Canadian Occupational Performance Measure

Last Updated

June 01, 2019

Infographic for Canadian Occupational Performance Measure

Purpose

The COPM assesses an individual’s perceived occupational performance in the areas of self-care, productivity, and leisure.

Link to Instrument

Instrument Details

Acronym COPM

Area of Assessment

Activities of Daily Living
Functional Mobility
Life Participation
Occupational Performance

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$225.45

Cost Description

A 45-minute DVD and Workbook with COPM manual and 100 Forms is $225.45 (Canadian) or a Manual/Form Kit for $52.45 (Canadian) can be purchased from the Canadian Association of Occupational Therapists (cost determined in November, 2012)

Diagnosis/Conditions

Brain Injury Recovery
Cerebral Palsy
Pain Management
Spinal Cord Injury
Stroke Recovery

Stroke

Pediatric Disorders

Older Adults and Geriatric Care

Mixed Populations

Chronic Pain

Cerebral Palsy

Brain Injury

Arthritis

The assessment involves a 5-step process nested within a semi-structured interview, typically conducted by an Occupational Therapist.
The interview focuses on identifying activities within each performance domain that the client wants, needs, or is expected to perform.
Following Step 3, the patient and therapist create goals for therapeutic interventions.
The interviewer may need to supplement information gathered during the COPM interview through other techniques including direct observation, administration of standardized tests, or an assessment of the patient's environment (Law et al., 1990).
The COPM has been translated into 35 languages and is used in over 35 countries. Also available in Pediatric, French, Hebrew, Icelandic, Japanese, German, Danish, Swedish, Greek, Spanish, Mandarin Chinese, Korean, Russian, Slavic, Italian, Portuguese and Norwegian versions.
A caregiver/proxy may respond on the patient’s behalf, but they may not identify the same deficits or problems as the patient would and there may be differences in option in regard to the importance of activities.

Number of Items

9 (3 subgroups with three items in each)

Paper and Pencil
Computer
Manual

10-45 minutes

Required Training

Reading an Article/Manual

Child

6 - 12

years

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by the Rehabilitation Measures Team;

Updated with references from the TBI population by Anna de Joya, PT, DSc, NCS, Coby Nirider, PT, DPT, and the TBI EDGE task force of the Neurology Section of the APTA in 2012;

Updated with references for Arthritis, Pediatrics, and Ankylosing Spondylitis by Brianna DeBois, SPT, Samantha Dillon, SPT, and Jennifer Kick, SPT in 11/2012.

Updated by Maggie Bland PT,DPT,NCS and Nancy Byl PT,MPH,PhD, FAPTA and the StrokEdge II task force of the Neurology Section of the APTA in 2016.

Updated by Bridget Hahn, OTD, OTR/L, Kia Ashley Burks, OTS, Jordan Ginsburg, OTS, Kathryn Riggilo, OTS in summer 2019.

ICF Domain

Participation

Measurement Domain

Activities of Daily Living
General Health
Motor
Participation & Activities

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:
HR	Highly Recommend
R	Recommend
LS / UR	Reasonable to use, but limited study in target group / Unable to Recommend
NR	Not Recommended

Recommendations for use based on acuity level of the patient:

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 months post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

Recommendations based on level of care in which the assessment is taken:

	Acute Care	Inpatient Rehabilitation	Skilled Nursing Facility	Outpatient Rehabilitation	Home Health
MS EDGE	UR	UR	UR	UR	UR
StrokEDGE	NR	UR	UR	UR	UR
TBI EDGE	NR	NR	NR	LS	LS

Recommendations for use based on ambulatory status after brain injury:

	Completely Independent	Mildly dependant	Moderately Dependant	Severely Dependant
TBI EDGE	N/A	N/A	N/A	N/A

Recommendations based on EDSS Classification:

