IDRC - Celebrating 25 Years

1993 - 2018

Linda Petty

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Table of Contents

Client Centered Outcome Measures

Outline of Workshop

Paper trail

Outcome Measures

What do we measure?

The Problem with outcomes

Essential Domains of Outcome

Personal Performance variables

For the Big Picture

Measuring Personal Performance

The Canadian Occupational Performance Measure

Traditional Seating

Client Centered Assessment

Person, Occupation, Environment

Training in the COPM

COPM as an outcome measure

Modified COPM in AT

COPM in Seating and Mobility

Summary of Findings

Satisfaction Data

Some notes on use of mCOPM

Recommendations from study

Recommendations from study

The mCOPM Instructions

The mCOPM Instructions

The mCOPM Instructions

The mCOPM Instructions

COPM reveals...

Strengths of COPM

Weaknesses of COPM

General Recommendations

Two keys

Proposed Research

Resources

Resources

New! AT Outcomes Listserve!

Subscribe to AToutcomes

Thank you for your interest!

 

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

    • Consumers
    • Funding agencies- public and private
    • Administrators
    • Clinicians
  • Who wants them?

 

What do we measure?

    • 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

    • 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

    • normalize tone and reflexes
    • reduce risk of deformities
    • provide independent mobility
    • improve sitting tolerance
  • Goals such as

    • 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…”

    • 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

    • 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:

    • personal care: dressing, bathing, toiletting
    • functional mobility: transfers, moving indoors and outdoors
  • Self care: community management

 

The mCOPM Instructions

    • Paid/unpaid work: finding/keeping a job, access to job site, volunteering
    • Household management, Play/school
  • Productivity

    • 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

    • 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

    • 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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Thank you for your interest!

    Here’s to success in demonstrating the value of seating and mobility intervention to all players.