Tests & Measures: A Resource for Pediatric Physical Therapy Practitioners

Canadian Occupational Performance Measure (COMP)

Mihee An, Robert J. Palisano, Chung-Hwi Yi, Lisa A. Chiarello, Carl J. Dunst & Edward J. Gracely (2017) Effects of a Collaborative Intervention Process on Parent Empowerment and Child Performance: A Randomized Controlled Trial, Physical & Occupational Therapy In Pediatrics, DOI: 10.1080/01942638.2017.1365324

The purpose of this study was to investigate the effects of a collaborative intervention approach on parent empowerment and child performance on a goal and to compare perspectives regarding intervention among parents and therapists. The authors hypothesized that the parents who received the collaborative intervention for six weeks would exhibit a higher mean change in scores on the adapted Family Empowerment Scale (FES) and a higher mean change in parent ratings of performance and satisfaction with performance on the Canadian Occupational Performance Measure (COPM). The study population included eighteen children with physical disabilities, one parent of each of the children, and sixteen physical therapists. Children included in this study were between ages 4 and 12 years and had been diagnosed with one or more of the following: cerebral palsy, arthrogryposis multiple congenital, down syndrome, Prader-Willi syndrome, moyamoya disease, and developmental delay.

Therapists were randomized into two groups: experimental and comparison. The experimental group was provided instruction in delivery of a collaborative intervention approach. Before the first session, therapists participated in two instructional sessions totaling 6 hours of training, performed confidence ratings, and practiced with the primary author to ensure they were able to correctly produce the intervention. Therapists in the comparison group were provided instruction regarding areas of goals for intervention and how to guide parents in rating their children’s performance using the COPM. No education on collaborative intervention was provided to this group. Both groups adhered to the following guidelines: Session 1) parents and therapists established goals, Session 2) created an intervention plan, and Sessions 3-6) provided intervention. Parents in both groups completed the COPM after setting goals in the first session regarding daily routine and leisure activities. Therapists in the experimental group created a collaborative environment, engaging with parents throughout the 6 sessions; therapists in the comparison group provided intervention as usual. At the end of the 6-week intervention, parents completed the FES and COPM. Both therapists and parents then completed the Experience Questionnaire.

One outcome measure utilized during the study was the FES, which was modified to provide information about parent empowerment regarding physical therapy services. The FES typically includes 3 levels of empowerment: family, service system, and community/political. However, community/political did not pertain to this study and was not used. The wording of the FES was also altered so that it would apply specifically to physical therapy and the collaboration between parents and therapists during intervention. The COPM was also utilized during the study to provide information about change in self-care, productivity, and leisure activities. When using the COPM, the child and/or parent indicates five priorities for intervention. The parent then rates the child’s current performance and reports his or her satisfaction with performance on a scale of 1 to 10. Lastly, the authors created an Experience Questionnaire to collect information on parents’ and therapists’ experiences and perspectives through the intervention. The questionnaire included both open and close-ended questions about collaboration, goal-setting, planning, and implementing intervention.

The results of the study showed that the mean score on the adapted FES increased post-intervention in both groups but did not differ between groups. Also, the parent ratings on the COPM increased after intervention with both groups but did not differ between groups. Regarding the Experience Questionnaire, parents in the experimental group reported feeling more confident in their abilities to continue participating in therapeutic activities beyond therapy. Therapists in the experimental group reported receiving more information about home environment, how the children were progressing outside of therapy, modifications that may have needed to be implemented, and overall child and parent satisfaction. Parents in the comparison group indicated that they were more focused on the goal rather than the intervention aiming to accomplish the given goal. Therapists in the comparison group felt that carryover to the home environment was not strongly implemented.

One of the limitations of this study was that it was conducted over a relatively short intervention period. In many cases, six weeks may not be enough time to produce a significant change in FES and COPM scores. Also, all of the outcome measures were based on subjective information from parents and therapists. Collecting additional objective data may have strengthened the study. The authors also did not take into consideration how the variety of diagnoses included in the study might change the outcomes. Nevertheless, a major strength of this study was the creation of the Experience Questionnaire. Parents and therapists from both groups were able to provide open-ended input about the intervention process, which revealed valuable information regarding quality collaboration between child, parent, and therapist. Another strength of this study was that no parent-child participants dropped out of the study. Also, all outcome measures were consistently provided in pre- and post-intervention to ensure the most accurate results and feedback. In future research, involvement of more than one parent, larger sample size, and longer duration of intervention could add depth and strength to the study.

In conclusion, authors saw an increase in the mean scores of the FES and COPM following collaborative intervention, although they did not differ between groups. Although there was not significant evidence in support of the hypothesis, authors were able to conclude that a collaborative intervention from initial goal-setting through intervention fosters partnership between parents and therapists, inspires parent involvement in the rehabilitation process, and can improve patient outcomes.