Canadian Occupational Performance Measure

Acquired Brain Injury:
(Jenkinson et al, 2007; Community dwelling individuals; n=34 (TBI=21; CVA=11; Others=2); total of 15 patients with ABI were involved in the stability study, ABI)

• Consistency of self- and relative ratings for no intervention group:
• No significant difference in COPM performance ratings for participants (M=4.62 (1.72)) and relatives (M=4.49 (1.86)); t=0.30, p=0.77)
• No significant difference in COPM satisfaction ratings for participants (M=4.24(1.89)) and relatives (M=5.01 (1.57)); t =-1.79, p =0.078)
• Participants rated their functional abilities on the Patient Competency Rating Scale (PCRS) (M=111.92 (17.58)) at a higher level than their relatives (M=105.75 (20.46)); however, no significant difference (t (62)=1.29, p =0.20)
• Participants’ self-ratings relatively consistent with their relatives’ ratings

Test–re-test reliability coefficients for the COPM ratings over the 8-week interval were all significant

• Excellent (r=0.75–0.86) for relative ratings; Adequate (r=0.53–0.67) for self-ratings

Acquired Brain Injury:

(Jenkinson et al, 2007; Community dwelling individuals; n=34 (TBI=21; CVA=11; Others=2) , ABI)

*p<0.05, two-tailed (PCRS: Patient Competency Rating Scale; HADS: Hospital Anxiety Depression Scale)

• Lower self-ratings of satisfaction were associated with higher levels of anxiety
• No significant difference between self-ratings of satisfaction with measures of awareness, depression and cognitive function
• No significant difference between self-ratings of performance with awareness of deficit, mood state, and cognitive function

The COPM assessment focuses on measuring a mismatch between a person’s abilities and the demands of a task leading to functional impairment. (Macedo et al, 2009)

Research (Law et al 2004) suggests:

• A change of 2 or more points is clinically significant
• Changes in scores from assessment to re-assessment tend to be meaningful

Acquired Brain Injury:

(Phipps et al, 2007; n=155 (TBI=38, CVA=117); Time from admission to discharge (TBI=141.26 (85.10); Right CVA=97.45 (72.99); Left CVA=96.47 (65.97), ABI)

• Significant change in performance ratings and satisfaction ratings from admission to discharge for entire sample and also for each diagnostic group

(Jenkinson et al, 2007; Community dwelling individuals; n=34 (TBI=21; CVA=11; Others=2); total of 10 patients involved in an 8-week intervention group, ABI)

• Significant improvement in COPM performance self-ratings (p=0.018) and satisfaction self-ratings (p=0.013) between the pre- and post-assessment
• Significant improvement in relatives’ ratings of performance between the pre- and post-assessment (p=0.008)
• Improvement for relatives’ ratings of satisfaction between the pre- and post-assessment was not significant (p>0.05)

Traumatic Brain Injury:

(Trombly et al, 1998; Outpatient therapy services; n=16; gender=7 female and 9 male; mean age=43 (12.6); time since injury=22 (5.4), TBI)

• Performance self-ratings were significantly better (p<0.001), and satisfaction self-ratings were significant as well (p=0.001) after treatment than before (discharge: 4-23 weeks after admission; mean=12.3 weeks)
• No significant difference from discharge to follow up (4-8 weeks after discharge)

(Trombly et al, 2002; outpatient rehabilitation; n=31; mean age=37.03 (12.16); gender=75% male; onset more than equal to 12 months=55%; onset less than equal to 3 months=19%; mixed level of severity, TBI)

• Performance self-ratings: significantly greater gain t(10)=5.029, p<0.001, r=0.84, during the treatment versus no treatment periods
• Satisfaction self-ratings: significantly greater gain t(10)=6.325, p<0.001, r=0.89 during the treatment versus no-treatment periods

Ankylosing Spondylitis:

(calculated from statistics in Kjenken et al, 2005; Rescore by personal interview, n=17, mean age 46.4 (12.8) years; Rescore by telephone, n=25, mean age 48.7 (13.3) years; Rescore by mail, n=24, mean age 46.6 (12.5) years; 2 weeks between assessments, Ankylosing Spondylitis)

• Personal interview
  • SEM for performance=0.66
  • SEM for satisfaction=0.84
• Telephone interview
  • SEM for performance=1.41
  • SEM for satisfaction=1.86
• Mail
  • SEM for performance=0.99
  • SEM for satisfaction=1.13

Ankylosing Spondylitis:

(calculated from statistics in Kjeken et al, 2005)

