Canadian Occupational Performance Measure

Diagnoses: Mixed populations, pediatric disorders, stroke, older adults/geriatric care, orthopedics, dementia, vision impairment, hearing loss, chronic pain, brain injury, cerebral palsy, arthritis, MS, Parkinson's, COPD, amputations, cancer, mental health conditions (depression, anxiety, schizophrenia, ASD, ADHD, bipolar disorder, PTSD, IDD)

Setting: Acute care hospitals, inpatient rehab, outpatient clinics, home health, community health centers, school-based, EI programs, mental health clinics, assisted-living, vocational rehab, telehealth

Purpose:

designed to capture a client's self-perception of occupational performance in everyday living over time

1) Identify problem areas in performance.

2) Provide a rating of the client's priorities.

3) Evaluate performance & satisfaction relative to problem areas.

4) Provide a basis for goal setting.

5) Measure changes in the client's perception of their performance throughout intervention sessions.

6) Draws on the client's own context & environment.

Problems identified in the initial COPM administration can serve as the basis for the development of occupational goals, establishment of priorities for intervention, and assess changes in occupational performance

Areas Assessed:

Self-care - occupations aimed at getting ready for the day & getting around
- Personal Care
- Functional Mobility
- Community Management
Leisure - occupations performed by an individual when free from the obligation to be productive
- Quiet Recreation
- Active Recreation
- Socialization
Productivity - occupations aimed at earning a living, maintaining home & family, providing services to others, and/or developing one's capabilities
- Paid or Unpaid Work
- Household Management
- School
- Play

Occupational Performance Problem: an occupation that a person wants to do, needs to do, or is expected to do, BUT can't do, doesn't do, or isn't satisfied with the way they do.

Administration

Time: 15-30 mins

Group/Individual: Individual

Subtests: Importance, Performance, Satisfaction, Change based on Self-Care, Productivity, Leisure

Instructions: The COPM is completed in 5 steps:
1. identify occupational performance problems.

2. once specific occupational performance problems have been identified, the client is asked to rate each one in terms of its importance in his or her life based on a 10-pt scale (1 = not important at all - 10 = extremely important)

3. Ask the client to choose up to five problems that seem most pressing or important, using the ratings just done

Recommended: show clients the five problems with the highest rating of importance and ask if these are the most important issues for intervention to allow the client to confirm those problems or if wish to focus on lesser rated onces for intervention
Useful to keep track of any problems identified, but not scored for future reference
Enter the chosen problems & their importance ratings in the score section (max 5 problems)

4. For each of the chosen problems, the client should rate:

Performance - how would you rate the way you do this activity now? (1 = not able to do it at all - 10 = able to do it extremely well)
Satisfaction - how satisfied are you with the way you do this activity now? (1 = not satisfied at all - 10 = extremely satisfied)

5. Establish date for re-assessment

*It is easier, though not necessary to complete performance and satisfaction ratings for each problem then move to the next one
Enter the values in the appropriate boxes for each of the identified problems
At an appropriate interval following initial assessment & intervention, performance and satisfaction for the initially identified problems will be reassessed (do not rate importance again)

Materials: Manual, Scoring Form

User Qualifications: designed to be used by experienced occupational therapists in interviewing, probing, & validating assumptions

Scoring Procedures

How to Score:

Using the chosen 5 problem areas and associated importance level (1-10),
- Performance scores: add the performance scores (1-10) for each problem to create the total performance score; then divide the number of identified problems to generate an average performance score
- Satisfaction scores: add the satisfaction scores (1-10) for each problem to create the total satisfaction score; then divide the number of identified problems to generate an average satisfaction score
Changes in scores at the second time interval will be calculated by subtracting Time 1 values from Time 2 values (T2-T1 = x)

Score Indications:

Baseline scores give an idea of the current performance and satisfaction on client-prioritized occupations
A change of 2 or more points (in performance or satisfaction) is considered clinically significant

Psychometrics

Reliability: High

Test-retest:
- COPD - r = .90-.92
- Stroke - r = .89-.88
- Schizophrenia - r =.84-.85
- Outpatient - ICC = .67-.69
- Ankylosing spondylitis - r = .92-.93
- Children - 80%
- Parent proxy - ICC = .73-.83

Validity:

SPSQ: r =.22-.39
FIM: r =.14 -.32
D-AIMS2: 80%
HAQ: r = .37-.67

Responsiveness: ability of the COPM to detect changes in perceived OP over time

Pain - sensitive
Hip fracture - sensitive to clinical change
Acquired brain injury - detects significant change
Cerebral palsy - sensitive to clinical change
Mixed outpatient

Pros & Cons

Strengths:

Culturally sensitive - used in over 50 countries & translated into 40+ languages
Client-centered - encourages clients to identify & prioritize occupational performance issues
Flexible to be used broadly across diagnoses, ages, & practice settings
Sensitive to detecting changes in performance & satisfaction over time
Useful in goal setting for intervention planning
Quick to administer
Conceptualized occupational performance as an individual subjective experience
Can be completed via telehealth
Includes a sub model - CMOP-E (Canadian Model of Performance & Engagement)
Suitable for use within the PEO, MOHO, OA, and EHP models

Weaknesses:

Scores are dependent on the nature and complexity of problems identified and cannot be compared with another's
Requires good communication skills which can be difficult with clients with cognitive, language or communication impairments
Subjective, relying self-report
Training is needed to do skilled interviews
Not designed to assess deviations in occupational performance from an empircally-derived norm - does not attempt to apply a population-based standard

Resources

COPM.pdf

References

Canadian Association of Occupational Therapists. (n.d.). Canadian Occupational Performance Measure (COPM). https://www.thecopm.ca/
Law, M., Polatajko, H., Pollock, N., Mccoll, M.A., Carswell, A.B. (1994). Pilot testing of the Canadian Occupational Performance Measure: Clinical and measurement issues. Canadian Journal of Occupational Therapy, 61(4), 191-197.
Law, M., Baptiste, S., Carswell, A., McColl, M.A., Polatajko, H., & Pollock, N. (2014). Canadian occupational performance measure (5th ed.). Canadian Association of Occupational Therapists Publications ACE.
Shirley Ryan Ability Lab. (2019, June 1). Canadian occupational performance measure. https://www.sralab.org/rehabilitation-measures/canadian-occupational-performance-measure

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