. The GAS results showed progress in achievement levels for all children; all goals were achieved or exceeded. Conclusions and implicationsCO-OP intervention can be helpful in improving motor skills and achieving self-identified, motor-based goals in children with CP.

Occupational needs and priorities of women experiencing homelessness: Les besoins et priorités occupationnels des femmes en situation d'itinérance.

Women in unstable housing or who are homeless experience disruptions of occupational engagement and performance. Little is known about their perspective on their occupational needs and priorities. This study aimed to determine how patterns of occupational engagement and performance are facilitated or hindered by personal factors and resources available to sheltered women. A participatory, descriptive mixed-methods study design was used. Twenty-one residents were interviewed using the Canadian Occupational Performance Measure, the Goal Attainment Scale, and a time-use inventory. Nineteen residents participated in semistructured qualitative interviews. Qualitative data were analysed using interpretive description. Participants spent most time on sleep and passive leisure and identified occupational performance issues and goals related to active leisure and employment. Participants' occupational lives were described as transitional journeys comprising five subthemes: seeking safety and stability, being sheltered, shaping one's identity, developing resilience, and engaging in contemplation, contribution, and connectedness through occupation. Trauma-informed and strengths-based approaches are recommended for this population. Future research should study the implementation of occupation-based interventions in community settings.