Date Presented 4/19/2018
Measuring outcomes is essential in the current health care environment, and teaching students the importance of documenting outcomes is an important part of the education process. This study examined outcomes in a university-based student learning clinic using client-centered measures.
Primary Author and Speaker: Sheryl Zylstra
Additional Authors and Speakers: Sue Doyle
PURPOSE AND BACKGROUND: At the university, second-year occupational therapy students learn to treat both pediatric and adult clients under the mentorship of experienced occupational therapists in on-site student learning clinics. This study examined student therapists’ use of standardized, client-centered outcome measures and client outcomes. Use of evidence-based practice and incorporation of clients’ perspectives into treatment planning are priorities in the American Occupational Therapy Association’s (2017) Vision 2025. Monitoring client outcomes to ensure progress toward goals is one component of evidence-based practice.
METHOD: This was a descriptive study involving a retrospective chart review. Participants included all occupational therapy clients presenting to the adult and pediatric student learning clinics in the 2016 year. Institutional review board approval was obtained. During coursework, students were educated in the use of key client-centered outcome measures including the Canadian Occupational Performance Measure (COPM; Law et al., 2000) and the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) measures (Cella et al., 2007). Assessments were used during the initial evaluation and discharge planning periods of the on-site clinics. Retrospective chart reviews were conducted to identify client demographics, student use of the required measures, and client outcomes. Client satisfaction survey data were also reviewed and analyzed.
RESULTS: A total of 70 charts were reviewed, with 64 meeting the inclusion criteria (33 pediatric clients and 31 adult clients). Pediatric clients’ age ranged from 3.1 to 10.3 yr; 36% were female and 64% male. Adult clients’ age ranged from 16.1 to 88.6 yr; 55% were female and 45% male. Major diagnostic categories for the pediatric clients were motor delay (33.3%), autism (21.0%), and cerebral palsy (18.2%) and for the adult clients were stroke (67.6%), Parkinson’s disease (5.5%), and traumatic brain injury (5.5%). Initial and discharge COPM data were complete in 88% of the pediatric charts and 71% of the adult charts.
Paired t tests showed significant changes in COPM Performance and Satisfaction scores for both the adult and pediatric clients (p < .01). In addition to being statistically significant, the average change in COPM Performance scores trended toward clinical significance, and Satisfaction scores reached clinical significance. Initial and discharge PROMIS measures were complete in 18% of pediatric charts and 27% of adult charts. Because of limited PROMIS data, no statistical analysis was completed for this measure. Returned client satisfaction surveys (n = 35) revealed an average score of 4.9/5.0 on questions related to overall satisfaction with the clinic.
CONCLUSION: Students were able to use the COPM as an outcome measure with greater consistency in the pediatric setting than in the adult setting. The NIH PROMIS measures were much more difficult to implement. Different strategies to increase use of the PROMIS measures may need to be identified. These university-based occupational therapy student learning clinics increased COPM Performance and Satisfaction scores for valued occupations for clients with chronic conditions across a variety of ages and diagnoses. In addition, clients reported high levels of satisfaction with the clinic and felt that the student therapists helped them meet their goals.
IMPACT STATEMENT: The COPM can be used as an effective outcome measure in clinical settings that treat clients of varying ages, diagnoses, and performance levels. Services provided by student occupational therapists can positively influence performance of and satisfaction with occupations in clients with varying conditions across the lifespan.
References
American Occupational Therapy Association. (2017). Vision 2025. American Journal of Occupational Therapy, 71, 7103420010. https://doi.org/10.5014/ajot.2017.713002
Cella, D., Yount, S., Rothrock, N., Gershon, R., Cook, K., Reeve, B., . . . Rose, M. (2007). The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH roadmap cooperative group during its first two years. Medical Care, 45, S3–S11. https://doi.org/10.1097/01.mlr.0000258615.42478.55
Law, M., Baptiste S., Carswell, A., McColl, M. A., Polatajko, H., & Pollock, N. (2000). Canadian Occupational Performance Measure (3rd ed.). Ottawa: CAOT Publications.
