Mary Ann McColl

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.

Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life.

ObjectiveTo describe the long-term health-related quality of life (HRQL) of survivors of sepsis and to evaluate the reliability and validity of the medical outcomes study Short Form-36 (SF-36) in this population. Study DesignCross-sectional survey. SettingUniversity intensive care unit. PatientsSurviving patients over the age of 17 yrs who met the criteria for the Society of Critical Care Medicine/American College of Chest Physicians definition of sepsis identified through a review of patients admitted to the intensive care unit from 1994 to 1998. InterventionsNone. Measurements and Main ResultsBaseline demographics and clinical characteristics were abstracted from the medical chart. After hospital discharge, the SF-36 and Patrick’s Perceived Quality of Life scale were administered by telephone. The SF-36 was readministered 2 wks later. We screened the charts of 109 patients; 78 had a diagnosis of sepsis. Of these, 31 had died, 3 had severe communication problems, 9 refused to participate, and 5 patients could not be located. A total of 30 patients completed the first interview; 26 completed the second. Compared with established norms for the U.S. general population, survivors of sepsis scored significantly lower on the physical functioning, role physical, general health, vitality, and social functioning domains, as well as on the Physical Health Summary Scale. Mean scores on the Mental Health Summary Scale were very similar between the survivors of sepsis and U.S. norms. The SF-36 demonstrated high internal consistency (Cronbach’s alpha ranged from 0.65 to 0.94) and excellent test-retest stability (intraclass correlation coefficient ranged from 0.75 to 0.97). Both the Physical Health Summary Scale and the Mental Health Summary Scale correlated well with overall Perceived Quality of Life scores (Pearson correlation coefficients 0.45 and 0.56, respectively). ConclusionsThe long-term HRQL of survivors of sepsis is significantly lower than that of the general U.S. population. The SF-36 demonstrated good reliability and validity when used to measure HRQL in survivors of sepsis.

Validity and community utility of the Canadian Occupational Performance Measure.

This study addressed the validity and community utility of the Canadian Occupational Performance Measure (COPM) (Law et al., 1991; 1994; 1998): a measure that now represents a national standard in clinical practice and research in occupational therapy in Canada. The study employed a crosssectional design. Participants for the study were former consumers of occupational therapy services, recruited from the Queens University catchment area (Kingston, North Bay, Oshawa, Perth, Peterborough). A sample of 61 disabled individuals living in the community were recruited. Each individual was sent a package of self-administered measures including the Satisfaction with Performance Scaled Questionnaire, the Reintegration to Normal Living Index, the Life Satisfaction Questionnaire, and the Perceived Problems List. An interview was also arranged with the project coordinator, which was based on the COPM and the Consumer Utility Questionnaire. Multivariate analyses showed that construct validity was supported; scores on the COPM were significantly related to theoretically related constructs: satisfaction with performance, reintegration to normal living and life satisfaction. In addition, criterion validity was supported. A majority of participants (53%), when asked about problems of daily living, spontaneously reported at least one of the problems raised on the COPM. Community utility was evaluated highly by participants, 75% of whom found the COPM useful in identifying and rating their problems, and 100% of whom reported no problems in understanding the COPM.

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.

The definition of community integration: perspectives of people with brain injuries

Despite considerable attention to community integration and related topics in the past decades, a clear definition of community integration continues to elude researchers and service providers. Common to most discussions of the topic, however, are three ideas: that integration involves relationships with others, independence in ones living situation and activities to fill ones time. The present study sought to expand this conceptualization of community integration by asking people with brain injuries for their own perspectives on community integration. This qualitative study resulted in a definition of community integration consisting of nine indicators: orientation, acceptance, conformity, close and diffuse relationships, living situation, independence, productivity and leisure. These indicators were empirically derived from the text of 116 interviews with people with moderate-severe brain injuries living in the community. Eighteen adults living in supported living programmes were followed for 1 year, to track their evolving definition of integration and the factors they felt were related to integration. The study also showed a general trend toward more positive evaluation over the year, and revealed that positive evaluation was frequently related to meeting new people and freedom from staff supervision. These findings are interpreted in the light of recommendations for community programmes.

Leisure time physical activity in a population-based sample of people with spinal cord injury part I: demographic and injury-related correlates.

OBJECTIVES To estimate the number of minutes a day of leisure time physical activity (LTPA) performed by people with chronic spinal cord injury (SCI) and to identify the demographic and injury-related characteristics associated with LTPA in a population-based sample of people with chronic SCI. DESIGN Cross-sectional telephone survey. SETTING General community. PARTICIPANTS Men and women with SCI (N=695). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The number of minutes/day of LTPA performed at a mild intensity or greater. RESULTS Respondents reported mean minutes +/- SD of 27.14+/-49.36 of LTPA/d; however, 50% reported no LTPA whatsoever. In a multiple regression analysis, sex, age, years postinjury, injury severity, and primary mode of mobility each emerged as a unique predictor of LTPA. Multiple correspondence analysis indicated that being a man over the age of 34 years and greater than 11 years postinjury was associated with inactivity, while being a manual wheelchair user and having motor complete paraplegia were associated with the highest level of daily LTPA. CONCLUSIONS Daily LTPA levels are generally low in people with SCI. Women, older adults, people with less recent injuries, people with more severe injuries, and users of power wheelchairs and gait aids are general subgroups that may require special attention and resources to overcome unique barriers to LTPA. Specific subgroups may also require targeted interventions.

