A scoping review of coaching in occupational therapy: Mapping methods, populations and outcomes

INTRODUCTION

Coaching is proposed as a core enabling skill of occupational therapy and increasingly suggested for a diverse range of health populations. In recent years, research on coaching has proliferated, emerging from within and outside of occupational therapy. Yet, concern has been raised about the absence of theoretical underpinning and diversity of descriptions of coaching in occupational therapy, as well as low-quality evidence supporting its effectiveness. The aim of this study is to map the use of coaching by occupational therapists from 2007 to 2022 to identify the populations, settings and outcomes it is applied to, differences between coaching interventions and evidence supporting its use.

METHODS

This systematic scoping review applied Arksey and O'Malley's five-stage methodological framework with further methodological direction using the Levac framework. There was no consumer involvement in undertaking this review.

RESULTS

Findings from 60 research publications on coaching indicate its use with populations across the lifespan in primarily community settings to improve occupational performance, participation and self-efficacy. A wide range of coaching interventions are designed or used by occupational therapists, with Occupational Performance Coaching being the most researched (16/27, 59% of named interventions). Common elements of coaching interventions included collaborative goal setting and problem-solving; however, a lack of described theory or coaching methods persists. High-quality study designs indicate its effectiveness; however, an absence of fidelity definition or monitoring limits interpretation of many studies.

CONCLUSION

The language of coaching is becoming common practice within occupational therapy, and evidence indicates effectiveness of some coaching interventions. Advances in coaching research and use by occupational therapists will be aided by an explicit statement of the theoretical basis for coaching interventions, with congruent coaching methods, mechanisms and outcomes stated.

PLAIN LANGUAGE SUMMARY

This scoping review maps the use of coaching by occupational therapists in current published research. Key aspects of coaching examined include how coaching is defined, who it is used with and how effective it is. The kinds of outcomes that coaching is intended to improve are also reported. From 633 publications, 60 research publications were fully analysed. The use of coaching by occupational therapists has grown rapidly over the past 10 years. Strong evidence of its effectiveness exists for achieving the personal goals of people receiving occupational therapy when goals describe changes in everyday life activities. Coaching is being used with people across the lifespan with a variety of disabilities and chronic conditions and their caregivers/parents, most commonly parents of children with developmental issues. The key features of coaching interventions used by occupational therapists include collaborative goal setting, shared problem-solving and client-led action planning. Some elements of coaching are also used within other interventions with a wider range of methods. Coaching is believed to work by supporting an individual's self-belief that they can make changes. Theories that underpin coaching vary but commonly focus on self-determination, behaviour change and occupational therapy theory. However, many of the coaching interventions do not describe any theoretical basis nor coaching methods in detail. Future research on coaching in occupational therapy should ensure a clear explanation of the theory that underpins it, coaching methods and monitoring of how well coaching is applied.

Comparing three coaching approaches in pediatric rehabilitation: contexts, outcomes, and mechanisms

PURPOSE

This Perspectives paper advances understanding of coaching in pediatric rehabilitation. We compare three coaching approaches designed for pediatric rehabilitation: Coping with and Caring for Infants with Special Needs (COPCA), Occupational Performance Coaching (OPC), and Solution-Focused Coaching in Pediatric Rehabilitation (SFC-peds).

OBJECTIVES

Our objectives are to contrast the theory underpinning the approaches, discuss the evidence for outcomes and hypothesized mechanisms of change, consider the necessary mindsets of effective coaches, and propose directions for research and practice.

SUMMARY

The coaching approaches have different theoretical bases and are designed for specific contexts, yet are similar in their mechanisms of change and intended outcomes. There is growing evidence of important effects of coaching on coachees' goal achievement, empowerment, and capacity building. Studies indicate that stakeholders value coaching, and provide a preliminary understanding of the mechanisms, including engagement and self-efficacy, by which coaching approaches support clients' self-directed and sustained change. Open, curious, and client-centered practitioner mindsets are fundamental to effective coaching.

