Responsiveness of the Canadian occupational performance measure

This study evaluated the responsiveness of the Canadian Occupational Performance Measure (COPM), an individualized, client-centered outcome measure for the identification and evaluation of self-perceived occupational performance problems. We recruited 152 consecutive patients with various diagnoses, admitted to the outpatient clinic of two occupational therapy departments, to complete a COPM interview and three self-reported health status questionnaires on two occasions: prior to the start of occupational therapy treatment and 3 months later. The three questionnaires were the Sickness Impact Profile (SIP68), the Disability and Impact Profile (DIP), and the Impact on Participation and Autonomy (IPA). We assessed criterion responsiveness by calculating the area under the curve (AUC) for the receiver operating characteristic curve and the optimal cutoff values for the COPM scores. To determine construct responsiveness, we calculated correlations between the change in COPM scores and the change in the SIP68, DIP, and IPA scores. The AUC ranged from 0.79 to 0.85, and the optimal cut-off values for the performance scores and satisfaction scores ranged from 0.9 to 1.9. We found significant positive correlations between the COPM scores and the SIP68, DIP, and IPA scores. The capability of the COPM to detect changes in perceived occupational performance issues is supporte

Prediction of Walking Disability by Disease-Related Factors in Patients with Rheumatoid Arthritis

Objective: To investigate the relationship between diseaserelated factors and walking disability in different phases of rheumatoid arthritis; and to predict future walking disability in rheumatoid arthritis, using disease-related factors assessed 2 years after diagnosis. Methods: A cohort of 848 newly diagnosed patients with rheumatoid arthritis was followed up for a maximum of 8 years. Walking disability and several disease-related and demographic factors were recorded during follow-up. A logistic regression model was used to study associations between walking disability and these factors at different time points. A multilevel logistic regression model for longitudinal data was used to predict walking disability during follow-up from potential predictors at year 2. Results: Global pain and disease activity were consistently related to walking disability at almost every time point. Significant predictors of future walking disability were: walking disability, knee pain, global pain, the passage of time during follow-up, and age. Conclusion: Global pain and disease activity are related to walking disability during the first 8 years of RA. Walking disability, knee pain, and global pain at 2 years follow-up predict walking disability later in the disease. In addition, the risk for walking disability increases during the disease process and with higher age at diagnosis. © 2010 Foundation of Rehabilitation Information

Avoidance of activity and disability in patients with osteoarthritis of the knee: the mediating role of muscle strength.

OBJECTIVE: Avoidance of activity is hypothesized to lead to muscle weakness and consequently, to physical disability. This study was undertaken to validate the avoidance model by providing evidence for the mediating role of muscle weakness in the relationship between avoidance of activity and physical disability in patients with osteoarthritis (OA) of the knee. METHODS: Data on avoidance of activity, observed physical disability, and muscle strength of the knee in 107 patients with knee OA were analyzed. A series of regression analyses was performed to establish the mediating role of muscle weakness. First, the effect of avoidance of activity on the level of disability was assessed. Next, the relationship between avoidance of activity and muscle strength was established. Finally, the mediating role of muscle strength could be established if the effect of avoidance of activity on disability decreased when muscle strength was taken into account. RESULTS: Initially, avoidance of activity accounted for 21.5% of variance in disability. Avoidance of activity also accounted for 3.9% of variance in muscle strength. After muscle strength was taken into account, the variance in disability accounted for by avoidance of activity was reduced from 21.5% to 15.7%. Thus, the criteria for establishing the mediating role of muscle strength were met. CONCLUSION: The results of this study provide evidence for the mediating role of muscle weakness in the relationship between avoidance of activity and disability in patients with knee OA. (aut.ref.

Coping, pain and disability in osteoarthritis: a longitudinal study.

This study aimed at establishing the role of coping styles as prospective determinants of pain and disability in patients with osteoarthritis (OA) of the knee or hip. Data were used on 87 patients with OS of the hip and 129 patients with OA of the knee. Coping styles were assessed with a questionnaire, pain was assessed with a VAS, and disability was assessed using an observational method. Regression analysis was used to analyze relationships between the use of active and passive coping styles and the level of pain and disability 36 weeks later. In patients with OA of the knee, the passive coping style of avoidance of activity (resting) was found to predict a higher level of disability 36 weeks later after controlling for the level of baseline disability (p<.05). In the same manner, the active coping style of transforming pain was found to predict higher levels of pain 36 weeks later, also in patients with OA of the knee (p<.05). In patients with OA of the hip, no significant relationships between coping styles and pain and disability were found. Thus the role of avoidance of activity as a prospective determinant of disability, previously reported in patients with other chronic conditions, could also be established for OA of the knee, but not for OA of the hip. Transforming pain was found to determine pain in OA of the knee. (aut.ref.