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Date of Award

Fall 2011

Degree Type

Thesis

Degree Name

Doctor of Philosophy (PhD)

Department

Rehabilitation Science

Supervisor

Dr Lori Letts

Language

English

Abstract

This thesis focuses on routine outcome measurement in occupational therapy; specifically the use of the Canadian Occupational Performance Measure (COPM) in inpatient geriatric rehabilitation.

The purpose of the first study (Chapters two and three) was to: 1) determine if routine COPM use was associated with improved functional outcome; 2) gather therapist perceptions on routine COPM use; and, 3) propose a template for summarizing COPM data. A cohort study with a therapist participant survey measured the difference in Functional Independence Measure (FIM) change scores between an experimental group (n = 45) that implemented the routine use of the COPM for evaluation/planning and a historical “usual care” comparison group (n = 58). Using generalized linear modeling, it was found that both groups had significant changes in FIMscores over time (p <. 05). Differences between groups were not significant. Therapists perceived that the COPM facilitated treatment but experienced challenges in routine use. Therapists placed more importance on individual than group data.

The second study (Chapter four) determined if routine use of the COPM was associated with changes in five domains of practice: focus of care on occupation, knowledge of client perspective, clinical decision-making, clinician ability to articulate outcomes, and documentation. Twenty-four occupational therapists on eight geriatric rehabilitation units completed a before-and-after study with a repeated baseline. Domains of practice during three months of standard care (no COPM) were compared using Chart Stimulated Recall and chart audit as outcome measures to three months of intervention (COPM). Mean practice scores indicated a significant effect for time (p < .0001) but no effect based on the frequency of COPM use. Chart audit indicated that COPM use resulted in more occupation-focused issue identification.

This thesis challenges assumptions regarding the value of measurement and contains the first study to demonstrate that routine outcome measure use affects occupational therapy practice.

McMaster University Library

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