Instrumental Activities of Daily Living (IADLs) for Individuals With Parkinson’s Disease: Results From the Canadian Occupational Performance Measure (COPM) as Compared to a Standardized Rating Scale

Parkinson’s disease (PD) is the second most common neurodegenerative disease in the world, and incidence and prevalence rates continue to rise as the population ages. PD is a complex and progressive neurological disorder that affects many areas of the nervous system and results in profound changes to the lives of those affected. Non-motor changes in cognition, thought, mood, behavior, and speech are common presentations and often impact affected individuals as much or more than the well known motor presentations commonly associated with PD. The Unified Parkinson’s Disease Rating Scale (UPDRS) is the most commonly-used assessment tool to quantify the symptoms and effects of PD as well as measure post-intervention changes. The Canadian Occupational Performance Measure (COPM) is a holistic and client-centered assessment that prioritizes issues that impact an individual’s performance in activities of daily living. The COPM is focused on determining the areas of the client’s life that are most meaningful to them. The categories of performance are divided into self-care, productivity and leisure. The client rates activities by importance, performance, and satisfaction. The COPM has not been frequently utilized in the literature addressing PD. The purpose of this study was to investigate the use of the COPM for capturing distinctive occupational performance problems experienced daily by those with PD.

METHODS: The COPM was administered to 12 individuals with PD. All participants self-identified their top five occupations of concern and provided a rating of performance and satisfaction for each of these areas. Occupational performance areas were compared to the items of the UPDRS that address activities of daily living.

RESULTS: Participants identified activities within each of the three occupational areas of the COPM. Leisure had the highest percentage of reported activities (43.1%), followed-by self-care (36.2%) and productivity (20.7%). Of the 32 identified activities, less than one third (27.7%) were captured by the UPDRS items.

DISCUSSION: The COPM resulted in a more complete understanding of the individual and the occupational areas that are impacted in the daily lives of the participants. Additionally, the semi-structured delivery of the COPM allowed individuals to discuss and elaborate on areas of importance and impact on their self-selected occupational areas. The UPDRS data allowed for a clear comparison between individuals but only on the areas predefined by the assessment.

IMPLICATIONS: The COPM provides a client-centered approach to address self-selected IADLs. The COPM may provide a more sensitive means of exploring changes in occupational performance as it allows the individuals to highlight areas that are meaningful and impactful.

References

Donnelly, C., O’Neill, C., Bauer, M., & Letts, L. (2017). Canadian Occupational Performance Measure (COPM) in primary care: A Profile of Practice. American Journal of Occupational Therapy, 71(6). doi:10.5014/ajot.2017.020008

Tuntland, H., Aaslund, M. K., Langeland, E., Espehaug, B., & Kjeken, I. (2016). Psychometric properties of the Canadian Occupational Performance Measure in home-dwelling older adults. Journal of Multidisciplinary Healthcare, 9, 411-423. doi:10.2147/jmdh.s113727