The evaluation of an adapted Canadian Occupational Performance Measure (COPM) to quantify functional ability in disabled adults in a developing community

Abstract

The restructuring of health services in South Africa was aimed at shifting the emphasis of health provision from the urban hospitals to a primary health care approach where selected health services, including rehabilitation services, would be available in the community where their clients live. A result of this is that the cultural background of the Health Care Worker frequently differs from that of their clients The concept of occupation is an integral part of the profession of occupational therapy. The challenge facing the Health Care Worker is to render their services in an appropriate manner to enable them to address occupation in a manner that is relevant to the individual and his community, which makes up that society. Occupational performance is viewed as a person's engagement and implementation of occupations in the performance areas of self-care, productivity and leisure in accordance with his role as an individual and his role within his own unique community. Any assessment model of occupational performance needs to express the interaction between occupation and the factors that influence it. Following a review of the literature, the researcher selected the Canadian Occupational Performance Measure to determine the occupational performance priorities of adults with physical disabilities in a developing community. The Canadian Occupational Performance Measure is based on the client-centred approach that allows the client to determine occupational performance priorities from his own perspective and to rate his performance and satisfaction with these priorities. The research was conducted in Kwaguqua an area within the Witbank Health District in the Highveld region of Mpumalanga, South Africa. Adults with physical disabilities who were registered at the two workshops for people with disabilities in Kwaguqua, and the health care professions who render services in this area, participated in the research. Following two pilot studies, semi-structured interviews were conducted with twenty-five adults with physical disabilities, to determine their occupational performance priorities. From these interviews a ranked list were subsequently obtained. Seven health care workers predicted the occupational performance priorities for adults with physical disabilities and these were ranked and reranked, using Delphi Technique, until consensus were reached. The ranked lists obtained from both groups of participants were categorized according to the International Classification of Functioning, Disability and Health and evaluated. The results indicated that although both groups of participants proposed similar priorities, some variations in the ranking existed. Valuable insight into the occupational performance priorities of the people with physical disabilities in Kwaguqua was obtained.