Form Structure: Canadian Occupational Performance Measure (COPM)
This form structure is an organized set of data definitions for a copyrighted form
Resource:
FITBIR
Title:
Canadian Occupational Performance Measure (COPM)
Short Name:
COPM
Description:
The Canadian Occupational Performance Measure (COPM) is an individualized measure designed for use by occupational therapists to detect self-perceived change in occupational performance problems over time.
References: Law M, Baptiste S, McColl M, Opzoomer A, Polatajko H, Pollock N. The Canadian occupational performance measure: an outcome measure for occupational therapy. Can J Occup Ther. 1990 Apr;57(2):82-7.
Copyright: ? 2017 COPM. All rights reserved. Unauthorized duplication is strictly prohibited, www.thecopm.ca/
This form structure is for modified version of COPM. The team is using fewer occupational problems.
Disease:
Traumatic Brain Injury
General (For all diseases)
Organization:
Allina Health
Required Program Form:
No
Standardization:
Standard Modified
Labels:
Form Type:
Clinical Assessment
Publication Date:
2017-04-04
Version:
1.0
Date Created:
2016-11-16
Owner:
Number of Data Elements:
56
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Vital status | Status of participant/subject as alive or dead | VitStatus | Optional | CDE |
| 5 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 6 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 7 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 8 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 9 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Form Administration (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Language form administration ISO code | Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration | LangCRFAdministratISOCode | Recommended | CDE |
| 2 | Language form administration ISO code other text | The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. | LangCRFAdministratISOCodeOTH | Recommended | CDE |
| 3 | Context type | The context to which the questions were answered | ContextType | Recommended | CDE |
| 4 | Context type other text | The free-text related to ContextType specifying other text | ContextTypeOTH | Recommended | CDE |
| 5 | Data source | Source of the data provided on the case report form | DataSource | Recommended | CDE |
| 6 | Data source other text | The free-text field related to Data source specifying other text. Source of the data provided on the case report form | DataSourceOTH | Recommended | CDE |
COPM Problem 1 Initial Assessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Problem Description Text | Description of patient identified problem of everyday living as part of the Canadian Occupational Performance Measure (COPM) | COPMProblemDescriptionTxt | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Importance Score | Importance of problem to the patient score for the Canadian Occupational Performance Measure (COPM) | COPMImportanceScore | Recommended | UDE |
| 3 | Canadian Occupational Performance Measure (COPM) Readiness Score Mod | Readiness to change score for the Canadian Occupational Performance Measure (COPM) | COPMReadinessScore | Recommended | UDE |
| 4 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 5 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 2 Initial Assessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Problem Description Text | Description of patient identified problem of everyday living as part of the Canadian Occupational Performance Measure (COPM) | COPMProblemDescriptionTxt | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Importance Score | Importance of problem to the patient score for the Canadian Occupational Performance Measure (COPM) | COPMImportanceScore | Recommended | UDE |
| 3 | Canadian Occupational Performance Measure (COPM) Readiness Score Mod | Readiness to change score for the Canadian Occupational Performance Measure (COPM) | COPMReadinessScore | Recommended | UDE |
| 4 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 5 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 3 Initial Assessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Problem Description Text | Description of patient identified problem of everyday living as part of the Canadian Occupational Performance Measure (COPM) | COPMProblemDescriptionTxt | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Importance Score | Importance of problem to the patient score for the Canadian Occupational Performance Measure (COPM) | COPMImportanceScore | Recommended | UDE |
| 3 | Canadian Occupational Performance Measure (COPM) Readiness Score Mod | Readiness to change score for the Canadian Occupational Performance Measure (COPM) | COPMReadinessScore | Recommended | UDE |
| 4 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 5 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 4 Initial Assessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Problem Description Text | Description of patient identified problem of everyday living as part of the Canadian Occupational Performance Measure (COPM) | COPMProblemDescriptionTxt | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Importance Score | Importance of problem to the patient score for the Canadian Occupational Performance Measure (COPM) | COPMImportanceScore | Recommended | UDE |
| 3 | Canadian Occupational Performance Measure (COPM) Readiness Score Mod | Readiness to change score for the Canadian Occupational Performance Measure (COPM) | COPMReadinessScore | Recommended | UDE |
| 4 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 5 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 5 Initial Assessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Problem Description Text | Description of patient identified problem of everyday living as part of the Canadian Occupational Performance Measure (COPM) | COPMProblemDescriptionTxt | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Importance Score | Importance of problem to the patient score for the Canadian Occupational Performance Measure (COPM) | COPMImportanceScore | Recommended | UDE |
| 3 | Canadian Occupational Performance Measure (COPM) Readiness Score Mod | Readiness to change score for the Canadian Occupational Performance Measure (COPM) | COPMReadinessScore | Recommended | UDE |
| 4 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 5 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 1 Reassessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 2 Reassessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 3 Reassessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 4 Reassessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
COPM Problem 5 Reassessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Performance Score | Problem performance Score for the Canadian Occupational Performance Measure (COPM) Performance Score | COPMPerformanceScore | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Satisfaction Score | Problem Satisfaction score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionScore | Recommended | UDE |
Total Scores Initial Assessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Performance Total Score | Performance total score for the Canadian Occupational Performance Measure (COPM) | COPMPerformanceTotalScore | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Satisfaction Total Score | Satisfaction Total Score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionTotalScore | Recommended | UDE |
Total Scores Reassessment (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Performance Total Score | Performance total score for the Canadian Occupational Performance Measure (COPM) | COPMPerformanceTotalScore | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Satisfaction Total Score | Satisfaction Total Score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionTotalScore | Recommended | UDE |
Changes (Appears Up To 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Canadian Occupational Performance Measure (COPM) Performance Total Score | Performance total score for the Canadian Occupational Performance Measure (COPM) | COPMPerformanceTotalScore | Recommended | UDE |
| 2 | Canadian Occupational Performance Measure (COPM) Satisfaction Total Score | Satisfaction Total Score for the Canadian Occupational Performance Measure (COPM) | COPMSatisfactionTotalScore | Recommended | UDE |
Keywords
