Understanding the Self-Perceived Occupational Performance of Individuals With Spinal Cord Injuries Using the Canadian Occupational Performance Measure

PURPOSE: The primary purpose of this study was to determine the self-perception of occupational performance through the use of the Canadian Occupational Performance Measure (COPM) and open-ended interview questions of participants within a spinal cord injury (SCI) recovery setting.

DESIGN AND METHOD: A mixed-method design and phenomenological approach were used to conduct this study using the COPM followed by open-ended questions. Seven individuals with a SCI were recruited using a convenience sample from a local outpatient SCI center. Using the COPM as a semistructured approach followed by open-ended questions, occupational performance limitations were identified. The responses were rated and categorized by level of importance; participants rated self-perceived performance and satisfaction for their top five occupations. Mean scores were then determined from these responses. Additionally, transcriptions for the open-ended questions were analyzed. Rich data were gathered using two independent researchers in a qualitative thematic method.

RESULTS: From the COPM, the average importance rates, out of 10, for all domains were as follows: work (9.43), activities of daily living (ADLs; 8.74), social participation (8.67), instrumental activities of daily living (IADLs; 7.36), and leisure (6.86). The total average self-performance ratings were as follows: work (1.60), ADLs (2.00), IADLs (3.31), social participation (3.33), leisure (4.38), and education (5.00). The total average satisfaction ratings were as follows: work (1.40), education (2.00), ADLs (2.32), IADLs (2.79), leisure (3.88), and social participation (3.13). The ADL mentioned with the greatest frequency was bowel care (100%), and the ADL mentioned least was feeding or cooking. IADLs indicated as most important were community mobility (100%), followed by care for others (90%); the least-mentioned IADL was safety (1%).

Six of the participants indicated that they did not currently have a job, were trying to find a job, or could no longer participate in their previous career path. Leisure activities of golfing and running were mentioned most often by participants, and education categories stated were formal education, education pursuits, and returning to school. Additionally, seven themes emerged from the interview data: feelings of burden, dependency, helplessness, anger, decreased productivity, decreased accessibility, and fear. Participants reported burdensome feelings in all of the areas of occupations, with ADLs (95%) being the most burdensome activity on others. In addition, a majority of participants (90%) indicated a lack of accessibility related to the categories of the Occupational Therapy Practice Framework (American Occupational Therapy Association, 2014).

CONCLUSION: The COPM is a holistic tool to determine the self-perception of participation and activity limitations experienced after SCI. There was a wide discrepancy between average performance ratings and satisfaction ratings of current performance status. Addressing occupational performance and psychosocial issues should not be overlooked for those who have experienced a SCI, and using a tool such as the COPM can assist in the creation of a meaningful treatment approach that may improve quality of life after SCI.

IMPACT STATEMENT: The impact of the results can direct rehabilitation professionals to identify meaningful goals after SCI related to occupational performance through the use of a client-centered assessment such as the COPM.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006