Implementing the Cognitive Orientation to daily Occupational Performance (CO-OP) approach in a group format with children living with motor coordination difficulties

Effectiveness of CO-OP Approach for Children With Neurodevelopmental Disorders: A Systematic Review

Objective

To examine the scientific evidence regarding the effectiveness of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach for children with neurodevelopmental disorders (NDDs).

Data Sources

Selected articles published between January 2001 and September 2020 and listed in CINAHL, MEDLINE, and PsycINFO on the EBSCO platform, or found searching with Scopus, Google Scholar, OTseekern Central Register of Controlled Trials in the Cochrane Library, WHO International Clinical Trials Registry Platform, Turning Research into Practice, and ProQuest Dissertations and Theses. An update was performed in March 2022.

Study Selection

Eligibility criteria included studies that assessed the effectiveness of the CO-OP approach on children (0-18 years) with NDDs. Unpublished results were excluded, as well as research published in a language other than English or French.

Data Selection

The first 2 authors independently reviewed the titles, abstracts, and full texts. Discrepancies were discussed and resolved by consensus. Included studies were quality appraised using the PEDro-P scale or using the risk of bias scale in N-of-1 trials (RoBiNT) according to experimental design.

Data Synthesis

Results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eighteen studies were initially included, with 2 additional studies added in the update. Three reached evidence level III (15%), 10 reached level IV (70%), and 5 reached level V (15%). All data collected on the activity-participation domain showed a significant improvement. Group therapy sessions show promising results for the improvement of activities or participation, as well as psychosocial dimensions such as self-esteem.

Conclusions

The scientific evidence analyzed shows that the CO-OP approach has a positive effect on children with NDDs, particularly in regard to their activities and participation. Future experimental studies should be designed in ways that allow determining effect sizes. Group therapy sessions appear relevant but require further research.

Effect of the cognitive orientation to daily occupational performance (CO-OP) approach for children with cerebral palsy: A randomized controlled trial

PURPOSE

The study aimed to examine the effects of "Cognitive Orientation to daily Occupational Performance" (CO-OP) approach in terms of performance and satisfaction as well as functional status in children with cerebral palsy (CP) receiving neurodevelopmental treatment (NDT) and determine the parents' satisfaction level.

METHODS

Thirty-two children with CP were randomized to experimental (n = 16) or control (n = 16) groups, with n = 2 dropouts. Therapy was applied twice a week for five weeks. The experimental group received a CO-OP plus NDT, while the control group received only NDT.

RESULTS

No baseline differences existed, except for years of schooling, which was higher in the experimental group. After treatment, there were statistically significant and clinically meaningful improvements in occupational performance and function, favouring children who received 5-weeks of CO-OP plus NDT over NDT alone (p < 0.05).

CONCLUSION

CO-OP is expected to be beneficial if incorporated into CP rehabilitation.

Benefits of an Intensive Individual CO-OP Intervention in a Group Setting for Children with DCD

Purpose

The present study focused on the impact of an adapted Cognitive Orientation to daily Occupational Performance (CO-OP) five-day intervention program for children with developmental coordination disorder (DCD). Important adaptations were the new combination of individual CO-OP sessions and group activities, the short and intensive program that was followed by a training and coaching trajectory, and the use of video logs.

Materials and Methods

Eighteen children with DCD (aged 8-16 years) participated in the five-day intervention during which they worked on three intervention goals. After the intervention, during an eight-week training and coaching trajectory for parents and children, children worked on a transfer goal. Assessment took place at four moments in time: two pretest measures, a posttest measure, and a 3-month follow-up measure. Primary outcome measures focused on changes in performance and satisfaction of self-chosen intervention and transfer goals. The secondary outcome measure explored changes in children's attitude, motivation, and confidence in relation to motor skill activities, social skills, and level of participation.

Results

Significant improvements were found with regard to the performance and satisfaction of intervention goals. For the transfer goal, only parents reported significant improvements. Finally, parents indicated potential improvements with regard to the attitude, motivation, and confidence of their children, but not for their social skills or level of participation.

Conclusion

The findings are promising with regard to the efficacy of this adapted CO-OP intervention for improving intervention goals, but less effective for transfer of learned skills to other goals after the intervention. Future research should focus on how postintervention parental coaching can be improved in order to increase generalization and transfer.

Cognitive Orientation to Daily Occupational Performance (CO-OP) in Children with Cerebral Palsy: A Systematic Review with Meta-analysis

Background: Cognitive orientation to daily occupational performance (CO-OP) is a client-centered treatment approach that was developed in the 1990s by occupational therapists. Purpose: Exploring current evidence about the effectiveness of CO-OP on children with cerebral palsy (CP). Method: Major electronic databases were searched. A narrative synthesis of current literature and meta-analyses on randomized control trials (RCTs) were conducted on changes in occupational performance. Findings: Seven studies with 103 participants were included. Four studies were RCTs with moderate levels of evidence, and three studies had single-subject designs. Although beneficial effects of CO-OP on goal achievement and transferring learned skills were reported, meta-analyses showed that CO-OP had no significant effect on the performance (WMD = 1.52, 95% CI = -1.58 to 4.63, P = .33) and satisfaction domains (WMD = 1.71, 95% CI = -1.14 to 4.57, P = .24) of Canadian Occupational Performance Measure scores compared to alternative interventions. Implications: CO-OP improves occupational performance but not more than alternative interventions. Results are inconclusive due to small sample sizes and heterogeneity of alternative interventions and participants. Therefore, research with a larger number of participants with sound RCT methods is needed.

