Emmah Doig, Jennifer Fleming, Pim Kuipers, Petrea L. Cornwell; Clinical Utility of the Combined Use of the Canadian Occupational Performance Measure and Goal Attainment Scaling. Am J Occup Ther 2010;64(6):904-914. doi: 10.5014/ajot.2010.08156.
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OBJECTIVE. We investigated the clinical utility of combined use of Goal Attainment Scaling (GAS) and the Canadian Occupational Performance Measure (COPM) to plan goals and measure progress in a community rehabilitation setting.
METHOD. Fourteen participants with traumatic brain injury completed an outpatient, goal-directed 12-wk occupational therapy program; 53 goals were generated. Performance and satisfaction self-ratings and GAS ratings were collected before and after intervention. Self-awareness, motivation to change, and perceived client-centeredness measures were taken before intervention.
RESULTS. Sensitivity to change was demonstrated by significant improvements after intervention for total performance self-ratings on the COPM and GAS T scores.
CONCLUSION. Combined use of these tools, although time consuming, resulted in goals that were perceived almost unanimously as client centered, despite most participants' having moderate or severe impairment in self-awareness. The process also enabled subjective and objective demonstration of goal achievement, thereby supporting the clinical utility and treatment validity of the combined use of these tools.
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Identification of objectives and problem areas. The COPM (Law et al., 1990) was administered by a trained user within the week after discharge from inpatient rehabilitation. Interviews involved the participants and their significant others. The therapist prompted participants using task analysis (Pedretti & Wade, 1996) and motivational interviewing techniques (Miranti & Heinemann, 2004) to break broader, long-term goals into specific problem areas to be targeted in a 12-wk program.
Identification of specific goal behaviors for each problem area was achieved by assessment and discussion. For example, for a handwriting problem, the therapist would clarify whether the goal was to improve legibility or writing speed after observing writing.
Determination of methods for goal measurement. Procedures for measuring performance on each goal were documented using objective and measurable terms to ensure a consistent approach. For example, the goal of taking a taxi, outlined in Table 1, included a written list of 11 possible steps, and the percentage of assistance required for taking a taxi was calculated by dividing the number of steps requiring assistance by the total number of steps.
Selection of expected level of performance was determined by observational assessment and input from the participants, their significant others, and the hospital occupational therapist.
Identification of the levels of performance. Current level of function (set at either –1 or –2 depending on the level of function) for each goal was determined by observational assessment and in consultation with the participant’s hospital occupational therapist. Most and least favorable levels were scaled around the expected level of performance.
Review of goals was completed to ensure equal gaps between levels, to avoid instances of performance being rated at more than one level, and to avoid performance falling between levels.
Weighting each goal to enable calculation of GAS T score. Participant’s COPM importance ratings were used to rank goals in order of priority. When a participant identified four goals, the most important goal was weighted 4, and the least important goal weighted 1. When goals were equally important, all were given the same weight.
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