Tests & Measures: A Resource for Pediatric Physical Therapy Practitioners

Canadian Occupational Performance Measure

Guidelines for Critical Review of Tests & Measures

 

1. Descriptive Information
   1. Title, Edition, Dates of Publication and Revision*

Canadian Occupational Performance Measure

5^th Edition

2013

1. Author (s)

Mary Law, Sue Baptiste, Anne Carswell, Mary Ann McColl, Helene J Polataiko, and Nancy Pollock

1. Source (publisher or distributor, address)

Canadian Association of Occupational Therapists

1. Costs (booklets, forms, kit)*

A 45-minute DVD and Workbook with COPM manual and 100 Forms is $225.45 (Canadian) or a Manual/Form Kit for $52.45

1. Purpose*

Assesses an individual’s perceived occupational performance in the areas of self-care, productivity, and leisure.

1. Type of Test (eg, screening, evaluative; interview, observation,

checklist or inventory)*

This outcome measure is a self-reported assessment based on how well each patient believes they are able to complete tasks that are required of them or that the wish to complete themselves.

1. Target Population and Ages*

The COPM was designed to be used with all populations however it has been validated for use following diagnoses of stroke, COPD, pain, cerebral palsy, TBI, Parkinson’s Disease, Arthritis, and Ankylosing Spondylitis, as well as within the Pediatrics population.

1. Time Requirements – Administration and Scoring*

10-30 minutes

 

1. Test Administration
   1. Administration

This test is administered by an occupational therapist trained in the use of this outcome measure.

1. Scoring

After the five most important problems are identified, the importance of address each problem, the patient’s satisfaction of how they are able to perform the task, and the patient’s self perceived ability too perform the task are all ranked from 1 to 10 (low to high).  For each task, the importance and performance scales are multiplied together as well as the importance and satisfaction scales.

i.e.  Machine Operation (Task)

Importance:9

Performance:1

Satisfaction:2
*Imp x Per:9

*Imp x Sat: 18

1. Type of information, resulting from testing

(e.g. standard scores, percentile ranks)

This outcome measure gives a score on a scale of 1-100 for both the patient’s perception of how they are able to perform a task and how satisfied they are with their ability as it relates to importance of performing the task.

1. Environment for Testing

The test is performed in a clinic.

1. Equipment and Materials Needed

All that is needed to perform the test is the evaluation form.

1. Examiner Qualifications
   The examiner must be an occupational therapist trained in how to perform this outcome measure.
2. Psychometric Characteristics*
3. Standardization/normative data

Standard Error of Measurement:

For personal interview: 0.66 for performance; 0.84 for satisfaction

For telephone interview: 1.41 for performance; 1.86 for satisfaction

By mail: 0.99 for performance; 1.13 for satisfaction

Minimal Detectable Change:

Ankylosing Spondylitis:

Personal interview

MDC for performance=1.59

MDC for satisfaction – 1.80

Telephone interview

MDC for performance=2.33

MDC for satisfaction=2.63

Mail

MDC for performance=1.95

MDC for satisfaction=2.08

Osteoarthritis:

MDC= 5

 

Stroke:

MDC for performance=1.7 points

MDC for satisfaction=2.7 points

MCID not established.

 

1. Evidence of Reliability

 

Test-retest Reliability

Adults with impairment in 1 or more ADL with various diagnoses; COPM administered twice, 7 days between assessments, as tested by Eyssen et al.

Adequate test-retest reliability

(ICC=0.67 performance and 0.69 satisfaction)

Ankylosing Spondylitis as tested by Kjenken et al;

Excellent test-retest reliability by personal interview

(ICC=0.92 performance and ICC=0.93 satisfaction)

Adequate test-retest reliability by telephone

(ICC=0.73 performance and ICC=0.73 satisfaction)

Excellent test-retest reliability by mail

(ICC=0.90 performance and ICC=0.90 satisfaction)

COPD as tested by Sewell & Singh

Excellent test-retest reliability

(ICC=0.81 performance and ICC=0.76 satisfaction)

Stroke as tested by Cup et al;

Excellent test-retest reliability

r=0.87 performance and r=0.88 satisfaction

 

Interrater/Intrarater Reliability

Acquired Brain Injury as tested by Jenkinson et al;

Consistency of self- and relative ratings for no intervention group:

No significant difference in COPM performance ratings for participants (M=4.62 (1.72)) and relatives (M=4.49 (1.86)); t=0.30, p=0.77)