	EDSS 0.0 – 3.5	EDSS 4.0 – 5.5	EDSS 6.0 – 7.5	EDSS 8.0 – 9.5
MS EDGE	UR	UR	UR	UR

Recommendations for entry-level physical therapy education and use in research:

	Students should learn to administer this tool? (Y/N)	Students should be exposed to tool? (Y/N)	Appropriate for use in intervention research studies? (Y/N)	Is additional research warranted for this tool (Y/N)
MS EDGE	No	No	No	Yes
StrokEDGE	No	No	Yes	Not reported
TBI EDGE	No	Yes	Yes	Not reported

Considerations

The COPM can be time consuming and difficult to administer (Toomey et al, 1995)
Requires that the therapist using the tool be comfortable with a client-centered approach to both assessment and practice (Law et al, 1994)
May not be appropriate for children under 8
The interview process is of critical importance both in eliciting relevant information and devising patient-centered therapeutic interventions. However, the interview process is not standardized and both the quality and adequacy of information obtained from interviews may vary considerably between interviewers.
Initially was not considered appropriate for children under 8 years of age, but more recent research supports it use with children
(Galvin et al 2010). Twenty six children with ischemic or hemorrhagic stroke ( 5-16 years of age) participated in this study to identify the functional tasks of concern and identify the most valued functional activities as measured by the COPM when completed by the children and by the parents). The satisfaction and performance parts of the COPM were not administered. A total of 103 goals were identified.
Preschool aged children had the most concerns about self care (45%) and productivity (36% ) with less concern about leisure (19%)
School aged children had the most concerns about self care (46%) and leisure activities (36%)
Parents had concerns about their children’s self care (47%), productivity (27%) and leisure activities (26%)

The COPM was designed for use with all clients regardless of diagnosis (Law et al, 2004).

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Interrater/Intrarater Reliability

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

Construct Validity

Acquired Brain Injury:

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

	PCRS Discrepancy	HADS Depression	HADS Anxiety	Health and Safety Subtest of the Independent Living Scale
COPM Performance	0.21	-0.23	-0.3	0.18
COPM Satisfaction	0.2	-0.33	-0.42*	-0.02

*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

Content Validity

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)

Responsiveness

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

Standard Error of Measurement (SEM)

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

Minimal Detectable Change (MDC)

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

Test/Retest Reliability

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)

Criterion Validity (Predictive/Concurrent)

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

Responsiveness

Arthritis:

(Macedo et al, 2009, Rheumatoid Arthritis)

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

Standard Error of Measurement (SEM)

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

Minimal Detectable Change (MDC)

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

Normative Data

Acute Stroke:

(Cup et al, 2003; n=26; mean age=68 (15) years; mean time between assessments=8 days (2.5) days, range 5–16 days, Acute Stroke)

Mean performance and satisfaction scores Mode number of problems identified over two assessments 3 to 5

Interview 1: mean performance score 3.5 (SD 1.8, range 1.0–7.0)
Interview 2: mean performance score 3.7 (SD 1.9, range 1.0–6.8)
Interview 1: mean satisfaction score 3.3 (SD 1.9, range 1.0–7.5)
Interview 2: mean satisfaction score 3.5 (SD 2.1, range 1.0–7.4)

Test/Retest Reliability

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

Interrater/Intrarater Reliability

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)

Internal Consistency

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.

Criterion Validity (Predictive/Concurrent)

(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.

Construct Validity

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

Content Validity

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)

Test/Retest Reliability

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)

Criterion Validity (Predictive/Concurrent)

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

Construct Validity

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

Population	COPM Performance Scale-DASH Questionnaire	COPM Performance Scale-MHQ	COPM Satisfaction Scale-DASH Questionnaire	COPM Satisfaction Scale-MHQ	DASH Questionnaire-MHQ

n	Correlation	n	Correlation	n	Correlation	n	Correlation	n	Correlation
Flexor tendon injury	41	−.506^b	41	.496^b	41	−.621^b	41	.602^b	43	−.625^b
Extensor tendon injury	6	.084	6	−.251	6	.064	6	.083	8	−.831^c
Dupuytren disease	16	−.137	16	.169	16	−.352	16	.606^c	21	−.621^b
Total	63	−.447^b	63	.419^b	63	−.579^b	63	.593^b	72	−.744^b

^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).

