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Rehab Measures: Canadian Occupational Performance Measure

Link to instrument

Available for purchase at the Canadian Association of Occupational Therapists (external link) 

Title of Assessment

Canadian Occupational Performance Measure 

Acronym

COPM

Instrument Reviewer(s)

Initially reviewed by the Rehabilitation Measures Team; Updated with references from the TBI population by Anna de Joya, PT, DSc, NCS, Coby Nirider, PT, DPT, and the TBI EDGE task force of the Neurology Section of the APTA in 2012; Updated with references for Arthritis, Pediatrics, and Ankylosing Spondylitis by Brianna DeBois, SPT, Samantha Dillon, SPT, and Jennifer Kick, SPT in 11/2012.

Summary Date

3/22/2013 

Purpose

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

Description

The assessment involves a 5-step process nested within a semi-structured interview, typically conducted by an Occupational Therapist.

  • Interview focuses on identifying activities within each performance domain that the client wants, needs, or is expected to perform.
  • Following Step 3, the patient and therapist create goals for therapeutic interventions.
  • The interviewer may need to supplement information gathered during the COPM interview through other techniques including direct observation, administration of standardized tests, or an assessment of the patient's environment (Law et al, 1990).
  • Has been translated into 24 languages and is used in over 35 countries. Also available in Pediatric, French, Hebrew, Icelandic, Japanese, German, Danish, Swedish, Greek, Spanish, Mandarin Chinese, Korean, Russian, Slavic, Italian, Portuguese and Norwegian versions.
  • Caregiver/proxy may respond on the patient’s behalf, but they may not identify the same deficits or problems as the patient would and there may be differences in option in regard to the importance of activities.

Area of Assessment

Activities of Daily Living; Functional Mobility; Life Participation; Occupational Performance 

Body Part

Not Applicable 

ICF Domain

Participation 

Domain

ADL; General Health; Motor 

Assessment Type

Patient Reported Outcomes 

Length of Test

06 to 30 Minutes 

Time to Administer

10-20 minutes

Number of Items

Not applicable  

Equipment Required

None necessary

Training Required

None necessary

Type of training required

Reading an Article/Manual 

Cost

Not Free 

Actual Cost

A 45-minute DVD and Workbook with COPM manual and 100 Forms is $225.45 (Canadian) or a Manual/Form Kit for $52.45 (Canadian) can be purchased from the Canadian Association of Occupational Therapists (cost determined in November, 2012)

Age Range

Child: 6-12 years; Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Arthritis; Cerebral Palsy; Chronic Obstructive Pulmonary Disease; Pain; Parkinson’s Disease; Spinal Cord Injury; Stroke; Traumatic Brain Injury 

Populations Tested

The COPM was designed for use with all clients regardless of diagnosis (Law et al, 2004). The COPM has been validated with patients drawn from the following populations:

  • Stroke
  • COPD
  • Pain
  • Cerebral Palsy
  • Traumatic Brain Injury
  • Parkinson's Disease
  • Arthritis
  • Pediatrics
  • Ankylosing Spondylitis

Standard Error of Measurement (SEM)

Ankylosing Spondylitis:

(calculated from statistics in Kjenken et al, 2005; Rescore by personal interview, n=17, mean age 46.4 (12.8) years; Rescore by telephone, n=25, mean age 48.7 (13.3) years; Rescore by mail, n=24, mean age 46.6 (12.5) years; 2 weeks between assessments, Ankylosing Spondylitis)

  • Personal interview
    • SEM for performance=0.66
    • SEM for satisfaction=0.84
  • Telephone interview
    • SEM for performance=1.41
    • SEM for satisfaction=1.86
  • Mail
    • SEM for performance=0.99
    • SEM for satisfaction=1.13

Stroke:

(calculated from statistics in Cup et al, 2003, Acute Stroke) 2 to 6 months post onset

