Measuring Occupational Performance Outcomes Using Case Study

Excerpt from Case Study :

Do not sit on the bottom of the tub, this causes too much bending of the hip. Use liquid soap to avoid dropping the bar of soap. A long-handles bath sponge will help in bathing below the knees."

The necessary precautions for the post-operative housekeeping process, according to the Center for Patient and Community Education (2009), "sit for rest breaks as needed. Slide objects along the countertop rather than carrying then. Use a utility cart with wheels to transfer items to and from the table. Attach a bag or basket to your walker or wear a fanny pack to carry small items. Use a long-handled reacher to reach objects on the floor. Remove all throw rugs and long electrical cords to avoid tripping in your home. Watch out for slippery/wet areas on the floor." (Center for Patient and Community Education, 2009) Certainly watch out for slippery floors if pets are in the area.

The problem definition involves the occupational therapist conducting the patient interview to verify any problems in occupational performance. The functionality of administering this approach is the client side identification of a need including whether there is an inability to perform a physical activity. If a difficulty is reported, the performance area is identified as a problem. The difficulty is addressed in accordance to the wishes of the patient and to the extent the patient demands. According to Simmons, Crepeau, White (2000), "The essence of client-centered care in occupational therapy is setting goals that are indivudially relevant (Law, 1998; Townsend, 1997). To do so, therapists must collaborate with clients and understand their priorities." (Simmons, Crepeau, White, 2000)

Problem weighting uses the Likert-Scale (1-10) with the client ranking their performance and satisfactory of each activity. Scoring is based on the importance rating from the previous step (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2). According to Law et al., "the five most urgent problems are identified. The client is then asked to rate his ability to perform these specified activities and his satisfaction with that performance using the same 1-10 scale. The ratings of ability and satisfaction are then each multiplied by the importance rating to determine baseline scores. The possible range of scores is from 1 to 100 for satisfaction and 1 to 100 for performance for each of the problems identified (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2).

Reassessment and follow-up involves the patient to re-evaluate his/her performance and satisfaction ratings in accordance to the problems identified in Step 1. Ratings are multiplied by the original importance ratings, added and divided to determine change in client performance over a period of time. Provides a means to measure change over time as a function of the therapeutic process. Follow-up is the means for discharge should the follow-up prove the physical therapy efforts to be successful. Using a COPM form, the therapist determines from the patient using six questions used in Step 1 to ascertain if occupational performance problems remain (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2).

The Occupational Therapy Outcomes for Clients with Traumatic Brain Injury and Stroke Using the Canadian Occupational Performance Measure (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2) utilizes established client identified performance goals to enable occupational therapy treatments and a methodology to measure clinical outcomes (Baum & Law, 1997; Law et al., 2005). (Phipps, Richardson, 2007)

The methods involved only data, which were from clients whom successfully participated in the identifying and self-scoring identified goals using the COPM (Phipps, Richardson, 2007). The Instrumentation (Phipps, Richardson, 2007) is again established form client specific goals to treat these goals by assessing the changes in client perceived performance and satisfaction as determined by occupational performance over time (Pollock, 1993). (Phipps, Richardson, 2007)

According to Phipps & Richardson (2007), "These studies used client-identified goals to guide occupational therapy intervention based on the specific needs of the clients. Therefore, each occupational therapy program was unique and based on the goals identified by the client and the family rather than the therapist. The COPM is a practical assessment that can be incorporated into the initial evaluation and improves efficiencies throughout the treatment program for the therapist by focusing on the client's primary goals." (Phipps, Richardson, 2007)

The COPM was administered to participants at the commencement of the occupational therapy program and at the discharge as well (Phipps, Richardson, 2007). As in the previous research study, the semi-structured interview approach where patients, according to Phipps & Richardson (2007), "were asked to describe a typical day in order to document their daily routines and participation in occupations before the onset of disability and after the onset of disability." (Phipps, Richardson, 2007)

The patients also referred to as participants rank each occupational performance problem identified in self-care, productivity, and leisure. Each patient then identifies and ranks the urgency of specific activities assessed to be areas where the patient wants additional work or requires additional ambulatory practice to work on the outpatient occupational therapy program, based on achieving the performance goals referenced as important by the COPM (Phipps, Richardson, 2007).

Introducing the Patient

HIPAA regulations prevents the identification of the individual receiving treatment as well as the release of medical information pertaining to their treatment and current physical health with the identifying information appended to the medical information. The 73-year-old female suffers from a fractured hip suffered from an accident occurring inside of the home. The female patient is independent of spirit and wishes to remain active. The term active refers to performing her ADL's unassisted as a function of the occupational performance outcomes measurement of her perception in being able to meet and/or exceed her goals of performing occupations such as getting into the bathtub, putting on and tying her shoes, and preparing a meal from start to finish, including the clean up.


The COPM is similar to the task force assertion of focus of care and the additional measures of self-care, productivity, and leisure, are primary to the success of the program. These methods provide the most optimal measures to identify the change in progress from entry to exit and ascertain the performance measurement criteria as operationalized into constructs using the semi-structured interview to obtain variables to be analyzed.

Therefore, the best measures are a function of the symbiotic nature of the literature review cases that point to the five step approach and the scoring criteria as the most appropriate method to create a client specific occupational therapy rehabilitation program. The methodology includes the problem definition, problem weighting, scoring, reassessment, and follow-up.

Applied Intervention

The intervention methodology is ostensibly the course of action as predicated by the literature review and as indicated by the aforementioned best measures. The case of the 73-year-old female geriatric patient that suffers from a fractured him and is adamant on performing to her capable faculties at full health is within the parameters of the program defined by the best measures.

The problem definition is defined as the hip flexor range of motion and ability to pronate and supinate as well as rotate to perform activities subject to ADL's. Additionally, the intervention seeks to establish a means to ensure the strength of the hip bone to prevent further fracture or possible breakage should the aged female fall aggressively and directly on the area of the previous injury. The interview process is to determine the level of therapy the female is in need of from a medical perspective. Her development is predicated on how well she feels her progression is going.

According to the Cleveland Clinic (2011), "For dressing, to prevent lifting your knee higher than your hip on the surgery side, you may be given a long shoehorn and a dressing stick which will help you in putting on and taking off your shoes, socks and pants independently. Remember to always put your operative leg in the pants first. If you wear tie shoes, elastic shoes may be used to eliminate the need for tying. For bathing, do not attempt to get into the bathtub to take a bath or to use an overhead shower. The excessive bending at the hips needed to get into and out of the bathtub should be avoided. Make sure not to use a walk-in type shower or take a sponge bath until 11 days following your surgery. Remember not to bend too far when performing household chores. Chores that you should avoid that may involve excessive bending include cleaning the floor, taking out the rubbish, and making beds." (Cleveland Clinic, 2011)

The success of the female patient to reach her goals of ADL activity is always a function of her determination, the medical intervention is rather uniform in nature and its success is based on how well the therapist is able to motivate the patient to rehabilitate herself in a strong yet timely fashion. The subjective scoring process…

Online Sources Used in Document:


Case-Smith, J. (2003). Outcomes in hand rehabilitation using occupational therapy services. American Journal of Occupational Therapy, 57, 409-506

(2009) Center for Patient and Community Education in association with the Department of Outcomes Management and the Communications & Marketing Department at California Pacific Medical Center.

Cipriano, L.E., Chesworth, B.M., Anderson, C.K., & Zaric, G.S. (2007). Predicting joint replacement waiting times. Health Care Management Science, 10(2), 195. Retrieved from

Cleveland Clinic (2011) Total Hip Replacement.

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