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

Abstract

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.

Individual and contextual factors influencing children's effort in pediatric rehabilitation interventions

“…patient diaries) or it may simply be reported as the number of actual or planned intervention hours. Objective measurements of dosage may include frequency counts of observed behaviors or time measured by body‐worn sensors such as accelerometers or inertial measurement units 18 . Even in established intervention approaches, practice dosage (in terms of number of reported intervention hours) can vary significantly across studies 19 .…”

“…Practice conditions such as CO‐OP that emphasize child‐led identification of cognitive strategies and problem‐solving on the part of the child undoubtably influence cognitive effort 18 . Involvement in goal‐setting may also influence effort.…”

“…Objective measurements of dosage may include frequency counts of observed behaviors or time measured by body-worn sensors such as accelerometers or inertial measurement units. 18 Even in established intervention approaches, practice dosage (in terms of number of reported intervention hours) can vary significantly across studies. 19 A longitudinal study of children with CP found no relationship between therapy dosage and outcomes.…”

“…23 Practice conditions such as CO-OP that emphasize childled identification of cognitive strategies and problem-solving on the part of the child undoubtably influence cognitive effort. 18 Involvement in goal-setting may also influence effort. Children can be hypothesized to be more motivated and willing to expend effort in interventions that directly address their goals.…”