Best Top-Down Assessment for Occupational Therapy

What is a good research-based top-down assessment to use? First of all, I think it’s awesome that you are looking at top-down assessments instead of bottom-up ones for occupational therapy practice.

Research continues to provide more evidence for the effectiveness of top-down approaches compared to bottom-up ones. For example, one systematic review titled, ‘Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review’ found top-down approaches to be more effective than bottom-up ones for pediatric interventions.[1]Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian occupational therapy journal, 66(3), 258-273.

You probably learned about the Canadian Occupational Performance Measure, or COPM in OT school.

In fact, the COPM is one of the most widely-used top-down approaches that I continue to see as an effective assessment for occupational therapy. They’re in a variety of studies across all settings from pediatrics to physical disabilities to mental health. The COPM is used in a variety of conditions from autism to stroke to depression.

About the COPM
The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained.

Besides effective outcomes, the COPM has been used in studies that show it’s value in the economics of occupational therapy, leading to value (low-cost and high effectiveness). This is optimistic as it helps to support the AOTA’s vision 2025 to advance occupational therapy practice, education, and research through standard setting and advocacy on behalf of its members, the profession, and the public.[2]Phipps, S., & Richardson, P. (2007). Occupational therapy outcomes for clients with traumatic brain injury and stroke using the Canadian Occupational Performance Measure. The American Journal of … Reference List[3]Nagayama, H., Tomori, K., Ohno, K., Takahashi, K., Nagatani, R., Izumi, R., … & Yamauchi, K. (2017). Cost effectiveness of the occupation-based approach for subacute stroke patients: result … Reference List

Due to its low cost and high outcome, it supports the AOTA’s mission for occupational therapy – “Occupational therapy is evidence based, client-centered, and cost-effective”. The COPM checks all three of these boxes and is client-centered and can provide both the client and therapist with useful insight into the occupational performance of the client.

This is why, in my opinion (but also commonly supported by the literature), the COPM is one of the useful top-down assessments that occupational therapists have at their disposal.

References

References
1 Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian occupational therapy journal, 66(3), 258-273.
2 Phipps, S., & Richardson, P. (2007). Occupational therapy outcomes for clients with traumatic brain injury and stroke using the Canadian Occupational Performance Measure. The American Journal of Occupational Therapy, 61(3), 328-334.
3 Nagayama, H., Tomori, K., Ohno, K., Takahashi, K., Nagatani, R., Izumi, R., … & Yamauchi, K. (2017). Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial. Topics in sTroke rehabiliTaTion, 24(5), 337-344.
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.