• Personal interview
  • MDC for performance=1.59
  • MDC for satisfaction - 1.80
• Telephone interview
  • MDC for performance=2.33
  • MDC for satisfaction=2.63
• Mail
  • MDC for performance=1.95
  • MDC for satisfaction=2.08

Osteoarthritis:

(calculated byMacDermid et al, 2009 from Kjeken et al, 2005; n=87, women, mean age=62.7 (5.4) years, Hand Osteoarthritis)

• MDC= 5

Ankylosing Spondylitis:

(Kjenken et al, 2005)

• Excellent test-retest reliability by personal interview (ICC=0.92 performance and ICC=0.93 satisfaction)
• Adequate test-retest reliability by telephone (ICC=0.73 performance and ICC=0.73 satisfaction)
• Excellent test-retest reliability by mail (ICC=0.90 performance and ICC=0.90 satisfaction)

Arthritis:

(Ripat et al, 2001; n=13, stage 2 or stage 3 RA, Rheumatoid Arthritis)

• Total Perfomance Scores on the COPM were not significantly correlated to total scores on the disability index of the Health Assessment Questionnaire (HAQ)
  • r =-0.37*, p=0.22
• 36 out of 50 activities identified on the COPM exactly matched activities included in the disability dimension of the HAQ. Individual performance scores on the COPM were significantly related to scores on the matched HAQ components and matched HAQ activities
  • r=-0.52*, p<0.01
  • r=-0.67*, p<0.01

*Pearson product-moment correlation coefficient

Arthritis:

(Macedo et al, 2009, Rheumatoid Arthritis)

• Means Changes in Satisfaction and Performance were found to be both clinically and statistically significant

Stroke:

(calculated from statistics in Cup et al, 2003, Acute Stroke) 2 to 6 months post onset

• SEM for performance=1.2 points
• SEM for satisfaction=1.9 points

Stroke:

(calculated from statistics in Cup et al, 2003, Acute Stroke) 2 to 6 months post onset

• MDC for performance=1.7 points
• MDC for satisfaction=2.7 points

Stroke:

(Cup et al, 2003; 2 to 6 months post onset, Acute Stroke)

• Excellent test-retest reliability
  • r=0.87 performance
  • r=0.88 satisfaction

Stroke:

(Cup et al, 2003; n=26; mean age=68 (15); gender; 11 males, 15 females; time post stroke: 24 patients 6 months post stroke, 2 patients 2 months post stroke, Stroke)

Test retest reliability: interval=8 days

• Spearman’s rho correlation coefficient for the performance scores=0.89 (p <0.001) and for the satisfaction scores 0.88 (p < 0.001)

Stroke:

(Cup et al, 2003, Acute Stroke)

26 participants were asked to identify problems over the course of two interviews. During the initial COPM interview 115 problems were identified. In the second interview 112 problems were identified. 64 problems (56%) mentioned in the first interview were also mentioned in the second interview.

(Martini et al 2014) Adults post stroke (6 community dwelling,> one year post stroke) and children post stroke (8 children performing below the 15^th percentile on the Movement Assessment Battery for Children) were videotaped and rated twice (separated by two weeks) by 3 different raters (research assistant, Occupational Therapist [OT] and OT student). The objective was to determine responsiveness, inter rater and test retest (2 weeks) reliability for the PQRS (Operational Definitions [OD] and Generic systems-[G]) as well as convergent validity between the PQRS-OD, the PQRS-G and the COPM Performance Scores. In terms of convergent validity there was:

• PreTest
  • Poor, virtually no convergent validity between PQRS-G or PQRS-OD with COPM Performance (-0.37 to 0.10) and COPM Satisfaction (-0.23 to -0.07)
• Post test:
  • Poor to Adequate convergent validity based on multiple raters for PQRS-G and PQRS-OD and COPM Performance ( 0.20 to 0.53)
  • Poor convergent validity for PQRS-G and PQRS-OD and COPM Satisfaction (0.04 to 0.29 )
• Change scores
  • Poor to Adequate correlations between PQRS-G and PQRS-OD and COPM Performance (-0.12 to 0.35) and COPM Satisfaction (017-0.58)
  • Correlations between change scores on the PQRS and the COPM were higher for research assistant raters (-0.14 to 0.58) and OT student raters (-0.20 to - 0.47) compared to licensed OT’s (-0.12 to -0.21)

(Hill et al, 2014). This study evaluated 49 community dwelling individuals (mean age of 59.67 (14.14), 72 (58.8) months post stroke to determine if there was a correlation between sensory discrimination (Touch-Test, similar to Semmes Weinstein Monofilaments) and valued activities (functional performance on the COMP).

