Assessing change in children with CP using the Canadian Occupational Performance Measure (COPM) Article Summary
Kang M, Smith E, Goldsmith CH, et al. Documenting change with the Canadian Occupational Performance Measure for children with cerebral palsy. Developmental Medicine & Child Neurology. 2020;62(10):1154-1160. doi:10.1111/dmcn.14569
Purpose: To evaluate the strength of the Canadian Occupational Performance Measure (COPM) to measure clinically meaningful change over 3 years in children with cerebral palsy (CP).
Study population details: The participants included 124 children, 47 females and 77 males, with a diagnosis of spastic CP. Ages 2-6 years old were recruited with an average age of 3 years and 11 months. Using the Gross Motor Function Classification System (GMFCS), 78 of the children were classified as level I, 21 as level II, and 25 as level III.
Methods: The children’s caregivers created one to three COPM goals that were framed to be achieved long-term, over 3 years. The goals were focused on improving participation in leisure and community activities or gross motor activities. The caregivers ranked each goal by their child’s performance, satisfaction, and overall importance at baseline and followed up annually for 3 years. The rankings were scored from 1 to 10, with 1 stating “not important/not able to do it/not satisfied at all” and 10 stating “extremely important/able to do it extremely well/very satisfied.” Changes in scores were measured over 3 years. An increase of ≥2 points indicated a clinically meaningful change, and 8 points represented a ceiling effect for the COPM.
Outcome measures: Canadian Occupational Performance Measure (COPM) and Gross Motor Function Classification System (GMFCS)
Interventions: Since this was an observational study, no interventions were performed. The children continued with treatments including ankle foot orthoses, botulinum neurotoxin A, and active physical therapy if previously indicated.
Results summarized: The COPM goals created by the caregivers were categorized into 10 groups including pre-ambulation gross motor skills, daily activities/transitions, jumping, biking, play, sports, running, walking, stairs, and other. All performance scores increased from baseline over 3 years following, with post hoc analyses indicating a significant difference between baseline and all 3 years. Satisfaction scores increased more from baseline over 3 years following compared to performance but only determined a significant difference between baseline and year 1, and year 1 and year 2. Importance scores did not show any significant differences from any years. Both performance and satisfaction goals increased ≥ 2 points from baseline to year 1, but majority reached a ceiling effect by years 2 and 3.
Major strengths/limitations: Major strengths of this study include a large sample size with an appropriate number of goals based on 3 clinically relevant factors. Also, the scores for a clinically meaningful change and ceiling effect were defined and supported by previous research. One major limitation is that the study was focused on one specific population so the findings cannot be appreciated in general. Another limitation is the children were aged 2-6 which are years that developmental growths are expected, contributing to the increase in goal scores.
Author’s overall conclusion: The findings indicate that the COPM has a strong capacity to evaluate long-term changes. However, since majority of the scores reached a ceiling before 3 years, it is suggested that the caregivers should readjust the goal definitions within smaller intervals compared to one over all 3 years. Also, the author notes that these results are significant to enhancing family-centered care with the use of customized goals.
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Great review, and it seems like an interesting article! It would be interesting to see what the patients/caregivers believed to be the limiting factors that could be affecting performance the most. I am also curious to see how the idea of readjusting the goals periodically would affect the patient’s participation in leisure and community-based activities.