No significant difference in COPM satisfaction ratings for participants (M=4.24(1.89)) and relatives (M=5.01 (1.57)); t =-1.79, p =0.078)

Participants rated their functional abilities on the Patient Competency Rating Scale (PCRS) (M=111.92 (17.58)) at a higher level than their relatives (M=105.75 (20.46)); however, no significant difference (t (62)=1.29, p =0.20)

Participants’ self-ratings relatively consistent with their relatives’ ratings

Test–re-test reliability coefficients for the COPM ratings over the 8-week interval were all significant

Excellent (r=0.75–0.86) for relative ratings; Adequate (r=0.53–0.67) for self-ratings

 

Stroke as tested by Cup et al;

Test retest reliability: interval=8 days

Spearman’s rho correlation coefficient for the performance scores=0.89 (p <0.001) and for the satisfaction scores 0.88 (p < 0.001)

1. Evidence of Validity
2. Discriminative

Mixed Population (Disorders of wrist, hand and arm, Central neurological disorder, neuromuscular diseases, other diagnosis) as tested by Eyssen et al;

Significant positive correlations between the COPM scores and the Sickness Impact Profile (SIP68), Disability and Impact Profile (DIP), and Impact on Participation and Autonomy (IPA) scores

 

Stroke as tested by Cup et al

COPM performance scores:

• Poorcorrelation with Barthel Index (r=–0.225)
• Poorcorrelation with Frenchay Activities Index( r=–0.115)
• Poorcorrelation with the Stroke Adapted Sickness Impact Profile (SA-SIP30) (r=0.102)
• Poorcorrelation with the Euroqol 5D (EQ-5D) (r=0.143)
• Poorcorrelation with the Rankin Scale (r=0.209)

Standardized performance measures did not correlate with the COPM indicating a strong evidence of discriminate validity.

 

1. Predictive

Arthritis as tested by Ripat et al,

Total Perfomance Scores on the COPM were not significantly correlated to total scores on the disability index of the Health Assessment Questionnaire (HAQ)

• r=-0.37*, p=0.22

• 36 out of 50 activities identified on the COPM exactly matched activities included in the disability dimension of the HAQ. Individual performance scores on the COPM were significantly related to scores on the matched HAQ components and matched HAQ activities
  • r=-0.52*, p<0.01
  • r=-0.67*, p<0.01

*Pearson product-moment correlation coefficient

 

Community Dwelling Disabled Individuals as tested byMcColl et al

• Participants identified 481 problems on the COPM and the Perceived Problem Check List (PPCL)
• 54 similar problems were identified on both measures:
  • 24% of PPCL problems were similar to COPM
  • 21% of COPM problems were similar to PPCL

 

• Summary Comments*
  1. Strengths
     • Specific to each patient and their needs
     • Highly adjustable to patients
  2. Weaknesses
     • Poor Discriminative validity
     • Potentially a 30 minute test
     • Scoring can be confusing
  3. Clinical Applications

I believe this outcome measure can be used as an adjunct measure to allow patients to observe their improvement in self-selected tasks.

 

COPM Article Summary

Law, M., Polatajko, H., Pollock, N., Mccoll, M. A., Carswell, A., & Baptiste, S. (1994). Pilot testing of the Canadian Occupational Performance Measure: clinical and measurement issues. Canadian Journal of Occupational Therapy,61(4), 191-197.

 

This article was the pilot study done by the researchers who developed the Canadian Occupational Performance Measure.  In the article, the authors described the outcome measure as a “measure of a client’s self-perception of occupational performance in the areas of self-care, productivity and leisure.  This pilot study was performed with 268 people from multiple countries including Canada, New Zealand, Greece, and England.  The authors believe that the COPM has a wide variety of uses in order to assess the change in the perception of performance over time.  Testing in this article was done in three phases.  Phase one was the initial testing by the 6 authors in their communities.  They used that phase to test out the wording, format, and directions of the test.  Phase two included further testing throughout Canada in order to determine issues that would arise from measurement.  Phase three included more detail information about the COPM.  They collected information on the use of the manual, the guidelines, and the addition of a instruction video.  As for clinical utility, this process determined that the COPM was able to identify problems “across all occupational performance areas.”  The authors also believe it has a high sensitivity to changes in occupational performance as reported by the clients.  The authors believe that this outcome measure will continue to be a valid measure even after its infancy stage in which this article was written.