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Client participation in the rehabilitation process
Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis evaluates the rehabilitation process with respect to client participation. The Swedish version of a client-centred structure, the Canadian Occupational Performance Measure (COPM), is evaluated from the perspectives of the clients, the occupational therapists and the members of a rehabilitation team. Data have been collected through diaries, the COPM, assessments of ability to perform activities of daily living, mobility, self-assessments of pain and health, interviews with clients, interviews with staff, and focus groups interviews.

The results show that a structured method is needed in order to improve clients’ active participation in goal formulation.

The Swedish version of the COPM has high responsiveness to change over time. The use of the COPM improved client participation in the goal-formulation process, according to the results from a study with experiment and control groups. The clients perceived that treatment goals were identified, they were able to recall the goals and felt that they were active participants. They also perceived they had a higher ability to manage after the rehabilitation period was completed compared to clients in the control group.

The clinical utility of the Swedish version of the COPM was confirmed in focus-group interviews with occupational therapists. The occupational therapists perceived the COPM as helpful in the goal-setting process and planning of treatment interventions. Even though problems are identified, they are directly related to, and formulated as, goals. Clients receive feedback on improvement over time. The COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role. Therapists need knowledge about the theoretical foundation of the instrument and have to develop a personal interview technique.

When the COPM is used in a team setting, it provides the team with broader information on what is purposeful occupation to the client. The focus is on occupational performance rather than function. According to team members the use of the COPM as a team tool increased client participation, was a good outcome measure, resulted in distinct goals, and focused on goals that were meaningful to the client.

Implementation of a client-centred approach is facilitated when a structured method is used, but this is not enough. Involvement and motivation from all team members are required, as well as support during the introduction and implementation period. Support from management, knowledge about the underlying theory, time for discussions and reflections as well as opportunities to develop a personal interview technique are pointed out as important factors for a successful implementation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. , 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 722
Keyword [en]
Occupational therapy, Client-centred practice, https://www.diva-portal.org/liu/webform/form.jsp#paper0COPM, Participation, Rehabilitation, Goal formulation, Outcome
National Category
Occupational Therapy
Identifiers
URN: urn:nbn:se:liu:diva-8594ISBN: 91-7373-167-6 (print)OAI: oai:DiVA.org:liu-8594DiVA: diva2:23342
Public defence
2002-04-05, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Note
On the day of the defence date the status on article V was Submitted.Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2012-01-25Bibliographically approved
List of papers
1. The rehabilitation process for the geriatric stroke patient: an exploratory study of goal setting and intervention
Open this publication in new window or tab >>The rehabilitation process for the geriatric stroke patient: an exploratory study of goal setting and intervention
1999 (English)In: Disability and Rehabilitation, ISSN 0963-8288, Vol. 21, no 2, 80-87 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim was to describe and analyse the rehabilitation process of the geriatric stroke patient from two perspectives; the treatment goals expressed by the staff and the patient and the treatment interventions chosen by the physiotherapist and occupational therapist. A secondary aim was to test whether the process, treatment goals and interventions could be classified according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH).

Method: Qualitative interviews were performed with patients and personnel; diaries were used to register treatment interventions. The 30 interviews were categorized according to the goals expressed by physiotherapists, occupational therapists, physicians and patients. The diaries (n= 22) were analysed to describe how treatment interventions were connected in time, at what levels (impairment, disability and handicap) the interventions were directed, and finally, whether certain decisions were made in order to change the rehabilitation process.

Results: The patients talked more about attaining their prestroke status than about their goals. The therapists set goals according to functional level, whereas the doctors expressed themselves in general terms. Three patterns of rehabilitation processes were found: one with clearly identified decision points, one with a set programme which was not changed through the process, and one where the goal was changed according to changes in medical status.

Conclusions: The patient does not participate in the goalsetting process, and the vaguely expressed goals are not measurable. The rehabilitation process and reason for discharge demonstrate different patterns. Treatment interventions, if related to the ICIDH, give a clear picture of the process, though certain interventions do not fit in the classification.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14363 (URN)10.1080/096382899298016 (DOI)
Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2009-08-21
2. Responsiveness of the Swedish version of the Canadian Occupational Performance Measure
Open this publication in new window or tab >>Responsiveness of the Swedish version of the Canadian Occupational Performance Measure
1999 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, Vol. 6, no 2, 84-89 p.Article in journal (Refereed) Published
Abstract [en]

