COPM

The Canadian Occupational Performance Measure (COPM) “is a client-centered outcome measure for individuals to identify and prioritize everyday issues restricting their participation in everyday living. This measure focuses on occupational performance in all areas of life, including self-care, leisure, and productivity. This outcome measure is used with persons of all ages.”(1) It is one of the most widely used tools in occupational therapy, specifically in rehabilitation settings.

The Health Canada and the Canadian Occupational Therapists (CAOT), developed this guideline for occupational therapy practice in Canada in the 1980s. In 1988, the National Health Research and Development Program along with the Canadian Occupational Therapy foundation, together funded the outcome measure of occupational performance and from then on, the Canadian Occupational Performance Measure (COPM) was established.(2)

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What is the purpose of the COPM?

The COPM is a framework and an assessment tool for occupational therapists to understand client’s needs and assists with creating intervention plans that are client-centered. It is an evaluation tool that requires collaboration between the therapist and client. 

“The COPM is a semi-structured interview that enables an open dialogue between client and therapist on issues of importance to the client. Administering the COPM draws on the therapist’s expertise and experience in occupation-based, client-centered practice.”(3)

An interview is conducted, and clients are asked to prioritize self-care/ADLs, productivity, and/or leisure activities that are difficult for them to perform. The client rates their level of satisfaction and performance level with each activity. 

The hallmark of the COPM is that it is a collaborative assessment tool with occupational therapists and clients. The role of Occupational therapists is ensuring that the COPM is client-centered, collaborative, and focused on the relevant needs and priorities of the client. 

Furthermore, the therapist respects the client’s needs and priorities, actively listens, offers explanations, and asks relevant open-ended questions to collaborate with goals and understand the client's needs on a deeper level.

COPM steps:

1. Therapist introduction and explanation of COPM
2. Client identifies specific activities and prioritize activities that are perceived as challenging for them
3. Rates the current level of performance and satisfaction on a scale of 1-10 for each activity
4. Therapist and client collaborate to set SMART client-centered goals based on identified activities
5. Therapist Documentation and intervention planning
6. Therapist Re-assessment and follow up

COPM scoring, goals, documentation and reassessment

The COPM has two main scoring categories which include performance and satisfaction, both are out of 10 points. A lower score indicates low performance and satisfaction, and a higher score indicates higher performance and satisfaction levels.

“Performance and satisfaction scores can be generated for up to 5 individual occupational performance problems. Average performance and satisfaction scores can be calculated by summing the individual problem scores and dividing by the number of problems.”(6)

Based on what the client deems as important to them, intervention plans can be established to meet goals. Intervention plans can incorporate therapeutic activities that are meaningful and relevant to the client, patient education, necessary tools and equipment, evaluating environmental factors, and breaking down goals into smaller steps. 

Regular re-assessment via follow-up interviews and detailed documentation is key for client success and making progress towards goals and in therapy. Documenting changes within the client, their performance, or satisfaction is key to gain a comprehensive picture of the client as well as to track performance, progress, to meet goals, modify goals, or to identify any barriers towards meeting their goals. COPM goals are based on self-care/ADLs, leisure, and/or productivity. Goals should be SMART and client-centered. Some examples of goals can be found below.

Self-care goal:

• Client will take on/off pull over tops with minimal assistance in 5 out of 7 days of the week.

Productivity goal:

• Client will improve time-management skills by completing IADL tasks of cooking more efficiently within 30 minutes.

Leisure Goal:

• Client will engage in social gatherings 2 out of 5 days of the week to increase engagement in the community.

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Addressing cultural sensitivity and diversity

The COPM was designed to be sensitive to North American and European cultures and health systems. Cultural differences such as accepting help, gender roles, social expectations, and professional roles need to be considered for different cultures when setting goals and collaborating with non-western health systems and cultures. Another factor to consider is that some cultures may not attribute value based on numbers and may use other systems or symbols.(4)

COPM pros and cons

Pros:

• Client-centered
• Collaborative
• Flexible and adaptive to meet client needs
• Allows client to be an active participant in therapeutic process

Cons:

• Language barriers
• Can have therapist bias
• Time-consuming
• Scores are dependent on client subjectivity