Anne Carswell

The Canadian Occupational Performance Measure: A Research and Clinical Literature Review

Backround. It has been 13 years since the Canadian Occupational Performance Measure (COPM) was published. In that time there has been a remarkable growth in its acceptance as an outcome measure within the occupational therapy practice and research. Purpose. The purpose of this paper is to review the emerging research and clinical literature related to the COPM since 1994 and to document its impact upon occupational therapy practice and research throughout the world. Method. A systematic search was conducted to the professional and research literature in English publications (primarily occupational therapy). Eighty-eight papers that met the inclusion criteria were reviewed, 86% of which examined the COPM in relation to its psychometric properties (19 papers), research outcomes (33 papers) or practice (33 papers). Results. Overall, although there are a few limitations discussed in the review, the conclusion is that the COPM is a valid, reliable, clinically useful and responsive outcome measure acceptable for occupational therapist practitioners and researchers. Practice Implications. The COPM is used with a wide variety of clients, enables client-centred practice, facilitates evidence-based practice and supports outcomes research.

Pilot Testing of the Canadian Occupational Performance Measure: Clinical and Measurement Issues

The Canadian Occupational Performance Measure (COPM) is a measure of a clients self-perception of occupational performance in the areas of self-care, productivity and leisure. The COPM is administered using a semi-structured interview in which the client identifies significant issues in daily activities which are causing difficulty. Extensive pilot testing of the COPM has been completed with 268 clients in communities across Canada and in New Zealand, Greece and Britain. Results indicate the COPM has a median administration time of 30 minutes, is able to identify a wide range of occupational performance issues and appears to be responsive to changes in perception of occupational performance over time. A number of clinical and measurement issues centering around the interview, test construction, scoring, timing of the assessment, respondents, and the assessment process are discussed.

Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia

Background: Practising physicians frequently seek advice on the most effective interventions for dementia. In this article, we provide practical guidance on nonpharmacologic and pharmacologic interventions for the management of mild to moderate dementia based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. Methods: We developed evidence-based guidelines using systematic literature searches, with specific criteria for the selection and quality assessment of articles, and a clear and transparent decision-making process. We selected articles published from January 1996 to December 2005 that dealt with the management of mild to moderate stages of Alzheimer disease and other forms of dementia. Recommendations based on the literature review were drafted and voted on. Consensus required 80% or more agreement by participants. Subsequent to the conference, we searched for additional articles published from January 2006 to April 2008 using the same major keywords and secondary search terms. We graded the strength of the evidence using the criteria of the Canadian Task Force on Preventive Health Care. Results: We identified 1615 articles, of which 954 were selected for further study. From a synthesis of the evidence in these studies, we made 48 recommendations for the management of mild to moderate dementia (28) and dementia with a cerebrovascular component (8) as well as recommendations for addressing ethical issues (e.g., disclosure of the diagnosis) (12). The updated literature review did not change these recommendations. An exercise program is recommended for patients with mild to moderate dementia. Physicians should decide whether to prescribe a cholinesterase inhibitor on an individual basis, balancing anticipated benefits with the potential for harm. For mild mood and behavioural concerns, nonpharmacologic approaches should be considered first. Interpretation: Although the available therapies for dementia can help with the management of symptoms, there is a need to develop more effective interventions.

Individualized Outcome Measures: A Review of the Literature

The client-centred nature of occupational therapy acknowledges the individual as the central element of treatment. This philosophy, however, challenges the therapist to choose an outcome measure that is capable of reflecting this individualized perspective. Recent papers published in the rehabilitation literature have reported on the increased responsiveness of such measures over traditional self-report questionnaires. Although the need for a comprehensive review of individualized outcome measures has been identified in the literature, none exists to date. The purpose of this paper is to review six individualized outcome measures that have been identified in the rehabilitation and psychology literature. The measures include: the Canadian Occupational Performance Measure, the Assessment of Motor and Process Skills, McMaster (MAC) Toronto Arthritis, Goal Attainment Scaling, Target Complaints and the Patient Specific Functional Scale. The reliability, validity, responsiveness and clinical utility of each outcome measure was examined and critiqued. Each tool, to a varying degree, met the description of a standardized, client-centred outcome measure.

The Clinical Utility of the Canadian Occupational Performance Measure

A qualitative research project was undertaken to investigate the clinical utility of the Canadian Occupational Performance Measure (COPM) among therapists from the Regional Municipality of Ottawa-Carletons Home Care Programme. Nineteen occupational therapists participated in one of four focus groups and in a plenary session to elicit reasons why some therapists used the COPM to assess clients and why others did not. The participants presented a wide range of opinions on the same theme, often from two polarities. The five themes that emerged from the focus groups and which were validated during the plenary session were: Use, environment, administration, outcome and suggested changes. The results demonstrated that COPM utility depended upon the degree to which therapists had incorporated the client-centred approach in their practice, the degree to which management valued and supported the use of the COPM and the degree to which the COPM could be flexible to fit practice context.

Management of mild to moderate Alzheimer’s disease and dementia

The authors were charged with making a series of evidence‐based recommendations that would provide concrete advice on all aspects of the management of mild to moderate stages of dementia and Alzheimers disease (AD). The recommendations were primarily targeted to primary care physicians practicing in Canada. The assigned topic area did not include either the assessment of a patient with suspected dementia or the prevention of AD and other dementias. An extensive examination of the available literature was conducted. Explicit criteria for grading the strength of recommendations and the level of evidence supporting them were used. The 28 evidence‐based recommendations agreed on are presented in this article.

Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia

Background: The management of mild to moderate dementia presents complex and evolving challenges. Practising physicians are often uncertain about the appropriate approaches to issues such as the disclosure of the diagnosis, driving and caregiver support. In this article, we provide practical guidance on management based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. Methods: We developed evidence-based guidelines using systematic literature searches, with specific criteria for the selection and quality assessment of articles, and a clear and transparent decision-making process. We selected articles published from January 1996 to December 2005 that dealt with the management of mild to moderate stages of Alzheimer disease and other forms of dementia. Recommendations based on the literature review were drafted and voted on. Consensus required 80% or more agreement by participants. Subsequent to the conference, we searched for additional articles published from January 2006 to April 2008 using the same major keywords and secondary search terms. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care. Results: We identified 1615 articles, of which 954 were selected for further study. From a synthesis of the evidence in these studies, we made 48 recommendations for the management of mild to moderate dementia (28) and dementia with a cerebrovascular component (8) as well as recommendations for addressing ethical issues (e.g., disclosure of the diagnosis) (12). The updated literature review did not change these recommendations. In brief, patients and their families should be informed of the diagnosis. Although the specifics of managing comorbid conditions might require modification, standards of care and treatment targets would not change because of a mild dementia. The use of medications with anticholinergic effects should be minimized. There should be proactive planning for driving cessation, since this will be required at some point in the course of progressive dementia. The patients ability to drive should be determined primarily on the basis of his or her functional abilities. An important aspect of care is supporting the patients primary caregiver. Interpretation: Much has been learned about the care of patients with mild to moderate dementia and the support of their primary caregivers. There is a pressing need for the development, and dissemination, of collaborative systems of care.

Internet-Based Caregiver Support for Chinese Canadians Taking Care of a Family Member with Alzheimer Disease and Related Dementia

The aim of this study was to assess the usability of a new Internet-based Caregiver Support Service (ICSS) and evaluate its effects on health outcomes of Chinese Canadians who cared for a family member with dementia. Demographic and questionnaire data were collected from 28 participants, and in-depth interviews were conducted with 10 participants. Results showed that non-users reported higher levels of burden post-intervetion, and frequent users showed postintervention reduction in experienced burden. Traditional beliefs shaped caregivers’ needs; also, ethno-cultural-linguistic contexts affected system usability and were associated with usage behaviour. This study indicates that caregivers can benefit from receiving professional support via asynchronous e-mails and a dedicated information web site. The ICSS is a feasible approach for supporting caregivers who prefer an alternative service model. This emerging service requires more research in: enhanced technology design, service delivery models for immigrant caregivers, and evaluation of effectiveness and cost-effectiveness. L’objectif de cette étude était d’évaluer la facilité d’utilisation d’un nouveau service de soutien pour personnel soignant basé sur Internet (ICSS) et d’évaluer ses effets sur la santé des Canadiens chinois qui ont soigné un membre de la famille atteinte de démence. Les données démogaphiques et de questionnaire ont été recueillies auprès de 28 participants, et des entrevues approfondies ont été realisées avec 10 participants. Les résultats ont démontré que ceux qui n’ont pas participé à ICSS ont revelé plus hauts niveaux de charge après l’intervention, lors que les participants fréquents a montré une réduction en charge après l’intervention. Les croyances traditionelles ont formées les besoins des soignants; de plus, les contextes ethnoculturelle-linquistiques ont touchées la facilité d’utilisation et ont été associées au comportement pendant l’utilisation. De même, l’utilisation d’ICSS a été influencée par la compétence informatique et par préferences linguistiques. Cette étude indique que les soignants peuvent bénéficier du soutien professionnel par e-mails asynchrones et un site Web dedié d’informations. L’ICSS est une approche possible pour soutenir les soignants qui préferent un modèle de service alternative. Ce service emergent nécessite plus de la recherche sur: la conception technologique amélioré, les modèles de prestation de services pour les immigrants soignants et l’évaluation de l’efficacité et rentabilité.

Targeted Applications of the Canadian Occupational Performance Measure

Background. The Canadian Occupational Performance Measure (COPM) is an outcome measure designed to assess performance and satisfaction with occupation. It was developed to coincide with the occupation-focused, client-centred Canadian Model of Occupational Performance. Purpose. The COPM has been a feature of the occupational therapy landscape for approximately 15 years and has pervaded the consciousness of occupational therapists around the world. In this paper, we examine issues associated with application of the COPM in targeted clinical and non-clinical situations. Results. The paper suggests considerations required to ensure that the highest quality of information is derived from the COPM in all situations. Practice Implications. Although the paper emphasizes the centrality of the client-centred approach, it also demonstrates the flexibility and adaptability of the COPM to different situations, clients, settings and purposes.

Activities of Daily Living, Cognitive Impairment and Social Function in Community Residents with Alzheimer Disease

One hundred and one patients with Alzheimer disease who were residing in the community were surveyed twice, in a six-month longitudinal study. A strong linear relationship was found between function, as measured by activities of daily living and cognitive impairment and between activities of daily living and social function. At the first interview the proportion of variance in activities of daily living explained by cognitive impairment and social function, controlling for age, estimated duration of the disease and marital status was 65%. After six months the proportion had increased to 67%. The proportion of social function accounted for by activities of daily living was 30% at the initial interview; the proportion increased to 43% after six months. Patients lose the ability to perform instrumental activities of daily living before they lose the ability to perform self-care activities. The pattern of deterioration in activities of daily living is hierarchical. The results of the study have implications for assessment and for intervention programmes. For those patients who have a diagnosis of Alzheimer disease, measures of activities of daily living are more useful for helping caregivers and for planning intervention programmes than measures of cognitive impairment.