The Canadian Association of Occupational Therapists, in collaboration with Health and Welfare Canada have developed and published a conceptual model for occupational therapy, the Occupational Performance model. This paper describes the development of an outcome measure, The Canadian Occupational Performance Measure (COPM), which is designed to be used with these guidelines for client-centred clinical practice. The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained. This paper describes the rationale and development of the COPM as wellas information about its use for therapists.

The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy:

In the United States, the incidence rate of new or recurrent stroke is approximately 795 000 per year, and stroke prevalence for individuals over the age of 20 years is estimated at 6.5 million.1 Mortality rates in the first 30 days after stroke have decreased because of advances in emergency medicine and acute stroke care. In addition, there is strong evidence that organized postacute, inpatient stroke care delivered within the first 4 weeks by an interdisciplinary healthcare team results in an absolute reduction in the number of deaths.2,3 Despite these positive achievements, stroke continues to represent the leading cause of long-term disability in Americans: An estimated 50 million stroke survivors worldwide currently cope with significant physical, cognitive, and emotional deficits, and 25% to 74% of these survivors require some assistance or are fully dependent on caregivers for activities of daily living (ADLs).4,5

Notwithstanding the substantial progress in acute stroke care over the past 15 years, the focus of stroke medical advances and healthcare resources has been on acute and subacute recovery phases, which has resulted in substantial health disparities in later phases of stroke care. Additionally, healthcare providers (HCPs) are often unaware of not only patients’ potential for improvement during more chronic recovery phases but also common issues that stroke survivors and their caregivers experience. Furthermore, even with evidence that documents neuroplasticity potential regardless of age and time after stroke,6 the mean lifetime cost of ischemic stroke (which accounts for 87% of all strokes) in the United States is an estimated $140 000 (for inpatient, rehabilitation, and follow-up costs), with 70% of first-year stroke costs attributed to acute inpatient hospital care1; therefore, fewer financial resources appear to be dedicated to providing optimal care during the later phases of stroke recovery.

Because there remains a …

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient A Scientific Statement From the American Heart Association

### The role of pulmonary rehabilitation

### Referral and assessment of patients for pulmonary rehabilitation

#### Specific situations at assessment

##### Smoking

/pdf/british-thoracic-society-guideline-on-pulmonary-3z0amgz4n9.pdf

British Thoracic Society guideline on pulmonary rehabilitation in adults.

Backround. It has been 13 years since the Canadian Occupational Performance Measure (COPM) was published. In that time there has been a remarkable growth in its acceptance as an outcome measure within the occupational therapy practice and research. Purpose. The purpose of this paper is to review the emerging research and clinical literature related to the COPM since 1994 and to document its impact upon occupational therapy practice and research throughout the world. Method. A systematic search was conducted to the professional and research literature in English publications (primarily occupational therapy). Eighty-eight papers that met the inclusion criteria were reviewed, 86% of which examined the COPM in relation to its psychometric properties (19 papers), research outcomes (33 papers) or practice (33 papers). Results. Overall, although there are a few limitations discussed in the review, the conclusion is that the COPM is a valid, reliable, clinically useful and responsive outcome measure acceptable fo...

The Canadian Occupational Performance Measure: A research and clinical literature review.

Background The upper-extremity portion of the Fugl-Meyer Scale (UE-FM) is one of the most established and commonly used outcome measures in stroke rehabilitative trials. Empirical work is needed to determine the amount of change in UE-FM scores that can be regarded as important and clinically meaningful for health professionals, patients, and other stakeholders.

Objective This study used anchor-based methods to estimate the clinically important difference (CID) for the UE-FM in people with minimal to moderate impairment due to chronic stroke.

Method One hundred forty-six individuals with stable, mild to moderate upper-extremity (UE) hemiparesis were administered the UE-FM before and after an intervention targeting their affected UEs. The treating therapists rated each participant's perceived amount of UE motor recovery on a global rating of change (GROC) scale evaluating several facets of UE movement (grasp, release, move the affected UE, perform 5 important functional tasks with the affected UE, overall UE function). Estimated CID of the UE-FM scores was calculated using receiver operating characteristic (ROC) curve with the GROC scores as the anchor.

Results The ROC curve analysis revealed that change in UE-FM scores during the intervention period distinguished participants who experienced clinically important improvement from those that did not based on the therapists' GROC scores. The area under the curve ranged from 0.61 to 0.70 for the different facets of UE movement.

Conclusions The estimated CID of the UE-FM scores ranged from 4.25 to 7.25 points, depending on the different facets of UE movement.

