Date Presented 03/28/20
A systematic review was completed on the effectiveness of CO-OP in the treatment of motor performance for adults with acquired brain injury. Three databases were searched, and 15 relevant articles were identified, critically appraised, and narratively analyzed. There is growing evidence that CO-OP is efficacious in promoting motor and functional outcomes for the stroke population. Findings also indicate transfer and generalization of the cognitive skill into everyday life for participants.
Primary Author and Speaker: Jesslene Jacob
Additional Authors and Speakers: Wen-Yi Lai, Grace Kim
Contributing Authors: Sabina Khanukayeva
BACKGROUND: The Cognitive Orientation to daily Occupational Performance (CO-OP) is a cognitive approach, which teaches clients problem-solving strategies to identify and improve on self-selected skills. CO-OP was originally developed and demonstrated to be effective in improving motor performance in children with developmental coordination disorder (DCD).
Based on the promising results, clinicians and researchers have increasingly adopted this approach to address functional impairments in the adult neurological population.
OBJECTIVE: This study aims to investigate the effectiveness of CO-OP on the occupational performance for adults with acquired brain injury (ABI).
METHOD: PubMed, Cinahl Plus, and PsycINFO databases were searched for relevant articles. Primary search terms used included “CO-OP”, “cognitive orientation to daily occupational performance”, “acquired brain injury”, “stroke”, “cerebrovascular accident”, and “traumatic brain injury”. Search limitations included adults, articles written in English and peer-reviewed articles. Critical appraisals and data extraction were conducted for analysis of the included articles. PEDro Scale was used to rate the methodological quality of each article. Narrative analysis was completed to determine common themes and to summarize the study results.
RESULTS: The initial search yielded 64 articles, and 15 articles met the inclusion criteria and were included in the study. Twelve studies focused on the stroke populations while were based on individuals with traumatic brain injury (TBI). Seven were case studies, and the other eight studies consist of a comparison group. Critical appraisals were completed using the PEDro scale. An average PEDro score was calculated based on scores from all studies which indicated fair quality of evidence overall. All 15 studies provided CO-OP intervention that utilized the global cognitive strategy, Goal- Plan - Do - Check. Thirteen of the included studies employed the Canadian Occupational Performance Measure (COPM), which demonstrated clinically significant improvements in motor performance and satisfaction ratings on the COPM both post-intervention and follow up. Four major themes identified were: COPM was the most commonly used outcome measure; increased functional performance; transfer and generalization effect; and the effect of CO-OP on non-motor outcomes.
CONCLUSION: There is growing evidence that the CO-OP approach appears to be effective for promoting motor and functional outcomes in adults with acquired brain injury especially stroke population. There is less evidence available for multiple sclerosis and TBI, to fully understand the significance and effectiveness of CO-OP in clinical practice.
IMPACT STATEMENT: CO-OP is a promising, top-down cognitive approach to promoting functional and motor outcomes in adults with stroke. The use of CO-OP should be explored in larger studies with stroke and with other neurological populations such as traumatic brain injury and multiple sclerosis.
References
Ahn, S., Yoo, E., Jung, M., Park, H., Lee, J., & Choi, Y. (2017). Comparison of Cognitive Orientation to daily Occupational Performance and conventional occupational therapy on occupational performance in individuals with stroke: A randomized controlled trial. NeuroRehabilitation, 40(3), 285–292. https://doi.org/10.3233/NRE-161416
McEwen, S., Polatajko, H., Baum, C., Rios, J., Cirone, D., Doherty, M., & Wolf, T. (2015). Combined cognitive-strategy and task-specific training improve transfer to untrained activities in subacute stroke: An exploratory randomized controlled trial. Neurorehabilitation and Neural Repair, 29(6), 526–536. https://doi.org/10.1177/1545968314558602
Polatajko, H. J., Mandich, A. D., Miller, L. T., & Macnab, J. J. (2001). Cognitive Orientation to Daily Occupational Performance (CO–OP): Part II—The evidence. Physical and Occupational Therapy in Pediatrics, 20, 83–106. https://doi.org/10.1080/J006v20n02_06
Wolf, T. J., Polatajko, H., Baum, C., Rios, J., Cirone, D., Doherty, M., & McEwen, S. (2016). Combined cognitive-strategy and task-specific training affects cognition and upper- extremity function in subacute stroke: An exploratory randomized controlled trial. American Journal of Occupational Therapy, 70(2), 1-10. https://doi.org/10.5014/ajot.2016.017293
