Case Study on "Measuring Occupational Performance Outcomes Using the Canadian"

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Measuring Occupational Performance Outcomes Using the Canadian Occupational Performance Measure in Older Adults w/Hip Fractures

The paper will provide analysis and recommendation for measurement of occupational performance outcomes via the Canadian occupational performance measures within the geriatric demographic that suffer from coxa (hip) fractures. Specifically, the hip fracture case of a 73-year-old female as a result of an accident occurring at the home. The performance measurement specific to the outcome of this case is endemic to the rate of therapeutic success associated with her ability to perform her activities of daily living or (ADL's). The ADL's include the following activities, tub (entry/exit), fitting & removal of footwear, tying of footwear, sewing and gardening, and cooking/serving a hot and cold meal.

Occupational performance is a function of understanding the specific physical ability and the mental stamina of the patient and addressing the need to stimulate each for a speedy recuperation leading to a full convalescence. The current research on the physical therapy process for hip fracture patients provides comprehensive and detailed information describing the Canadian occupational performance measure, which includes areas for Self-Care, Productivity, and Leisure (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2).

A conceptual comparison is further established with the occupational performance measurement of patients suffering from traumatic brain injury including stroke (Phipps, Richardson, 2007). The rate of performance improvement is then established as rate of improvement based on a function in the marginal time to reach full convalescence between each the brain trauma and the hip fracture trauma.

The purpose of this case report is to determine the optimal path to occupational performance outcomes measurement success for the described patient and the patient type. The physical therapy process for geriatric patients is vastly different than the process undertaken with younger patient populations. Geriatric patients have different nutritional needs and are less able to establish muscle mass and to absorb the necessary levels of calcium to strengthen bone structure. The plan will address these issues and recommend the most appropriate physical therapy program to restore optimal functional ability equivalent to an otherwise healthy 73-year-old female Caucasian patient.

Literature Review

According to Cree (1998), "The term hip fracture is a generic term referring to a number of different types of fracture of the femur. The primary classification of hip fractures divides those within the capsule of the hip joint (intracapsular) from those outside it (extracapsular)" (Parker and Pryor). While extracapsular fractures tend to heal well, prognosis was poor for intrcapsular fractures." (Cree, 1998)

Most importantly, research from patients monitored in Ontario indicates that a hip therapy rehabilitation time of > 6 months can have detrimental effects to the performance outcome. According to Cipriano, Chesworth, Anderson, Zaric (2007), "Currently, the median waiting time for total hip and knee replacement in Ontario is greater than 6 months. Waiting longer than 6 months is not recommended and may result in lower post-operative benefits." (Cipriano, Chesworth, Anderson, Zaric, 2007)

Additionally, pain management is critical during the post-operative rehabilitation process, when the patient is regaining strength in the hip bone, joint, and muscle region. Management of pain is necessary for the patient to perform the activities that include ambulating in/out of the tub, and operating a vacuum during housekeeping activities. According to Hallstrom (2001), "patients with hip fractures are in pain. From the patients' point-of-view, pain is something that is related to illness and surgery, and they rarely complain about inadequate pain medication (Patterson et al., 1992)." (Hallstrom, 2001)

The Canadian Association of Occupational Therapists share the viewpoint and opinion that the patient is primary to the success of the occupational therapy program. The occupational performance model (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2) is established on the set of beliefs concerning the individual as the focal and core component to the therapeutic process. The therapeutic process, according to Law et al., "an individual's occupational performance as a balance between performance in three areas: self-care, productivity and leisure (DNHW & CAOT, 1983). ((Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2)

According to Law et al., "This task force used the occupational performance model as a basis to investigate current outcome measures of self-care, productivity and leisure (DNHW & CAOT. 1987). The task force reported that no measure was available to adequately evaluate occupational performance as described by the Guidelines for the Client-centred Practice of Occupational Therapy (DNHW & CAOT. 1987). (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2)