CONCLUSIONS

Coaching is a distinctive group of relational, goal-oriented, and evidence-based approaches that support goal achievement and empowerment. These approaches reflect and advance an ongoing paradigm shift in pediatric rehabilitation-a movement from therapist-as-expert approaches to those that build empowerment and capacity.

The effect of parent-based occupational therapy on parents of children with cerebral palsy: a randomised controlled trial

Background/Aims

Parents of children with cerebral palsy face higher levels of stress, anxiety and depression, sadness, exhaustion and burnout. Parent-based therapies have been found to increase parents' satisfaction with therapy, parent–child interactions and reduced parental stress. This study examined the effects of parent-based occupational therapy on stress levels, coping skills, and emotional skills and competencies of parents of children with cerebral palsy.

Methods

A total of 15 children and their parents who were admitted to the paediatric rehabilitation unit for occupational therapy were divided into two groups (control group: n=7, study group: n=8) using the coin toss randomisation method. The control group received standard occupational therapy, while the study group received parent-based occupational therapy for 45 minutes a session, twice a week, until 10 sessions had been completed. Participants were evaluated before and after the intervention.

Results

The study group showed a decrease in stress levels (P=0.034) and increases in coping skills (P=0.016), and emotional skills and competencies (P=0.036). In addition, only an improvement in parents' stress levels (P=0.046) was observed in the control group.

Conclusions

The parent-based occupational therapy programme was more effective regarding stress levels, coping skills, emotional skills and competencies of the families of children with cerebral palsy compared to classical occupational therapy. This study is important in terms of demonstrating the benefits of parent-based occupational therapy for parents of children with cerebral palsy.

Coaching-in-Context With Informal Maternal Care Partners of Children With Spinal Cord Injury

BACKGROUND

Coaching-in-Context (CinC) is a conversation-based process for working with people that draws on the tenets of positive psychology, is solution-focused and strength-based, and uses evidence-informed coaching techniques that create opportunities for clients to be at their best when engaging in the roles and activities that are desired, required, or expected of them.

OBJECTIVES

To explore the use of CinC with informal maternal care partners (mothers, grandmothers) of children with spinal cord injury (SCI).

METHODS

This study was a multicenter, single group, pre-post treatment design. Participants received up to 10 sessions of CinC over a 10-week period. The Canadian Occupational Performance Measure (COPM), Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF), and Pediatric Measure of Participation Short Form (PMoP SF) were administered before and after coaching. The number of coaching sessions completed, missed, and rescheduled was recorded. Descriptive and nonparametric statistics were used to summarize sample characteristics and to evaluate changed COPM scores. PSI-4-SF stress percentiles were examined descriptively. Wilcoxon signed-rank test was used to determine whether there was a statistically significant change between baseline and postcoaching COPM and PMoP SF scores.

RESULTS

Nine caregivers enrolled in the study; two had face-to-face coaching, five had phone coaching, and two dropped out. The seven who completed were mothers with an average age of 37.14 (range, 32-45; SD = 5.15) years, with children an average age of 10 (range, 7-13; SD = 2.89) years with paraplegia (n = 4) or tetraplegia (n = 3) sustained an average of 6.71 (range, 2-13; SD = 3.73) years prior to the study. Fifty-five (average = 7.86, mode = 9; range, 3-10) coaching sessions were provided; two sessions were missed and nine were rescheduled. After coaching, mean COPM performance scores increased by 2.48 (SD = 2.01) (Z = -4.057, p < .001), mean COPM satisfaction scores increased by 2.81 (SD = 1.33) (Z = -4.812, p < .001), and PMoP self scores increased (Z = -2.023, p < .043).

CONCLUSION

This study provides preliminary support for CinC with informal care partners of children with SCI. It also highlights several factors that are important to consider when implementing a coaching program, namely mode of delivery and time commitment.