• Good to excellent correlations were found between individuals who scored high on the COPM (5.9-9.6) and low on the Touch-Test (X²=9.80 (P<0.05);
• No significant relationships were reported between the COPM scores below the median (1.2-5.8) and overall hand sensation ((X²=.523; P=0.97)
• Little to no correlations were reported between touch sensation of the hand and performance of valued activities for those who scored low on the COPM
• No significant relationships were reported for subjects scoring above or below the median for specific hand testing locations and COPM scores
• Subjects with minimal to moderate sensation impairments did not report speech or communication as a valued activity

Subjects with severe impaired sensation did not report exercise as a valued activity.

Stroke:

(Cup et al, 2003, Acute Stroke)

COPM performance scores:

• Poor correlation with Barthel Index r=–0.225*
• Poor correlation with Frenchay Activities Index r=–0.115*
• Poor correlation with the Stroke Adapted Sickness Impact Profile (SA-SIP30) r=0.102*
• Poor correlation with the Euroqol 5D (EQ-5D) r=0.143*
• Poor correlation with the Rankin Scale r=0.209*

In other words, standardized performance measures did not correlate with the COPM indicating strong evidence of discriminate validity.

*(Spearman rho)

• Poor correlation with the Goal Attainment Scaling (GAS) measure compared to COPM Performance score, r=-0.16 and COPM Satisfaction score, r=-0.13
• COPM performance and satisfaction scores are highly correlated, r=0.5, p=0.0012

The COPM assessment focuses on measuring a mismatch between a person’s abilities and the demands of a task leading to functional impairment. (Macedo et al, 2009)

Adults with impairment in 1 or more ADL:

(Eyssen et al, 2005; n=95; mean age 47 (15) years; various diagnoses; COPM administered twice, 7 days between assessments)

• Adequate test-retest reliability (ICC=0.67 performance and 0.69 satisfaction)

COPD:

(Sewell & Singh, 2001, COPD)

• Excellent test-retest reliability (ICC=0.81 performance and ICC=0.76 satisfaction)

Community Dwelling Disabled Individuals:

(McColl et al, 2000; n=61; disability unspecified, Community Dwelling Disabled Individuals)

• Participants identified 481 problems on the COPM and the Perceived Problem Check List (PPCL)
• 54 similar problems were identified on both measures:
  • 24% of PPCL problems were similar to COPM
  • 21% of COPM problems were similar to PPCL
• Problems mentioned on both measures include:
  • Transportation and errands
  • Dressing
  • Toileting
  • Climbing stairs
  • Cooking
  • Cleaning
  • Socializing

Mixed Population (Disorders of wrist, hand and arm, Central neurological disorder, neuromuscular diseases, other diagnosis):

(Eyssen et al, 2011; Dutch version; n=138; mean age=51 (13), Mixed Population)

• Significant positive correlations between the COPM scores and the Sickness Impact Profile (SIP68), Disability and Impact Profile (DIP), and Impact on Participation and Autonomy (IPA) scores

Flexor Tendon Injury, Extensor Tendon Injury, and Dupuytren Disease (Van de Ven-Stevens, Graff, Peters, Van der Linde, & Geurts, 2016; n=72)

• Adequate correlations between the COPM performance scale and the DASH questionnaire (r= -.447).
• Adequate correlations between the COPM performance scale and the MHQ (r= .419).
• Adequate correlations between the COPM satisfaction scale and the DASH questionnaire (r= -.579).
• Adequate correlations between the COPM satisfaction scale and the MHQ (r= .593).
• Excellent correlations between the COPM satisfaction scale and the MHQ (r= -.744).

Pearson Product Moment Correlations Between Assessments per Diagnosis and Overal ^a

^aCOPM=Canadian Occupalonal Performance Measu e; DASH=Disabilities of Arm, Shoulder, and Hand; MHQ=Michigan Hand Outcomes Questionnaire.

^bCorrelation was significant at the .01 level (2-tailed).

^cCorrelation was significant at the .05 level (2-tailed).

The COPM assessment focuses on measuring a mismatch between a person’s abilities and the demands of a task leading to functional impairment. (Macedo et al, 2009)

Flexor Tendon Injury, Extensor Tendon Injury, and Dupuytren Disease (Van de Ven-Stevens, Graff, Peters, Van der Linde, & Geurts, 2016)

• Excellent floor or ceiling effects were observed for the COPM, DASH questionnaire, or MHQ.

