Linda Petty
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Table of Contents
Client Centered Outcome Measures
Personal Performance variables
Measuring Personal Performance
The Canadian Occupational Performance Measure
Person, Occupation, Environment
Client Centered Outcome Measures
Using the Canadian Occupational Performance Measure
Presented by Linda Petty, (O.T.)
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Outline of Workshop
Introductions and handouts
Overview of Outcome Measures
Client Centered practice and the COPM
Training video in administering COPM
Modifications to the COPM in AT in general and seating/mobility in particular
Practice, Research and networking
Paper trail
Abstract and references in Proceedings
Copy of COPM to be handed out
Powerpoint presentation to be posted on Adaptive Technology Resource Centre’s website: www.utoronto.ca/atrc
Go to bottom of Library section for Conference Slides
Join a new list serve for a text version
Outcome Measures
What are they?
Tools which measure and document the effectiveness of an intervention
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- Consumers
- Funding agencies- public and private
- Administrators
- Clinicians
Who wants them?
What do we measure?
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- Clinical results for clinician and payer
- Functional status for all parties
- Quality of life for client, clinician
- Consumer satisfaction for all parties
- Cost factors for administrator and payer
Different stake holders want different information
The Problem with outcomes
Difficulty in adding another task into busy clinical/private settings
Client’s often not interested in going through hoops unrelated to their own needs
If clinical outcomes are not required by administration, they may not be supported
Lack of familiarity/training with outcome tools
Essential Domains of Outcome
Need to find out what change in Personal Performance has occurred, and at what Cost, to establish the Value of the intervention
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- R.O. Smith, Univ. of Madison, WI
Best intervention is high performance at low cost, worst is low performance at high cost
Personal Performance variables
Intervention with equipment is dependent on many other variables:
Service to prescribe, fabricate, fit, train, repair device
Environment in which device is used- may be mis-match between device and support for it
For the Big Picture
Need to consider subjective and objective outcome data on Intervention Performance, Support Performance and Personal Performance, as well as Cost
Need to find how well an assistive device and service works to improve Personal Performance and at what cost.
Measuring Personal Performance
Many standardized tests use a medical model designed from an environment-free perspective
Functional Independence Measure and the Sickness Impact Profile were created without consideration of AT, any AT use is imbedded in scale and cannot tease out the impact separately
The Canadian Occupational Performance Measure
taps the perspective of the individual with a disability, so is client centered
general instrument, questioning wide environmental/personal domains
assesses only the problem areas considered by the client to be worth examining
performance, satisfaction and importance data merged using a multiplicative process
Traditional Seating
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- normalize tone and reflexes
- reduce risk of deformities
- provide independent mobility
- improve sitting tolerance
Goals such as
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- client/caregiver report
- measurement in clinical setting at fitting
Success measured by
Client Centered Assessment
Focuses the assessment and the intervention on the needs and problems identified by the client
Results are then evaluated based on the impact they have had on the initial needs/problems
Some functional testing, mat eval, etc. will be needed to direct intervention choice
Person, Occupation, Environment
Interaction between the 3 areas will be seen in needs/problems identified
May not be able to address all areas with equipment
Use cross referrals, support staff to address areas in the environment which equipment cannot accommodate
Training in the COPM
Recommended as a sensitive outcome measure for seating and mobility by Prof. Mary Law, at the 1988 CSMC panel
Training video excerpts to review theory of Client Centered Practice and administering the COPM with several clients
Next look at modifications for seating and mobility, other areas of AT
COPM as an outcome measure
Useful in assessment but only used as OM by comparing follow-up results to original ratings in performance and satisfaction
Considered clinically significant if change of 2 points from original ratings
Best used as series of single case studies or by reporting mean of a group of clients
Modified COPM in AT
Used in augmentative communication: “What kind of problems do you have in leisure things like outings and travel groups because of the speech impediment…”
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- Question problems in reading/writing in 3 areas
Used at U of T Vision Technology Service for clinical development and for QA reports to ADP since 1996
COPM in Seating and Mobility
As yet unpublished Master’s thesis completed by Ingrid Barlow, O.T. at Glenrose Rehabilitation Hospital in AB
“Reliability and clinical utility of selected outcome measure with adult clients of seating clinics”
Examined the reliability of the Seated Postural Control Measure and modified COPM or mCOPM