Clinically Important Differences for the Upper-Extremity Fugl-Meyer Scale in People With Minimal to Moderate Impairment Due to Chronic Stroke

In 1987, Health and Welfare Canada and the Canadian Association of Occupational Therapists Task Force recommended that work go forward to develop an outcome measure for occupational therapy which reflects the Occupational Performance Model. The first step in this process was to review critically those outcome measures which assess occupational performance and that are currently available in the literature. This paper will present the review process, describe in more detail eight assessments that fulfilled many of the review criteria, discuss the limitations of these measures using the "Guidelines for the Client-centred Practice of Occupational Therapy as the framework, and make recommendations for the development of a new outcome measure for use in occupational therapy.

Occupational Performance Measures: A Review Based on the Guidelines for the Client-centred Practice of Occupational Therapy:

As occupational therapists, we, too, hear and see unmet health needs specifically when there is no follow-up on patients after discharge from therapy. We, too, become despondent when many are re-admitted after what was considered a successful effort at readjustment to trauma, illness or disability. We, too, are acutely aware of and concerned with the pathology, disease and limb-oriented illness concept prevalent to-day in our health care system. We, too, have made an effort in cultivating the prevention of illness or trauma and a successful life readjustment post-illness or trauma. As we occupational therapists have evolved from \"basket weavers\" to therapists vitally concerned with the habilitation or rehabilitation of the total patient, we have been forced to face — along with our health colleagues — the increasing and rightful consumer demand to 'do something', to produce, to meet their needs. Traditionally, the occupational therapist has provided her program in one type or another of institutional settings, either hospital, centre or clinic. In an effort to prepare the patient for successful living patterns, the occupational therapist has created a simulated home, play, or work environment. In spite of her efforts, however, it is still an artificial and isolated atmosphere, complicated by the fact that once the person has left this atmosphere, dependency is reinforced by the necessary institutional routine. The therapist is unable to validly determine whether the patient, able to function within the program, could, given its real pressures and attitudes, function within the \"well\" society. Factors which determine our ability to function — family attitudes, work, social and economic pressures — are recognized by the occupational therapist, but are impossible to deal with in isolation. The therapist who finds the handicapped housewife relegated to dependency by family attitudes ; who sees 83% of her paediatric patients re-admitted; who sees the chronic patient withdraw into a nonproductive shell, begins to question the traditional focus of occupational therapy. It is this therapist who states \"this is not enough\". To provide a successful re-adjustment to living, we must take into consideration the community, the familial and cultural framework of the

Occupational therapy--a change of focus.

The following report outlines the findings of the CAOT Task Force established in 1980 to undertake a national manpower survey. With the assistance of Statistics Canada a survey was designed and through CAOT, it was distributed in the Fall of 1981. Although a completed methodology and tabulation were sent to the CAOT Executive in March 1982, an analysis was not completed until November 1982. This report is to inform all participants of the findings, implications and future considerations. The objectives, methodology and problems encountered are described. Unfortunately, most of the objectives were not met. The task of developing an effective survey tool and the process of collecting meaningful data was far greater than anticipated. Such a massive project, which entails money and time, requires professional assistance to reduce ambiguities in the survey forms and computerization to correlate the information. Much of the information received could not be used nor correlated; however, the results do give a brief description of the profile of an occupational therapist to build on in the future. In addition, the experience gained will facilitate future survey development and distribution.

Report on the Canadian Association of Occupational Therapists' manpower survey: 1981.

The Occupational Therapy Department of the Scarborough General Hospital has been involved in the \"habilitation\" of perceptually handicapped children since 1968. The majority of children are between 9 and 14 years of age, and are not performing adequately in social or academic areas, but cannot be categorized on an intellectual basis as being \"retarded\". It was our concern that these children were referred much too late for adequate remediation in academic skills; and, for the most part, our programs were geared to developing fine and gross motor skills, as well as self-esteem. It was postulated that: 1) early diagnosis and remediation would improve the perceptually handicapped child's academic prognosis, 2) detection and prevention of perceptual problems is an educational rather than a medical function. A pilot study to examine whether a detective and preventive program was possible and feasible was conducted conjointly by the Reading Centre of the Scarborough Board of Education and the Occupational Therapy Department of the Scarborough General Hospital.

Anne Opzoomer

Papers

The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy:

Occupational Performance Measures: A Review Based on the Guidelines for the Client-centred Practice of Occupational Therapy:

Occupational therapy--a change of focus.

Report on the Canadian Association of Occupational Therapists' manpower survey: 1981.

Pilot project study on perceptual handicapped children in kindergarten.