In a client-centred approach, clients and therapists work together to define the occupational performance problem, the focus of and need for intervention and the preferred outcomes. Application of specific theories or techniques to involve clients in goal-setting may influence the therapist to use a client participation approach. The Canadian Occupational Performance Measure (COPM) presents a structure for formulating the treatment goals identified by the client in co-operation with the therapist. The aim of this study was to test the responsiveness of the Swedish version of the COPM. After translation into Swedish, the COPM was introduced to 21 occupational therapists who performed data collection. A sample of 108 clients within geriatric, neurologic and orthopaedic rehabilitation identified 418 problems at initial scoring and reassessment. Inclusion criteria for patients were the need for rehabilitation interventions and the ability to communicate well enough in an interview. The results indicate that the Swedish version of the COPM is responsive to change, with 73% of the problems identified having a change in score of 2 points or more.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14364 (URN)10.1080/110381299443771 (DOI)
Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2009-08-21
3. Improved client participation in the rehabilitation process using a client-centred goal formulation structure
Open this publication in new window or tab >>Improved client participation in the rehabilitation process using a client-centred goal formulation structure
2002 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, Vol. 34, no 1, 5-11 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to evaluate whether the use of a client-centred instrument, the Canadian Occupational Performance Measure (COPM), affects the patients' perception of active participation in the rehabilitation process. The study included 155 patients in the experiment group and 55 in the control group, within geriatric, stroke, and home rehabilitation. The COPM was used in the experiment group. A structured interview was performed within 2-4 weeks after discharge with 88 patients in the experiment group and 30 patients in the control group. The results show significant differences between the groups. More patients in the experiment group perceived that treatment goals were identified, were able to recall the goals, felt that they were active participants in the goal formulation process, and perceived themselves better able to manage after completed rehabilitation compared with patients in the control group. The study indicates that the COPM improves client participation in the rehabilitation process.

Keyword
Copm, Client-centred, Participation, Goal, Evaluation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14365 (URN)10.1080/165019702317242640 (DOI)
Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2009-08-21
4. Clinical utility of the Canadian Occupational Performance Measure: Swedish version
Open this publication in new window or tab >>Clinical utility of the Canadian Occupational Performance Measure: Swedish version
2002 (English)In: Canadian Journal of Occupational Therapy / Revue Canadienne d`Ergotèrapie, ISSN 0008-4174, Vol. 69, no 1, 40-48 p.Article in journal (Refereed) Published
Abstract [en]

The Canadian Occupational Performance Measure (COPM) is an individualised outcome measure intended to detect change in a client's perception of occupational performance over time. The aim of this study was to test the clinical utility of the Swedish version of the COPM. Data was collected from 27 occupational therapists in six focus groups. Emerging themes included goal-setting, preparations, limitations, interactions with clients, and impact on practice. The results indicated that the COPM is helpful in the goal-setting process and in planning treatment interventions. Therapists need knowledge about the theoretical foundation of the instrument and a personal interview technique. Problems were found using the instrument with clients who had poor insight or in acute settings. The COPM facilitated feedback on improvement over time. In summary, the COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14366 (URN)
Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2017-12-13
5. The Canadian Occupational Performance Measure as an outcome measure and team tool in a day treatment program
Open this publication in new window or tab >>The Canadian Occupational Performance Measure as an outcome measure and team tool in a day treatment program
Show others...
2003 (English)In: Disability and rehabilitation, ISSN 0963-8288, Vol. 25, no 10, 497-506 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate the usefulness of the Canadian Occupational Performance Measure (COPM) in a day treatment programme for clients with rheumatoid arthritis.

Method: The study was conducted in two parts. In the first part rehabilitation without changes in the programme was performed (n = 16). After that the COPM was introduced to all team members. In part two the COPM was used (n = 40). Clients' experiences of participation in the process were studied via a structured interview 2 - 4 weeks after discharge in both parts. Qualitative interviews were conducted with team members before part one and after completion of part two.

Results: Staff expressed that the COPM improved client participation in the rehabilitation process. Goals were formulated distinctly, and focused on activity and performance rather than function. Team conferences were focused on the client's needs. Outcome was considered clear and evident to the client. The changes in client routines demands thorough introduction, support and involvement, and takes time. Involvement and motivation for changing practice were difficult to obtain, this could be a result of a large staff turnover during the data collection period.

Conclusions: The COPM should be seen as an aid to ensuring client participation in the goal formulation process, and facilitating treatment planning and evaluation of outcome.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14367 (URN)10.1080/0963828031000090560 (DOI)
Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2009-08-21

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Wressle, Ewa

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