Mira is a 60-year old woman of Indian descent, who experienced a stroke three weeks ago, and has been left with significant hemiplegia. She appears to be achieving some spontaneous recovery, but cannot be enticed to participate in therapy of any kind, and is at risk of developing complications associated with prolonged bed-rest. Occupational therapy has been asked to address ADL training.
The COPM is designed to take account of the cultural environment of individuals by asking about expectations and requirements for occupational performance within the socio-cultural environment. In this way, the COPM permits a culturally adaptable assessment of occupational performance, provided the therapist is aware of the views of disability and illness held by the client, and by other members of his or her community. Thus the onus rests with the therapist to be informed about the cultural implications of disability and occupational performance. As in most instances, in cross-cultural applications, the COPM is only as good as the therapist who administers it. Other considerations in administering the COPM across different cultures include: cultural assumptions and expectations about therapy, roles in society, family obligations and duties, relationships with professionals and about comfort in expressing needs, setting goals and accepting help.
Another issue in using the COPM with people from non-Western cultures is the degree of comfort with client-centred practice, and the extent to which clients are willing to be decision-makers and active participants in their therapy. The client-centred approach to practice was developed with the North American and European health care environments in mind, and may require some interpretation for use in other systems or cultures.
It should also be noted that the numerical rating scale is something that has become an inherent part of our culture. Even colloquially, we often “rate things on a scale of 1 to 10”. This way of assigning value and importance is second-nature to most Westerners. However, the idea of assigning an abstract number between 1 and 10 to occupational performance may be quite foreign to someone from another culture or from a less numerate way of life. Therefore alternative symbolic ways to illustrate the intent of the scale should be considered to facilitate clients’ understanding and engagement.