Summary of Findings
mCOPM performance ratings had reliability coefficients of .91 (inter-rater) and .76 (test-retest); the satisfaction score had reliability correlations of .71 and .08
mCOPM facilitated identification of occupational performance concerns
Detected clinically significant change in in performance in 1 of 4 participants
Satisfaction Data
Problems with reliability of satisfaction data
Postulates that clients find it easier to quantify performance than satisfaction
Satisfaction is affected by many other issues, environment
Useful in getting a sense of client’s emotional priorities and makeup
Some notes on use of mCOPM
Seating is a process- need to do pre-test, then post-test after intervention is complete, not day of clinic assessment
Need to emphasize selecting the 5 most important items for intervention
mCOPM very useful for drawing out the functional problems instead of general concerns of skin or comfort
Recommendations from study
Change rating scale to 7 point and attach word descriptions to each level
In satisfaction word descriptions, clarify the difference between occupational performance satisfaction and device satisfaction
Reword the instructions to emphasize the 5 items for intervention
Recommendations from study
Strengthen study design, improve retention and repeat study
Administer mCOPM to caregivers as well to see if there are differences with client
Request COPM information via a pre-clinic questionnaire to decrease time to administer
The mCOPM Instructions
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- the things that you need to do
- the things you want to do
- the things you are expected to do
- what you can do now
- and how satisfied you are with what you do
Think about how your wheelchair &/or seat affects:
The mCOPM Instructions
Identify activities that you feel the wheelchair &/or seat is making difficult to do something, or to do it well in the following areas:
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- personal care: dressing, bathing, toiletting
- functional mobility: transfers, moving indoors and outdoors
Self care: community management
The mCOPM Instructions
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- Paid/unpaid work: finding/keeping a job, access to job site, volunteering
- Household management, Play/school
Productivity
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- participation/access to hobbies, quiet recreation, sports, travel, active recreation, socializing
Leisure
The mCOPM Instructions
Ask the client to rate on a scale of 1 -10 the importance of each activity
Confirm and record the 5 most important problems
Rate each problem on performance an satisfaction
On retest repeat the scoring in the 5 areas, subtract 1st scores from 2nd scores
COPM reveals...
changes in occupational performance before and after equipment intervention
adequacy or failures in support performance and intervention performance
need for further equipment intervention, support training, environmental changes or re-assessment
Strengths of COPM
not restricted to specific age groups, disabilities or cognitive levels
sensitive enough to detect change in quality of performance that equipment can make
considers subjective data of client satisfaction
can bring consensus on problems in team
Weaknesses of COPM
Less well known by administrators, payers
Data is specific to the client, so harder to generalize
Less well researched, so far, in assistive technology
Requires more interview time at assessment and requires follow-up
General Recommendations
Stay abreast of the increasing number and types of outcome measures
Consider the breadth and depth of the type of data you need
Identify instruments which collect a variety of outcome data , from varying perspectives
Plan on collecting data and in a consistent fashion
Two keys
No outcome are documented without collecting data
Data are worth more when they can be examined across time and users
Proposed Research
Possible research proposal to be developed if there are a number of centres/individuals interested in collaborating to collect data
Potential to submit request for funding to the Canadian Occupational Therapy Foundation for research assistant, etc.
Dr. Jan Polgar, UWO interested in being a principal investigator
Resources
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- COPM plus 100 measure forms $25
- and COPM training materials $110
- Combined COPM and training:$120
- Guidelines for Client Centered Practice $22
- Phone: (800)-434-2268
- Website: www.caot.ca
- Email:This email address is being protected from spambots. You need JavaScript enabled to view it.
CAOT
Resources
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- Outcomes Research: Measuring the Impact of Assistive Technology, research symposium from June 98 conference available as webcast at www.rit.edu/~easi/audio/resna
- Resource Guide: 3 part series , $10 USD each,
- Assistive Technology Journal, Vol 8.2/1996
- Phone: (703) 524-6686
- Website: www.resna.org, This email address is being protected from spambots. You need JavaScript enabled to view it.
RESNA
New! AT Outcomes Listserve!
Hosted by the Adaptive Technology Resource Centre, University of Toronto
Provides automatic email mailings of messages submitted to all subscribers
Available to share questions, resources with others interested in outcome measures in assistive technology
resources: Dr. Jan Polgar, Prof. Mary Law
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Here’s to success in demonstrating the value of seating and mobility intervention to all players.