  • SEM for performance=1.2 points
  • SEM for satisfaction=1.9 points

Minimal Detectable Change (MDC)

Ankylosing Spondylitis:

(calculated from statistics in Kjeken et al, 2005)

  • 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:

(calculated byMacDermid et al, 2009 from Kjeken et al, 2005; n=87, women, mean age=62.7 (5.4) years, Hand Osteoarthritis)

  • MDC= 5

Stroke:

(calculated from statistics in Cup et al, 2003, Acute Stroke) 2 to 6 months post onset

  • MDC for performance=1.7 points
  • MDC for satisfaction=2.7 points

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Acute Stroke:
(Cup et al, 2003; n=26; mean age=68 (15) years; mean time between assessments=8 days (2.5) days, range 5–16 days, Acute Stroke)
Mean performance and satisfaction scores Mode number of problems identified over two assessments 3 to 5
  • Interview 1: mean performance score 3.5 (SD 1.8, range 1.0–7.0) 
  • Interview 2: mean performance score 3.7 (SD 1.9, range 1.0–6.8)
  • Interview 1: mean satisfaction score 3.3 (SD 1.9, range 1.0–7.5)
  • Interview 2: mean satisfaction score 3.5 (SD 2.1, range 1.0–7.4)

Test-retest Reliability

Adults with impairment in 1 or more ADL:

(Eyssen et al, 2005; n=95; mean age 47 (15) years; various diagnoses; COPM administered twice, 7 days between assessments)

  • Adequate test-retest reliability (ICC=0.67 performance and 0.69 satisfaction)

Ankylosing Spondylitis:

(Kjenken et al, 2005)

  • 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:

(Sewell & Singh, 2001, COPD)

  • Excellent test-retest reliability (ICC=0.81 performance and ICC=0.76 satisfaction)

Stroke:

(Cup et al, 2003; 2 to 6 months post onset, Acute Stroke)

  • Excellent test-retest reliability
    • r=0.87 performance
    • r=0.88 satisfaction

Interrater/Intrarater Reliability

Acquired Brain Injury:

(Jenkinson et al, 2007; Community dwelling individuals; n=34 (TBI=21; CVA=11; Others=2); total of 15 patients with ABI were involved in the stability study, ABI)

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:

(Cup et al, 2003; n=26; mean age=68 (15); gender; 11 males, 15 females; time post stroke: 24 patients 6 months post stroke, 2 patients 2 months post stroke, Stroke)

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)

Internal Consistency

Cerebral Palsy:

(Cusik et al, 2007; n=42; mean age=3.9 years; time post diagnosis unknown; GMPM Level 1, Spastic Hemiplegic Cerebral Palsy)

·         Using an adapted form of the COPM competed by a parent proxy (deleted the categories of ‘‘paid/unpaid work’’ and ‘‘household management”), internal consistency reliability was found to be acceptable for Performance (Cronbach’s α=0.73) and Satisfaction (Cronbach’s α=0.83).

 

Stroke:

(Cup et al, 2003, Acute Stroke)

26 participants were asked to identify problems over the course of two interviews. During the initial COPM interview 115 problems were identified. In the second interview 112 problems were identified. 64 problems (56%) mentioned in the first interview were also mentioned in the second interview.

Criterion Validity (Predictive/Concurrent)

Arthritis:

(Ripat et al, 2001; n=13, stage 2 or stage 3 RA, Rheumatoid Arthritis)

  • 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:

(McColl et al, 2000; n=61; disability unspecified, Community Dwelling Disabled Individuals)

  • 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
  • Problems mentioned on both measures include:
    • Transportation and errands
    • Dressing
    • Toileting
    • Climbing stairs
    • Cooking
    • Cleaning
    • Socializing

Construct Validity (Convergent/Discriminant)

Discriminant Validity:
Acquired Brain Injury:
(Jenkinson et al, 2007; Community dwelling individuals; n=34 (TBI=21; CVA=11; Others=2) , ABI)