Mixed neurologic sample:

(Bodium, 1999; in-patient rehabilitation; n=17; admission to discharge=10 weeks, Mixed Neurologic Sample)

• significant differences in improvement in self-ratings of performance and satisfaction

Mixed neurological, orthopedic and cardiology sample:

(Wressle et al, 2002; n=155 experiment group and 55 in control group within geriatric, stroke and home rehabilitation; median age=80 experiment group and 79 control group; assessment after discharge=2-4 weeks with 88 patients in control group; 30 in control group, Mixed patients)

• Significant differences between groups: more patients in the experiment group perceived that treatment goals were identified, were able to recall the goals, felt that they were active participants in the goal formulation process, and perceived themselves better able to manage after completed rehabilitation compared with patients in the control group

Mixed Population (Disorders of wrist, hand and arm, Central neurological disorder, neuromuscular diseases, other diagnosis):

(Eyssen et al, 2011; Dutch version; n=138; mean age=51 (13), Mixed Population)

• Significant differences between assessment and reassessment scores (p<0.001)
• The AUC ranged from 0.79 to 0.85, and the optimal cut-off values for the performance scores and satisfaction scores ranged from 0.9 to 1.9

Neuro Rehabilitation:

(Chenq et al, 2002; n=12, 7=cerebrovascular accident, 2=spinal cord injuries, & 3=TBI; mean age 42.5; Taiwanese sample, Neuro Rehabilitation)

• Mean changes in Satisfaction and Performance were found to be both clinically and statistically significant

Cerebral Palsy:

(Cusik et al, 2007; n=42; mean age=3.9 years; time post diagnosis unknown; GMPM Level 1, Spastic Hemiplegic Cerebral Palsy)

• Using an adapted form of the COPM competed by a parent proxy (deleted the categories of ‘‘paid/unpaid work’’ and ‘‘household management”), internal consistency reliability was found to be acceptable for Performance (Cronbach’s α=0.73) and Satisfaction (Cronbach’s α=0.83).

The COPM assessment focuses on measuring a mismatch between a person’s abilities and the demands of a task leading to functional impairment. (Macedo et al, 2009)

Cerebral Palsy:

(Cusick et al, 2007, Spastic Hemiplegic Cerebral Palsy)

• The adapted COPM demonstrates an ability to detect change above the published minimum clinically important difference of 2 points

Chronic Pain (Calculated from sats in Nieuwenhuizen, de Groot, Janssen, van der Maas, & Backerman , 2014; n= 87; mean age = 41.7 (11.4) years; PDI score 34.9 (7.72);

• SEM for entire group  (n= 87): 1.22

Chronic Pain (Calculated from stats in Nieuwenhuizen, de Groot, Janssen, van der Maas, & Backerman, 2014)

• MDC for entire group (n=87): 3.35

Chronic Pain (Nieuwenhuizen, de Groot, Janssen, van der Maas, & Backerman , 2014)

• Poor construct validity with the PDI (r= -0.260).
• Poor construct validity was found with all subscales of the RAND-36: physical functioning (r= 0.106), social functioning (r= 0.125), physical role limitations (r= -0.007), emotional role limitations (r= 161), mental health (r= 0.206), vitality (r= 0.248), pain (r=0.184), & general health perception (r=0.106).

Construct validity: Spearman correlations between Canadian Occupational Performance Measure performance scale (COPM-P) and Pain Disability Index (PDI) and RAND 36-Item Health Survey (RAND-36) domains at start of treatment.

Chronic Pain (Nieuwenhuizen, Nieuwenhuizen, de Groot, Janssen, van der Maas, & Backerman , 2014)

• Excellent floor/celing effects were found. 

(Carpenter et al, 2001; n=87 completed the COPM at baseline, end of program and 3 month post intervention; mean age=44, range=19 to 72 years, patients undergoing pain management treatment)

• Changes in satisfaction and performance scores were found to be statistically and clinically significant

Chronic Pain Patients: (Nieuwenhuizen, et al., 2014; assessed at week 1 and week 12 during the program)

• There is a negative correlation between the COPM-P and PDI (r= -0.380, p < 0.001)
• There is a negative correlation between the COPM-P and the subscale of vitality for the RAND-36 (r= -0.031, p < 0.001).
• There is a positive correlation between the COPM-P and the subscale of physical functioning for the RAND- 36 (r= 0.388).
• There is a positive correlation between the COPM-P and the subscale of social functioning for the RAND-36 (r= 0.302, p < 0.005).
• There is a positive correlation between the COPM-P and the subscale of physical role limitations for the RAND-36 (r= 0.381).
• There is a positive correlation between the COPM-P and the subscale of the emotional role limitations for the RAND-36 (r= 0.139).
• There is a positive correlation between the COPM-P and the subscale of mental health and the RAND-36 (r= 0.084, p < 0.005).
• There is a positive correlation between the COPM-P and the subscale of pain and the RAND-36 (r= 0.160).
• There is a positive correlation between the COPM-P and the subscale of general health perception (r= 0.273, p < 0.05)