Consumer engagement in occupational therapy health-related research: A scoping review of the Australian Occupational Therapy Journal and a call to action

INTRODUCTION

Consumer engagement in research is becoming an ethical, political, and moral imperative. The aim of this scoping review was to provide a snapshot of the current status of the emerging area of consumer engagement in occupational therapy health-related research, as published in the Australian Occupational Therapy Journal.

METHODS

A scoping review was conducted of all health-related original research published in the Australian Occupational Therapy Journal for 5½ years, plus Early View, as at June 2019. Eligible papers were examined for consumer engagement content which included any active choice or control by consumers, beyond being a research participant. A recognised six stage methodology was used with quantitative and qualitative data analysed. Two consumers collaborated in interpreting the data including finalising themes, leading theme naming, developing key discussion points, and producing recommendations.

RESULTS

Of the 123 eligible papers, 48 (39.02%) included consumer engagement. However, only two incorporated consumer engagement across all research phases-preparation, execution and translation. A total of 103 consumer engagement activities were charted and categorised across all papers. There were limited instances of consumer collaboration (14/103, 13.59%) or consumer-led research processes (15/103, 14.56%) reported. Four themes emerged: Parity in research partnerships; It's important to know the Who, What, When, How and So What of consumer involvement; Consumer engagement must be a two-way process-not a dead end street; and Meeting the challenge-being diverse and inclusive.

CONCLUSION

Comprehensive consumer-researcher partnerships may not be common-place in health-related occupational therapy research in the Australian Occupational Therapy Journal. This paper is a call to action. Occupational therapists must embrace consumer research partnerships as a demonstration of the key philosophies of enabling and empowering consumers and communities. Collaboration with two consumers in finalising data analysis, results interpretation and reporting added a diverse and valuable perspective.

Measuring treatment outcome in children with developmental coordination disorder; responsiveness of six outcome measures

Purpose: Although measuring outcome of rehabilitation in children with Developmental Coordination Disorder is considered important no consensus exists on which instruments to use. An important attribute of a measurement instrument would be that it is sensitive to clinical changes. The aim of this prospective, observational study was therefore to investigate the responsiveness of six potentially suitable instruments.Methods: Forty-one children (34 boys, median age 7.8 years, Inter Quartile Range: 7.2-9.2) receiving multidisciplinary rehabilitation treatment for Developmental Coordination Disorder were included (mean treatment time: 32.8 h, Standard Deviation 7.3). The following instruments were applied before and after rehabilitation: Movement-Asessment-Battery-Children-2 (MABC-2), Canadian Occupational Performance Measure (COPM), Systematic detection writing problems (SOS-2-NL), DCD-daily, Behaviour Rating Inventory of Executive Function (BRIEF), and TNO-AZL children's Quality of Life questionnaire (TACQOL)). Change-scores (paired t-test/Wilcoxon-test) and responsiveness (Effect-sizes and Standardized-Response-Means) were calculated.Results: Significant differences over time were found for the Canadian Occupational Performance Measure, DCDdaily and Movement-Asessment-Battery-Children-2 (p < 0.05). The responsiveness of these instruments was moderate-high (Canadian Occupational Performance Measure-performance Effect-Size:1.70/Standardized-Response-Mean:1.81, Canadian Occupational Performance Measure-satisfaction Effect-Size:1.65/Standardized-Response-Mean 1.53; DCDdaily-total-score Effect-Size:0.40/Standardized-Response-Mean:0.62, DCDdaily-Quality-score Effect-Size:0.74/Standardized-Response-Mean:0.89, DCDdaily-time-score Effect-Size:0.21/Standardized-Response-Mean:0.43; MABC-2-total-score Effect-Size:0.42/Standardized-Response-Mean:0.43, MABC-2-Ball-skills-score Effect-Size:0.33/Standardized-Response-Mean:0.36). Systematic detection of writing problems (SOS-2-NL), Behaviour Rating Inventory of Executive Function (BRIEF) and TNO-AZL children's Quality of Life questionnaire (TACQOL) were not responsive to change.Conclusion: Although the Movement-Asessment-Battery-Children-2 test is the most widely used instrument when measuring rehabilitation outcome in Developmental Coordination Disorder, the Canadian Occupational Performance Measure and DCDdaily seem to be more responsive and constitute a valuable addition.Implications for rehabilitationCurrently, there is no consensus on the preferred measurement instruments to evaluate the outcomes of rehabilitation in children with Developmental Coordination Disorder.The responsiveness of the Canadian Occupational Performance Measure (COPM) was found to be large, of the DCDdaily moderate to large, and of the Movement-Assessment-Battery-Children-2 (MABC-2) small, whereas the systematic detection of writing problems (SOS-2-NL; Systematisch Opsporing Schrijfproblemen-2-NL), Behavior Rating Inventory of Executive Functioning (BRIEF) and TNO-AZL Questionnaire for Children's Health-Related Quality of Life (TACQOL) were not responsive to change.Although the Movement-Assessment-Battery-Children-2 (MABC-2) is commonly used in Developmental Coordination Disorder rehabilitation, applying the Canadian Occupational Performance Measure (COPM) and DCDdaily should be considered, as these instruments were more sensitive to clinical changes.