Content Validity

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)

Floor/Ceiling Effects

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.

Responsiveness

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

Internal Consistency

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).

Content Validity

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)

Responsiveness

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

Standard Error of Measurement (SEM)

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

Minimal Detectable Change (MDC)

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

MDC for entire group (n=87): 3.35

Construct Validity

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).

Outcome Measure	COPM-P Score
PDI	-0.260
RAND-36
Physical Functioning	0.106
Social Functioning	0.125
Role Limitations (Physical)	-0.007
Role Limitations (Emotional)	0.161
Mental Health	0.206
Vitality	0.248
Pain	0.184
General Health Perception	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.

Floor/Ceiling Effects

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

Excellent floor/celing effects were found.

Responsiveness

(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)

Outcome Measure	ΔCOPM-P Score
ΔPDI	-0.380
ΔRAND-36
Physical Functioning	0.388
Social Functioning	0.302
Role Limitations (Physical)	0.381
Role Limitations (Emotional)	0.139
Mental Health	0.084
Vitality	-0.031
Pain	0.160
General Health Perception	0.273

Minimally Clinically Important Difference (MCID)

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

Global perceived change	Number of participants	Mean change score (SD)
COPM-P
Much improved	97	4.6 (2.1)
A little improved	74	3.0^* (2.0)
No change	28	1.6 (2.2)
COPM-S
Much improved	96	4.8 (2.1)
A little improved	73	3.2^* (2.1)
No change	28	2.2 (2.2)

Notes: Independent samples t-tests performed.

^*The MIC.

Cut-Off Scores

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

Construct Validity

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

Instrument	Dimension	COPM dimension	Hypotheses^a	Results	Confirmed hypotheses (yes/no)
SPPB	Sum score physical function	Performance	Low	0.22^*	Yes
SPPB	Single-item score, gait test	Performance	Low/moderate	0.13	Yes
EQ-5D	Single-item score, usual activities	Performance	Low/moderate	−0.36^*	Yes
EQ-5D	VAS score health today	Performance	Low/moderate	0.23^*	Yes
SOC-13	Sum score coping	Performance	Low	0.02	Yes
SOC-13	Sum score coping	Satisfaction	Low	0.04	Yes
MHC-SF	Sum score mental health	Performance	Low	0.03	Yes
MHC-SF	Sum score mental health	Satisfaction	Low	−0.02	Yes

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.

Content Validity

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..

Responsiveness

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

Instrument	Hypotheses	Result	Confirmed hypotheses (yes/no)
Global rating scale	Significant mean difference^a in COPM-P change score for “no change” versus “a little improved”	−1.45^*	Yes
Global rating scale	Significant difference^a in mean COPM-S change score for “no change” versus “a little improved”	−1.12	No
Global rating scale	Significant difference^a in mean COPM-P change score for “a little improved” versus “much improved”	−1.53^**	Yes
Global rating scale	Significant difference^a in mean COPM-S change score for “a little improved” versus “much improved”	−1.61^**	Yes
SPPB (sum score)	Low correlation^b between SPPB change scores and COPM-P change scores	0.40^**	No
EQ-5D (single-item score)	Low correlation^b between EQ-5D self-care change scores and COPM-P change scores	−0.33^**	No
SOC-13 (sum score)	Low correlation^b between SOC-13 change scores and COPM-P change scores	0.11	Yes
MHC-SF (sum score)	Low correlation^b between MHC-SF change scores and COPM-P change scores	0.17	Yes

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.

Interrater/Intrarater Reliability

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.

Construct Validity

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

Bibliography

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