A PRACTICAL MODEL FOR USING THE CANADIAN OCCUPATIONAL PERFORMANCE MEASURE (COPM) IN THE REHABILITATION OF MILITARY PERSONNEL AND CIVILIANS IN ACUTE AND POST-ACUTE REHABILITATION IN UKRAINE

Abstract

Objective. The aim of the study was to develop a scientifically based model for the effective use of the Canadian Occupational Performance Measure (COPM) in the acute and post-acute rehabilitation phase of military personnel and civilians in Ukraine. Material and methods. To develop a model based on constructivist grounded theory, 20 individual interviews with occupational therapists from six regions of Ukraine were conducted and analyzed. Multilevel qualitative analysis was conducted by two independent researchers using the methodology of immersive interview reading, constant comparative analysis, sequential levels of abstraction to develop codes, concepts and categories during open, axial and selective coding resulting in a graphic model. To verify and supplement the data, we held a focus group with interview participants and conducted additional four interviews with occupational therapy clients/patients. Results. As a result of data analysis, a model of effective use of the COPM in Ukraine with military personnel and civilians during acute and post-acute rehabilitation was developed. The process of using the COPM is symbolically depicted as a mechanism of interaction between an occupational therapist and an occupational therapy client/patient that results in the set goals for an individual rehabilitation program. The model is based on factors of the therapist and the occupational therapy client/patient that have the potential to promote effective therapeutic interaction or be barriers in the process of using the COPM. Factors that concern the occupational therapist include: occupational focus, client-centeredness, individualization of the occupational therapy process, training in the use of the COPM, explaining the purpose of the COPM to the client, effective interviewing and communication skills, appropriate use of examples, trauma-informed care, and client advocacy in involving the family in the rehabilitation process. The client/patient factors necessary for the effective use of the COPM are the following: a positive attitude towards the client- centeredness and occupational focus of occupational therapy, the presence of a specific occupational need, a sufficient level of cognition and speech, understanding of occupational therapy scope of practice, motivation, an unbiased attitude towards the occupational therapist, adequate insight into one’s own condition and occupational freedom. The study participants identified a significant impact of the COPM on the professional development of therapists, in particular the development of an occupational paradigm and improving the quality of service provision due to the increased occupational focus of occupational therapy. Occupational therapists also appreciate the informative nature of the COPM, its ability to demonstrate progress of the client/patient, the expanded professional impact and environment of service provision, providing occupational therapy with a potentially leading role in the multidisciplinary rehabilitation team and professional pride. The discussion highlighted the unique factors of the Ukrainian context during a full-scale war, as well as factors that are supported by data from foreign literature. Conclusions. As a result of qualitative research, a model of effective use of the COPM in the acute and post-acute stage of rehabilitation of the military personnel and civilians in Ukraine was developed and scientifically substantiated. The model will be useful in the process of formal education of occupational therapists and continuous professional development of practicing therapists.