The COPM allowed us to examine change scores across performance problems and across children, making it possible to examine the effectiveness of the intervention.
In our research examining the use of cognitive strategies to improve outcomes for children with motor-based performance problems we chose the COPM as one of our major outcome measures. The COPM not only afforded us the opportunity to engage the children in identifying their individual performance problems but also in measuring individualized outcomes at post-test and at follow-up. The COPM also allowed us to examine change scores across performance problems and across children, making it possible to examine the effectiveness of the intervention (see Polatajko, Mandich, Miller, & Macnab, 2001).
The COPM pre-test interviews were usually conducted in a casual atmosphere on floor mats. The time frame and focus of the interview were set by saying, “For the next half hour or so, we’re going to talk about you—what’s easy for you; what’s tricky for you…”. A day log completed by the child for the previous day was reviewed to provide the therapist with contextual information about the child. The 1 to 10 rating scale was introduced, including clarification that 0s and 1/2s were not permitted. Examples of the rating of some Olympic events or popular movies were given. The domain of self-care was introduced with “Let’s think together about the sorts of things that you do every day to take care of yourself—head to toe, inside and out.”
The domain of productivity was introduced with “Let’s think together about the jobs of your day (paid and not paid) at home, in the neighbourhood and at school. Think of all the sorts of things that other people expect you to do.” A list was generated of home chores (surveyed by room) and school activities (surveyed by time of day and by subject) and recorded as for self-care. The domain of leisure was introduced with “Playing can be quiet or busy, alone or with other people, in any combination, at any time. What sorts of things do you do because you want to?” and was explored as for the other domains.
At pre-test, post-test, and follow-up, the children rated each of their occupational performance problems for the construct Performance by judging “At this moment, how well do you…?” and for the construct Satisfaction by judging “At this moment, how happy are you with how well you…?”.
Sarah is an energetic girl who was 9 years old at the time of the COPM interview. She lives with her mother, her widowed grandfather and her teenaged sister in a detached home in a working class urban neighbourhood. Sarah has been identified as having Developmental Coordination Disorder, with fine and gross motor incoordination. She had failed Grade 1, was diagnosed as learning disabled and was withdrawn from her classroom daily for language and mathematics tutoring from the resource teacher. Twice each day, Sarah was taking Ritalin, a medication for attention control. During the COPM, Sarah identified her three occupational performance goals as shuffling cards, slicing cheese, tomatoes, and hamburger buns using kitchen knives, and writing capital letters.
This table illustrates the change in Performance and Satisfaction for each of the prioritized occupational performance problems. (you may need to scroll horizontally to view all the data)
|Occupational Performance Problem||Time 1||Time 2|
|Slice using kitchen knives||1||1||10||10|
|Writing capital letters||1||1||5||10|
|Average Scores (Total Scores / number of problems):||1.3||1.3||8.3||9.6|
(Time 2 – Time 1):
|+ 7.0||+ 8.3|