PCRS Discrepancy

HADS Depression

HADS Anxiety

Health and Safety Subtest of the Independent Living Scale

COPM Performance

0.21

-0.23

-0.30

0.18

COPM Satisfaction

0.20

-0.33

-0.42*

-0.02

*p<0.05, two-tailed (PCRS: Patient Competency Rating Scale; HADS: Hospital Anxiety Depression Scale)

  • Lower self-ratings of satisfaction were associated with higher levels of anxiety
  • No significant difference between self-ratings of satisfaction with measures of awareness, depression and cognitive function
  • No significant difference between self-ratings of performance with awareness of deficit, mood state, and cognitive function

Mixed Population (Disorders of wrist, hand and arm, Central neurological disorder, neuromuscular diseases, other diagnosis):

(Eyssen et al, 2011; Dutch version; n=138; mean age=51 (13), Mixed Population)

  • 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

Pediatrics:

(Cusick et al, 2006, Pediatrics)

Stroke:

(Cup et al, 2003, Acute Stroke)

COPM performance scores:

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

In other words, standardized performance measures did not correlate with the COPM indicating strong evidence of discriminate validity.

*(Spearman rho)

 

  • Poor correlation with the Goal Attainment Scaling (GAS) measure compared to COPM Performance score, r=-0.16 and COPM Satisfaction score, r=-0.13
  • COPM performance and satisfaction scores are highly correlated, r=0.5, p=0.0012

Content Validity

The COPM assessment focuses on measuring a mismatch between a person’s abilities and the demands of a task leading to functional impairment. (Macedo et al, 2009)

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Research (Law et al 2004) suggests:

  • A change of 2 or more points is clinically significant
  • Changes in scores from assessment to re-assessment tend to be meaningful

Acquired Brain Injury:

(Phipps et al, 2007; n=155 (TBI=38, CVA=117); Time from admission to discharge (TBI=141.26 (85.10); Right CVA=97.45 (72.99); Left CVA=96.47 (65.97), ABI)

  • Significant change in performance ratings and satisfaction ratings from admission to discharge for entire sample and also for each diagnostic group

(Jenkinson et al, 2007; Community dwelling individuals; n=34 (TBI=21; CVA=11; Others=2); total of 10 patients involved in an 8-week intervention group, ABI)

  • Significant improvement in COPM performance self-ratings (p=0.018) and satisfaction self-ratings (p=0.013) between the pre- and post-assessment
  • Significant improvement in relatives’ ratings of performance between the pre- and post-assessment (p=0.008)
  • Improvement for relatives’ ratings of satisfaction between the pre- and post-assessment was not significant (p>0.05)

Arthritis:

(Macedo et al, 2009, Rheumatoid Arthritis)

  • Means Changes in Satisfaction and Performance were found to be both clinically and statistically significant

Cerebral Palsy:

(Cusick et al, 2007, Spastic Hemiplegic Cerebral Palsy)

  • The adapted COPM demonstrates an ability to detect change above the published minimum clinically important difference of 2 points

Mixed neurologic sample:

(Bodium, 1999; in-patient rehabilitation; n=17; admission to discharge=10 weeks, Mixed Neurologic Sample)

  • significant differences in improvement in self-ratings of performance and satisfaction

Mixed neurological, orthopedic and cardiology sample:

(Wressle et al, 2002; n=155 experiment group and 55 in control group within geriatric, stroke and home rehabilitation; median age=80 experiment group and 79 control group; assessment after discharge=2-4 weeks with 88 patients in control group; 30 in control group, Mixed patients)

  • Significant differences between groups: more patients in the experiment group perceived that treatment goals were identified, were able to recall the goals, felt that they were active participants in the goal formulation process, and perceived themselves better able to manage after completed rehabilitation compared with patients in the control group

Mixed Population (Disorders of wrist, hand and arm, Central neurological disorder, neuromuscular diseases, other diagnosis):