Structural relationships between social support and coping

Relationships between social support and coping were examined over a one-year period in a sample (n = 120) exposed to a specific stressor (i.e. a spinal cord injury). Two issues were evaluated: (1) patterns of social support and coping over time; and (2) the direction of the effects of coping on social support or vice versa. Subjects had incurred a spinal cord injury within the preceding year, completed their rehabilitation, and returned to the community. They were assessed at 1, 4 and 12 months post-discharge to capture possible changes in patterns of social support and coping. Covariance structure modelling indicated a single-factor construct based on three measured subscales for social support (instrumental/informational/emotional), and for coping (problem-oriented/perception-oriented/emotion-oriented). While the factor structure of coping was invariant over time, the structure of social support changed from a high concentration of informational support at one month to a higher saturation of emotional support at 4 and 12 months, potentially reflecting changes in the salience of different components of the network. The perceived availability of social support was seen to have direct effects on future coping. At one month, social support had a direct positive effect on coping at four months. However, at four months social support had a negative effect on coping at 12 months, which may reflect a change in the structure of the social support construct itself. That is, as the factor structure of social support varied with time, coping may also have been influenced by differing perception of ones needs and circumstances. Thus, the study provides evidence for the dynamic effects of social support on coping, depending on ones stage in the process of long-term adjustment. The findings underscore the interplay between social support and coping, and the need for future research and practical applications to recognize temporal effects on the relationships between these two complex constructs.

A model of resource needs of aging spinal cord injured men

It has always been understood that those who deal effectively with a disability call upon special resources that members of the able bodied population are not required to develop. However, the nature and relationship of these resources to aging outcomes is as yet only superficially understood. The present study provides further information and clarification about the resources needed for aging with a spinal cord injury. The sample consists of 70 individuals who have had a spinal cord injury for at least 15 years, and who are currently over the age of 45, and are therefore either anticipating or experiencing aging. Data from the sample were examined to produce a model of resources empirically associated with positive outcomes in aging. Emotional support was found to be positively related to the outcomes of life satisfaction, adjustment to disability and the absence of depressive symptomatology. Further, health concerns, financial security and instrumental support were also related to specific outcomes. These findings send a clear message to rehabilitation and community service providers to be watchful of survivors with limited social support, concerns about their health and an apparent lack of financial resources. The findings underline the need for better access to health services, and improved knowledge and attitudes of community health care providers working with older disabled individuals.

Community integration: a useful construct, but what does it really mean?

The primary objective of this paper is to contribute to a clearer understanding of the construct of community integration. Rehabilitation literature is discussed in relation to three measures of community integration: the AIMS Interview, Community Integration Measure and Community Integration Questionnaire. Results of a principal components analysis with varimax rotation indicated that the measures are independent and coherent. Significant correlations were not found between total scores on the three measures and problem behaviour or quality of life. However, analysis of individual items on the scales yielded one significant correlation between the first item on the Community Integration Measure (i.e. sense of belonging) and quality of life. The need for a clear statement in future research regarding the definition of community integration is emphasized, and inclusion of both subjective perceptions and objective indicators of community integration is recommended.

Aging, spinal cord injury, and quality of life: structural relationships

OBJECTIVE To quantify relationships among 3 sets of factors: demographic factors, health and disability factors, and quality of life (QOL). DESIGN Part of a program of longitudinal research on aging and spinal cord injury (SCI) involving 3 populations: American, British, and Canadian. The present analysis uses data from the 1999 interval. SETTING The Canadian sample was derived from the member database of the Ontario and Manitoba divisions of the Canadian Paraplegic Association. The British sample was recruited from a national and a regional SCI center in England. The American sample was recruited through a hospital in Colorado. PARTICIPANTS A sample of 352 participants was assembled from 4 large, well-established databases. The sample included individuals who had incurred an SCI at least 20 years earlier, were admitted to rehabilitation within 1 year of injury, and were between the ages of 15 and 55 at the time of injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A combination of self-completed questionnaires and interviews. Data included demographics, injury-related variables, health and disability-related factors, QOL, and perceptions about aging. RESULTS Using linear structural relationships modeling, we found that QOL was affected both directly and indirectly by age, health and disability problems, and perceptions of aging. Two surprising findings were as follows: those who experienced fewer disability-related problems were more likely to report a qualitative disadvantage in aging, and the younger members of the sample were more likely to report fatigue. CONCLUSIONS Fatigue is a concern because of the relationship of fatigue with perceived temporal disadvantage in aging, health problems, and disability problems. This finding highlights the need for clinical vigilance among those just beginning to experience the effects of aging.