Nancy Pollock

The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy

The Canadian Association of Occupational Therapists, in collaboration with Health and Welfare Canada have developed and published a conceptual model for occupational therapy, the Occupational Performance model. This paper describes the development of an outcome measure, The Canadian Occupational Performance Measure (COPM), which is designed to be used with these guidelines for client-centred clinical practice. The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained. This paper describes the rationale and development of the COPM as wellas information about its use for therapists.

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.

Focus on function: a cluster, randomized controlled trial comparing child‐ versus context‐focused intervention for young children with cerebral palsy

Aim  This study evaluated the efficacy of a child‐focused versus context‐focused intervention in improving performance of functional tasks and mobility in young children with cerebral palsy.

Implementing client-centred practice: why is it so difficult to do?

This paper explores the challenges of implementing client-centred occupational therapy practice. While many occupational therapists believe in the principles of client-centred practice and espouse them, it seems much more difficult to implement these into everyday practice. Findings from three qualitative studies with three different populations (i.e., family-centred care for children and their families, community-based home care, facility-based care for older adults) are used to illustrate the challenges which are divided into three broad categories: challenges at the level of the system, at the level of the therapist and at the level of the client. Suggestions for change at each level are addressed. Organizations, therapists and clients must work together to facilitate these changes and ensure that each occupational therapy client receives respectful, supportive, coordinated, flexible and individualized service.

Context therapy: a new intervention approach for children with cerebral palsy

Aim  To describe the development of context therapy, a new intervention approach designed for a randomized controlled trial.

Partnering for Change: An Innovative School-Based Occupational Therapy Service Delivery Model for Children with Developmental Coordination Disorder

Background. Developmental coordination disorder (DCD) is a common, chronic health condition that is poorly recognized and understood in school settings. Without appropriate support, children with DCD are at increased risk of depression, decreased fitness, and obesity. Evidence shows that occupational therapy intervention needs to shift from remediation of impairment to chronic disease management. Purpose. This paper describes Partnering for Change (P4C), an innovative, empirically derived school health service delivery model for children with DCD. Key Issues. The model emphasizes the partnership of the occupational therapist with educators and parents to change the life and daily environment of a child. The P4C partnership focuses on capacity building through collaboration and coaching in context. The model uses a tiered approach which includes whole class instruction, dynamic performance analysis, and monitoring response to intervention. Implications. P4C is a model that responds to the needs of this population, addresses issues identified in research, and provides a continuum of services designed to build capacity.

Perceived Efficacy and Goal Setting in Young Children

One of the central tenets of client-centred occupational therapy is to enable clients to select goals to work on in therapy (Law, 1998). The process of identifying and prioritizing goals is fairly abstract, therefore occupational therapy goals for children are often prescribed by the therapist or by parents and teachers. The purpose of this study was to pilot test a measure and a process that would provide young children with the opportunity to assess their performance on daily tasks and to establish goals for occupational therapy intervention. Parents and children completed the Perceived Efficacy and Goal Setting System (PEGS), a measure of childrens perception of their competence performing fine and gross motor tasks. Children 5–9 years of age were able to discriminate among tasks and to rate whether or not they were able to perform each task competently. They were also able to use this information to select and prioritize goals for intervention. While parents often rated the childs competence lower than the child did, there was a high level of agreement regarding which tasks were difficult for the child. Parents and children often did not agree about the specific selection or priority of these tasks for intervention, however, which highlights the need for further research.

Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder.

This study explored whether or not a population-based sample of children with developmental coordination disorder (DCD), with and without comorbid attention deficit/hyperactivity disorder (ADHD), experienced higher levels of psychological distress than their peers. A two-stage procedure was used to identify 244 children: 68 with DCD only, 54 with ADHD only, 31 with comorbid DCD and ADHD, and 91 randomly selected typically developing (TD) children. Symptoms of depression and anxiety were measured by child and parent report. Child sex and caregiver ethnicity differed across groups, with a higher ratio of boys to girls in the ADHD only group and a slightly higher proportion of non-Caucasian caregivers in the TD group. After controlling for age, sex, and caregiver ethnicity, there was significant variation across groups in both anxiety (by parent report, F(3,235)=8.9, p<0.001; by child report, F(3,236)=5.6, p=0.001) and depression (parent report, F(3,236)=23.7, p<0.001; child report, F(3,238)=9.9, p<0.001). In general, children in all three disorder groups had significantly higher levels of symptoms than TD children, but most pairwise differences among those three groups were not significant. The one exception was the higher level of depressive symptoms noted by parent report in the ADHD/DCD group. In conclusion, children identified on the basis of motor coordination problems through a population-based screen showed significantly more symptoms of depression and anxiety than typically developing children. Children who have both DCD and ADHD are particularly at heightened risk of psychological distress.

Development of hand function among children with cerebral palsy: growth curve analysis for ages 16 to 70 months

This study documents the development of hand and upper-extremity function in young children who have cerebral palsy (CP) with upper-extremity involvement using longitudinal data. Assessments of hand function and the quality of upper-extremity movement were conducted on 29 males and 22 females (mean age 36.2 months, SD 10.6; age range 16 to 60 months at baseline) and on four other occasions over 10 months. Linear mixed effects modeling was used to estimate average developmental curves and the degree of individual differences in the patterns of development which were conditional on the body-site distribution of CP and severity of impairments. Results indicate that hand function in this clinical population develops differently from overall upper-extremity skills with declines in function in upper-extremity skills being more common and pronounced among older children. However, there is substantial interindividual variation. Distribution of CP and severity of impairments were significant predictors of development. Results are discussed in terms of their clinical implications.