(Eyssen et al, 2011; Dutch version; n=138; mean age=51 (13), Mixed Population)

  • Significant differences between assessment and reassessment scores (p<0.001)
  • The AUC ranged from 0.79 to 0.85, and the optimal cut-off values for the performance scores and satisfaction scores ranged from 0.9 to 1.9

Neuro Rehabilitation:

(Chenq et al, 2002; n=12, 7=cerebrovascular accident, 2=spinal cord injuries, & 3=TBI; mean age 42.5; Taiwanese sample, Neuro Rehabilitation)

  • Mean changes in Satisfaction and Performance were found to be both clinically and statistically significant

Pain:

(Carpenter et al, 2001; n=87 completed the COPM at baseline, end of program and 3 month post intervention; mean age=44, range=19 to 72 years, Pain)

  • Changes in satisfaction and performance scores were found to be statistically and clinically significant

Traumatic Brain Injury:

(Trombly et al, 1998; Outpatient therapy services; n=16; gender=7 female and 9 male; mean age=43 (12.6); time since injury=22 (5.4), TBI)

  • Performance self-ratings were significantly better (p<0.001), and satisfaction self-ratings were significant as well (p=0.001) after treatment than before (discharge: 4-23 weeks after admission; mean=12.3 weeks)
  • No significant difference from discharge to follow up (4-8 weeks after discharge)

(Trombly et al, 2002; outpatient rehabilitation; n=31; mean age=37.03 (12.16); gender=75% male; onset more than equal to 12 months=55%; onset less than equal to 3 months=19%; mixed level of severity, TBI)

  • Performance self-ratings: significantly greater gain t(10)=5.029, p<0.001, r=0.84, during the treatment versus no treatment periods
  • Satisfaction self-ratings: significantly greater gain t(10)=6.325, p<0.001, r=0.89 during the treatment versus no-treatment periods

Professional Association Recommendations

Recommendations from the Neurology Section of the American Physical Therapy Association’s StrokEDGE Taskforce, MSEDGE Taskforce, SCI EDGE Taskforce, TBI EDGE Taskforce are listed below.  These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

UR

UR

UR

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

NR

UR

UR

UR

UR

MS EDGE

UR

UR

UR

UR

UR

TBI EDGE

NR

NR

NR

LS

LS

 

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

UR

UR

UR

UR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Is this tool appropriate for use in intervention research studies? (Y/N)

StrokEDGE

No

No

Yes

MS EDGE

No

No

No

TBI EDGE

No

Yes

Yes

Considerations

  • The COPM can be time consuming and difficult to administer  (Toomey et al, 1995)
  • Requires that the therapist using the tool be comfortable with a client-centered approach to both assessment and practice (Law et al, 1994)
  • May not be appropriate for children under 8
  • The interview process is of critical importance both in eliciting relevant information and devising patient-centered therapeutic interventions. However, the interview process is not standardized and both the quality and adequacy of information obtained from interviews may vary considerably between interviewers
Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography

Bodiam, C. (1999). "The use of the Canadian Occupational Performance Measure for the assessment of outcome on a neurorehabilitation unit." The British Journal of Occupational Therapy 62(3): 123-126. 

Bowie, C., Shackleton, T., et al. (1999). "Exploring the responsiveness of the COPM in an outpatient rehabilitation program." Unpublished manuscript.