Community Dwelling Older Adults: (Tuntland, Aaslund, Langeland, Espehaug, & Kjeken, 2016;  n=225; mean age = 80.8 (6.7) years)

Participants who reported “a little improved” after 10 weeks; Performance and Satisfaction scale

• MCID for COPM-P = 3.0 points
• MCID for COPM-S = 3.2 points

The mean change scores (SD) for occupational performance and satisfaction with performance scored on a numerical rating scale (range 1–10), according to participants’ answers in the global rating scale of perceived change

Notes: Independent samples t-tests performed.

^*The MIC.

Abbreviations: COPM, Canadian Occupational Performance Measure; COPM-P, COPM measuring occupational performance; COPM-S, COPM measuring satisfaction with performance; MIC, minimal important change; SD, standard deviation.

Community Dwelling Older Adults: (Tuntland, Aaslund, Langeland, Espehaug, & Kjeken, 2016)

• Recommended cut-off value for distinguishing between older adults that experience minimal important change in performance and satisfaction is 3 points

Community Dwelling Older Adults: (Tuntland, Aaslund, Langeland, Espehaug, & Kjeken, 2016)

• Moderate Construct Validity (Spearman's correlation ICC = .22, confirming the hypothesis of discriminant validity)
• “Moderate correlation found between COPM-P and EQ-5D usual activities, indicating that these two indices partly measure the same construct.”

Construct validity hypotheses and results

Notes:

^aExpected level of Spearman’s correlations.

^*Correlation is significant at 0.01 level (two-tailed).

Abbreviations: COPM, Canadian Occupational Performance Measure; SPPB, Short Physical Performance Battery; EQ-5D, European Quality of Life Scale; VAS, visual analog scale; SOC-13, Sense of Coherence questionnaire; MHC-SF, Mental Health Continuum – Short Form.

Community Dwelling Older Adults: (Tuntland, Aaslund, Langeland, Espehaug, & Kjeken, 2016)

• Pattern of prioritized occupations in line with what would be expected in an older adult population, therefore confirming content validity..

Community Dwelling Older Adults: Tuntland, Aaslund, Langeland, Espehaug, & Kjeken (2016) suggests:

• Statistically significant change scores between groups who answered  “no change” versus “a little improved” and “a little improved” versus “much improved” within 3 out 4 hypothesis
• Moderate responsiveness

Responsiveness hypotheses and results

Notes:

^aIndependent samples t-test.

^bPearson’s correlation coefficient.

^*Statistically significant at 0.05 level (two-tailed).

^**Statistically significant at 0.01 level (two-tailed).

Abbreviations: COPM, Canadian Occupational Performance Measure; COPM-P, COPM measuring occupational performance; COPM-S, COPM measuring satisfaction with performance; SPPB, Short Physical Performance Battery; EQ-5D, European Quality of Life Scale; SOC-13, Sense of Coherence questionnaire; MHC-SF, Mental Health Continuum – Short Form.

Pediatrics: (Verker, Wolf, Louwers, Meester-Delver, & Nollet, 2006; n=80; Psychomotor retardation = 34 (42.5); Cerebral palsy = 14 (17.5); Congenital syndromes = 10 (12.5); Congenital hand/arm deformities = 6 (7.5); Neuromuscular diseases = 3 (4); Other = 13 (16); mean age = 3.7 (1.8); age range = 1 - 7.5; average interval between the interviews = 7 days (2.8))

Interrater

• The limits of agreement for performance scores were -2.4 to +2.3 and for satisfaction scores -2.3 to +2.6.

Pediatrics: (Verker, Wolf, Louwers, Meester-Delver, & Nollet, 2006)

Discriminant

• 157 (71%) of 221 problems reported matched the prioritized problems reported in the COPM.
• 66 (30%) of the 221 matched problems concerned temperament or impairments and behavior of the child, but not activities.

  Convergent

• Of the 196 (50%) problems prioritized in the first COPM, there was a comparable item in the PEDI-NL and for 151 prioritized problems (39%) there was a comparable item in the TAP(C)QOL
• 144 (95%) of corresponding items were also ticked by the parents on the TAP(C)QOL.
• 142 (36%) of prioritized problems in the COPM not comparable item could be found in either the PEDI-NL or the TAP(C)QOL