According to Law et al., "the following beliefs important to the practice of occupational therapy: that the individual client is an essential part of occupational therapy practice: that the client should be treated in a holistic manner: that activity analysis and adaptation may be used to effect change in the individual client's performance: that an important consideration in the therapy process is the client's developmental stage: and that role expectations must be taken into consideration in assessing a client's performance (DNHW & CAOT, 1983). (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2)

The focus on occupational performance model by the National Health and Welfare and the Canadian Association of Occupational Therapists Task Force is a strategic belief in the individual's ability to lead a balanced life based on self-care, productivity and leisure (DNHW & CAOT. 1983). Additionally, the task force points to more holistic aspects of the patient's physical, emotional, and spiritual condition as a means to an ends of expeditious physical therapy occupational performance measurement success.

Patients undergoing rehabilitation using the COPM with the assistance from their occupational therapist that facilitate the ranking process for the patient. The sessions are contingent to establishing the range of motion needed to conduct the activities, which develop the neural network and motor skills to perform the ADL's. According to Case-Smith (2003), "examples of goals selected by the participants are driving, typing, writing, cooking, child care, doing laundry, using tools, gardening activities that involved lifting heavy objects, specific work tasks (hair dressing, teaching), and a wide variety of leisure activities." (Case-Smith, 2003)

According to Law et al., "The individual's mental, physical, socio-cultural and spiritual characteristics, as well as environmental factors, have a great influence on achievement of this balance. Occupational therapy based on this model involves the assessment of the abilities and disabilities of the individual client within his/her environment and role expectations. Together the client and the therapist determine therapeutic goals, implement treatment and assess the outcome of treatment." (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2)

The Administration and Scoring of the Canadian Occupational Performance Measure (COPM) (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2), is the methodology, which models the occupational performance outcomes and successes for self-care, productivity and leisure, including process, and assessment of performance of range of motion and flexibility. The advantage of this method is such that the therapy is individualized based on physiological response although not diagnosis specific ((Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2), yet specific to the patient's goals and the outcomes of the therapy in relation to the successes of meeting each goal, collectively.

Self-Care constitutes such areas as Personal Care, which includes dressing, bathing, and feeding; Functional Mobility, which includes stairs, bed, and cars; Community Management, which includes transportation, finances, and services (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2). The COPM uses a five step process inclusive of a semi-structured interview performed between the therapist and patient, the steps are 1.) Problem definition, 2.) Problem weighting, 3.) Scoring, 4.) Re-assessment, 5.) Follow-up (Law, Baptiste, Opzoomer, Polatajko, Pollock, Vol. 57 -- No. 2).

According to Kuhler, de Beer, Houdijk, Frings-dresen, (2009), "It is quite normal to assume that, if joint function improves, people can resume their normal lives, including their work. However, this may not always be the case. It could be that, despite nearly normal range of motion, working activities remain difficult to perform for a certain period of time." (Kuijer, de Beer, Joudijk, Frings-dresen, 2009) Therefore, it is important to continuously think through the motions of housekeeping activities that require hip/joint movements, including vacuuming and the bending associated with bathtub cleaning/maintenance.

The rehabilitation process allows for the patient to transition from requiring assistance either from a human or non-human provider to performing these same occupations, unassisted. According to the Center for Patient and Community Education (2009), the precautions necessary to avoid further hip damage when putting on and tying shoes require the following: "Do not bend your fractured hip beyond a 90 degree angle. Do not turn your operated leg inward in a pigeon-towed position. Do not cross your operated leg. Avoid bending forward when putting on socks and shoes. Keep your back touching the back of the chair. Use elastic shoelaces or slip-on shoes." (Center for Patient and Community Education (2009)

The process for ambulation into and out of the bathtub and housekeeping require the following post-operative precautions and ambulatory suggestions. According to the Center for Patient and Community Education (2009), "place a non-skid rubber bath… READ MORE

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