Carpenter, L., Baker, G. A., et al. (2001). "The use of the Canadian occupational performance measure as an outcome of a pain management program." Can J Occup Ther 68(1): 16-22. Find it on PubMed

Chenq, Y. H., Rodger, S., et al. (2002). "Experiences with the COPM and client-centred practice in adult neurorehabilitation in Taiwan." Occup Ther Int 9(3): 167-184. Find it on PubMed

Cup, E. H., Scholte op Reimer, W. J., et al. (2003). "Reliability and validity of the Canadian Occupational Performance Measure in stroke patients." Clin Rehabil 17(4): 402-409. Find it on PubMed

Cusick, A., Lannin, N. A., et al. (2007). "Adapting the Canadian Occupational Performance Measure for use in a paediatric clinical trial." Disabil Rehabil 29(10): 761-766. Find it on PubMed

Cusick, A., McIntyre, S., et al. (2006). "A comparison of goal attainment scaling and the Canadian Occupational Performance Measure for paediatric rehabilitation research." Pediatr Rehabil 9(2): 149-157. Find it on PubMed

Dedding, C., Cardol, M., et al. (2004). "Validity of the Canadian Occupational Performance Measure: a client-centred outcome measurement." Clin Rehabil 18(6): 660-667. Find it on PubMed

Eyssen, I. C., Beelen, A., et al. (2005). "The reproducibility of the Canadian Occupational Performance Measure." Clin Rehabil 19(8): 888-894. Find it on PubMed

Jenkinson, N., Ownsworth, T., et al. (2007). "Utility of the Canadian Occupational Performance Measure in community-based brain injury rehabilitation." Brain Inj 21(12): 1283-1294. Find it on PubMed

Kjeken, I., Dagfinrud, H., et al. (2005). "Activity limitations and participation restrictions in women with hand osteoarthritis: patients' descriptions and associations between dimensions of functioning." Ann Rheum Dis 64(11): 1633-1638. Find it on PubMed 

Kjeken, I., Dagfinrud, H., et al. (2005). "Reliability of the Canadian Occupational Performance Measure in patients with ankylosing spondylitis." J Rheumatol 32(8): 1503-1509. Find it on PubMed

Law, M., Baptiste, S., et al. (2004, 2005). "COPM Questions and Answers." from http://www.caot.ca/copm/questions.html. MacDermid, J. C., Grewal, R., et al. (2009). "Using an evidence-based approach to measure outcomes in clinical practice." Hand Clin 25(1): 97-111, vii. Find it on PubMed

Macedo, A. M., Oakley, S. P., et al. (2009). "Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy." Arthritis Rheum 61(11): 1522-1530. Find it on PubMed

McColl, M. A., Paterson, M., et al. (2000). "Validity and community utility of the Canadian Occupational Performance Measure." Can J Occup Ther 67(1): 22-30. Find it on PubMed

Phipps, S. and Richardson, P. (2007). "Occupational therapy outcomes for clients with traumatic brain injury and stroke using the Canadian Occupational Performance Measure." The American journal of occupational therapy 61(3): 328-334.

Ripat, J., Etcheverry, E., et al. (2001). "A comparison of the Canadian Occupational Performance Measure and the Health Assessment Questionnaire." Can J Occup Ther 68(4): 247-253. Find it on PubMed

Sewell, L. and Singh, S. (2001). "The Canadian Occupational Performance Measure: is it a Reliable Measure in Clients with Chronic Obstructive Pulmonary Disease?" The British Journal of Occupational Therapy 64(6): 305-310.

Toomey, M., Nicholson, D., et al. (1995). "The clinical utility of the Canadian Occupational Performance Measure." Can J Occup Ther 62(5): 242-249. Find it on PubMed

Trombly, C. A., Radomski, M. V., et al. (1998). "Achievement of self-identified goals by adults with traumatic brain injury: Phase I." The American Journal of Occupational Therapy 52(10): 810-818.

Trombly, C. A., Radomski, M. V., et al. (2002). "Occupational therapy and achievement of self-identified goals by adults with acquired brain injury: phase II." Am J Occup Ther 56(5): 489-498. Find it on PubMed

Wressle, E., Eeg-Olofsson, A. M., et al. (2002). "Improved client participation in the rehabilitation process using a client-centred goal formulation structure." Journal of Rehabilitation Medicine 34(1): 5-11.

Year published

1991 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 12/4/2013 6:03 PM  by Jason Raad