Date Presented 04/200/21
OT has a valuable role in promoting quality of life for individuals with PD in all aspects of daily life. The Canadian Occupational Performance Measure (COPM) enables practitioners to address the holistic needs of clients, rather than exclusively focusing on predetermined areas of disability. This study has shown that the full breadth of clients' needs are vast and varied and exist beyond those included in standardized assessment tools because only one-third of the items identified by the COPM were included in the Movement Disorder Society—Unified Parkinson's Disease Rating Scale.
Primary Author and Speaker: Abdullah Alsaeed
Additional Authors and Speakers: Kristen A. Pickett
Contributing Authors: Maria Widmer
INTRODUCTION: Parkinson disease (PD) is a movement disorder that occurs in approximately 10 million people worldwide, with a disproportionate one million of those affected residing in the United States. PD is characterized by a heterogeneous and progressive presentation of motor and non-motor symptoms which impact activities of daily living and decrease quality of life. Occupational therapists (OT) are well positioned to treat individuals with PD early in the disease progression as OTs employ a holistic view of clients and are uniquely positioned to assess and use functional activities to promote physical and mental health, prevent deterioration, and restore/sustain or even improve the level of independence in ADL/IADLs. Additionally, OT as a practice area employs numerous assessment tools that can identify clients' unique needs and desires for their occupational engagement.The purpose of this study was to investigate and better understand the impact of PD on ADL/IADLs using two standardized assessment metrics and then compare the activities identified by each tool.
DESIGN: The study design is cross-sectional, quasi-experimental research study. Individuals with confirmed PD were recruited from a larger on-going intervention study and from local PD support programs.
METHOD: The Canadian Occupational Performance Measure (COPM) was completed following standard administration guidelines for determining performance and satisfaction of self-selected occupations. The COPM is a semi-structured interview tool designed by OTs to focus on areas of occupational performance that the client wishes to address. For the purpose of this study, the top three identified occupational program areas were analyzed. Occupations identified by the COPM were then compared to those examined by the Movement Disorder Society-Sponsored Revision Unified Parkinson's Disease Rating Scale (MDS-UPDRS), a standardized questionnaire and assessment battery designed to address all areas affected by PD.
RESULT: Preliminary results including 45 total items from 15 individuals showed that of the top three self-identified occupations identified using the COPM, less than one-third (27.7%) were captured by the UPDRS. The MDS-UPDRS placed a focus on ADL related occupations more than twice as often as the COPM, 56% vs 27% respectively. In contrast, the MDS-UPDR under sampled IADL classified tasks by half as compared to the participant identified tasks in the COPM. Overall, leisure was the most impacted area of occupational performance (43.1%), followed by self-care (36.2%) and productivity (20.7%) as identified by the COPM.
CONCLUSION: OT has tremendous potential for promoting quality of life for individuals with PD in all aspects of daily life. The COPM was created to identify occupational performance problems that are more client centered and consider all facets of life, rather than limit the clinical approach to only the disease or loss of function. The COPM meets client-centered requirements as it elicits a narrative around impacted occupations, while also focusing on the environment and social role expectations of the client. In contrast, the MDS- UPDRS, while comprehensive, does not allow for input from the individual with PD beyond the responses to standardized questions focused on the severity of the disease. Preliminary results from this study highlight the extent to which a more holistic view of the client may allow for improved understanding of the areas of occupation that are impacted for each individual. Clients will be best served by incorporating the MDS-UPDRS and the COPM when screening for impairment and determining therapy services. These two assessments could serve a complementary role in identifying and addressing the occupational impairments caused by PD
References
Hariz, G. M., & Forsgren, L. (2011). Activities of daily living and quality of life in persons with newly diagnosed Parkinson’s disease according to subtype of disease, and in comparison to healthy controls. Acta Neurologica Scandinavica, 123(1), 20-27. https://doi.org/10.1111/j.1600-0404.2010.01344.x
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