As of February 2017, the COMP review remains largely unchanged from the original blog post on March 16, 2015.  The MCID for the COMP remains not established.  Listed below are a few additions to the original list.

  • Equipment and Materials Needed
    • A paper form can be used or an App can be used on electric devices
  • Psychometric Characteristics
    • Not well established

With regard to the overall summation of the COMP (in addition to the original post)

Summary Components:

  • Strengths
    • Used in 40 countries and translated to 35 different languages
    • Takes into consideration and utilizes patients important perceived problems
    • Client centered practice
    • Focuses on occupational performance as well as leisure, self-care, and productivity
    • Longevity in use (originally published in 1991)
  •  Weaknesses
    • Designed for the use of Occupational Therapists
    • Data is specific to the paitent, making it a harder test to generalize
    • Legitimacy of the patients viewpoints

References:

  • http://www.rehabmeasures.org/Lists/RehabMeasures/PrintView.aspx?ID=928
  • http://www.thecopm.ca
  • http://www.rehab.research.va.gov/jour/11/485/pdf/eyssen485.pdf

Article Summary:

Functional outcomes of intramuscular botulinum toxin type A and Occupational Therapy in the upper limbs of children with Cerebral Palsy: a randomized controlled trial. Physical Medicine and Rehabilitation Journal. Available from: http://www.archives-pmr.org/article/S0003-9993(06)01425-0/fulltext

The purpose of this article was to investigate the functional outcomes of using Botulinum Toxin Type A injections to the upper limbs in conjunction with Occupational Therapy in children diagnosed with Cerebral Palsy.  The study utilized a randomized controlled trial design and obtained baseline measures with follow up at 2 weeks, 3 months, and 6 months.  The study included 80 children diagnosed with spastic quadriplegic, triplegic, or hemiplegic CP and were randomly assigned into 4 different groups: a Botulinum Type A Injection with OT group, Botulinum Type A injection only group, OT only group, and a no treatment control group.  Intervention consisted of a single set of Botulinum Toxin Type A injections and 12 weeks of OT if allocated to those groups.  Furthermore, the participants were only eligible if they were between the ages of 2-14 with a mean age of 5 years and 11 months +/- 3 years, had a Modified Ashworth Scale score of 2 or 3 in at least one of their UE’s, and goals of the patient/family were related to improving some form of UE function.  The study used the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS) as their primary outcome measures.  OT invention began 1 week after baseline assessments and children in one of the OT groups received 1 hour a week of therapy for 12 weeks.  The therapy components of the intervention were not standardized, but determined by the treating clinicians to ensure the intervention was appropriate for the participants to meet their goals.  Intervention did include the following: stretching, casting splitting, and attempts to enhance activity by motor training, environmental modification, and practice of specific goals.  The results of the study found that the combination of the Botulinum Toxin Type A injection and OT resulted in an increased attainment of the goals set by the patient, measured using both the GAS and the COPM.  Interestingly, other secondary outcome measures and performance measures that were looked at including the quality of UE skills tests, the Pediatric Evaluation of Disability Inventory, the Melbourne Assessment of Unilateral Upper Limb Function, active and passive ROM showed no differences between the groups.  With regard to muscle tone, there was a significant reduction 2 weeks after injection, but returned to baseline levels by the 6 month follow up.  In conclusion, it was shown that OT enhanced individualized functional outcomes following Botulinum Toxin Type A injections in the upper limbs of children with CP, based off of their functional goals.  It also enhanced the self-reported, individualized outcome measures of both the COMP and the GAS in children with CP.

Strengths of the article: I think a strength of this article was the large sample size with relatively equal representation amongst the 4 different groups examined.  Also, I think the baseline assessment as well as assessment at 2 weeks, 3 months, and 6 months gave a good representation of the effect of treatment, injection, the combination, or the control.

Limitations of the article: One of the biggest limitations to me was the variability in therapeutic rehabilitation treatment.  Treatment was non-uniform amongst patients and was based off of their own goals and presentation.  This lack of uniformity could had increased the potential for error without a set, specific exercise protocol.  I think overall more control devoted to the actual rehabilitation protocol would have increased the strength of comparison, both with the OT only group and the OT and Botulinum Toxin Type A injection group.