Date Presented 04/06/19
We introduced the COPM to guide our multidisciplinary polytrauma rehab team’s efforts in order to focus on client-identified goals and more cohesive client-centered care. Paired sample t-tests conducted for our 78 participants revealed significant functional improvement (t = -13.23, p < 0.001) and improvement in satisfaction with performance (t = -14.36, p < 0.001) from admission to discharge. Team members agree that the instrument supports more cohesive and client-centered care.
Primary Author and Speaker: Christine Gentry
Additional Authors and Speakers: Sherri Pearson
PURPOSE: Two of the most challenging problems faced by physical rehabilitation teams are developing client-centered treatment goals and measuring these outcomes to demonstrate program successes. As occupational therapists on a Veterans Administration Polytrauma Rehabilitation team (PTRP), in 2014 we introduced the Canadian Occupational Performance Measure (COPM) as a tool to guide our whole team’s efforts. In using COPM in this way, we hoped to focus the team on client-identified goals, offer more cohesive client-centered care, and track outcomes across client stays to determine if we were indeed succeeding in our rehabilitation efforts.
DESIGN: During the study period, from January 2014 to January 2017, 78 participants completed the study. All of these participants were either active-duty military service members or military veterans recovering from complex multi-system injuries. The study followed a simple pre-test/post-test quasi-experimental model, in which all incoming inpatients to the program were invited to participate.
METHOD: COPM was conducted by OTs trained in the instrument’s administration upon PTRP admission; this data was shared with all team members at team meetings and recorded on the participant’s medical chart. At team meetings, all team members were asked to identify how their interventions addressed the participant-identified goals from COPM, and all were encouraged to act collaboratively in pursuing these goals. The OTs again conducted COPM on discharge. Paired sample t-tests were conducted on the 78 data sets.
RESULTS: COPM Performance Change: We found a significant change in functional performance on self-identified goals between admission and discharge (t = -13.23, p < 0.001), with perceived performance at discharge (M = 7.37, SD = 1.62) higher than at admission (M = 4.59, SD = 2.03).
COPM Satisfaction with Performance Change: We found a significant change in satisfaction on self-identified goals between admission and discharge (t = -14.36, p < 0.001), with satisfaction at discharge (M = 7.28, SD = 1.85) higher than at admission (M = 3.95, SD = 2.40).
We are currently examining COPM goal response themes and will include that analysis in our poster presentation. Our first pass examined goals across the three domains addressed by the COPM (productivity, self-care, and leisure). Among our participants, 51% of goals addressed productivity, 40% addressed self-care, and 9% addressed leisure activities.
CONCLUSION: These findings show that clients feel that our program has a significant positive impact on functional performance and satisfaction with functional performance on their self-identified goals. Prior to implementation of this model, we did not have a systematic way of measuring client goals, implementing them across disciplines in our program, or determining success in treatment. Based on our experience, COPM appears to be a useful tool not only for OTs, but for multi-disciplinary rehabilitation programs that wish to develop client-centered approaches to treatment. As an assessment instrument developed by OTs and widely used across treatment settings, we feel that COPM can additionally support the importance of goal-centered occupational function in multi-disciplinary treatment programs and the leading role that OTs can play in advancing such care.
We are in the process of identifying objective measurements of client performance in our data records to compare with subjective COPM measures in order to further clarify the impact of this program on the well-being of our clients. We hope to have these comparisons in place for our poster presentation. We plan to include results of clinician surveys on usefulness and impact of COPM from their perspectives as well.
References
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Wressle, E., Lindstrand, J., Neher, M., Marcusson, & J., Henriksson, C. (2009.) The Canadian Occupational Performance Measure as an outcome measure and team tool in a day treatment programme. Disability and Rehabilitation. 25(10), 497-506. https://www.tandfonline.com/doi/abs/10.1080/0963828031000090560.
Jenkinson, N., Ownsworth, T., & Shum, D. (2007.) Utility of the Canadian Occupational Performance Measure in community-based brain injury rehabilitation. Brain Injury. 21(12), 1283-1294. https://www.tandfonline.com/doi/full/10.1080/02699050701739531.
