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Full Course Details: Public course page
Learn more about our guest: Helene Polatajko
Agenda
Intro (5 minutes)
Breakdown and analysis of journal article (5 minutes)
- 00:00:00 Intro to CO-OP Approach and Cerebral Palsy
- 00:01:50 OT Potential Podcast intro
- 00:03:44 What is the CO-OP Approach™?
- 00:04:38 Does the CO-OP Approach™ work?
- 00:05:16 Intent of this research
- 00:05:43 Research methods
- 00:08:40 Research results
- 00:09:38 Discussion
- 00:11:06 Conclusion
Discussion on practical implications for OTs (with Helene Polatajko) (50 minutes)
- 00:13:12 How the CO-OP Approach™ was born
- 00:21:00 Formally researching the Approach
- 00:22:48 Initial impressions of this research
- 00:29:20 Addressing performance versus specific components
- 00:33:41 Who is a good fit for the CO-OP Approach™?
- 00:34:54 Explaining the importance of setting your own goals
- 00:39:32 Explaining the importance of trial and error and reflective questions
- 00:45:20 Important therapist qualities
- 00:50:50 The Olympic Spirit in OT
- 00:54:00 Final thoughts
Supplemental Materials
Article Review
Read Full Text: The Cognitive Orientation to daily Occupational Performance (CO-OP) Approach is superior to ordinary treatment for achievement of goals and transfer effects in children with cerebral palsy and spina bifida – a randomized controlled trial
Journal: Disability and Rehabilitation
Year Published: 2022
Let’s be honest:
Many OT approaches introduced over the years have not held up to research scrutiny.
But, of those that have, there seems to be a uniting theme: clients setting their own goals.
Today, we look at a pioneer of client-centered processes: The CO-OP Approach™. Yet again, we see the CO-OP approach outperforming conventional therapy—this time for children with cerebral palsy and spina bifida.
Next week on the podcast, we’re honored to have the founder of this approach, Helene J. Polatajko, PhD, OT Reg(Ont), to talk more about its applications and benefits.
Let’s dive in.
What is the CO-OP Approach™?
CO-OP stands for “Cognitive Orientation to (Daily) Occupational Performance.”
The CO-OP Approach™ is performance-based, task-specific, and goal-focused.
It is rooted in a cognitive strategy that helps clients do their own trial-and-error-based problem-solving to navigate their challenges.
Clients are taught the simple and powerful strategy of:
Goal-Plan-Do-Check
Clients initially use this strategy to meet self-identified therapy goals. They can then carry it forward beyond therapy to navigate future challenges.
To learn more about this strategy, I’d recommend not only reading the intro to the full article, but also perusing the CO-OP website. (There’s actually a track to become a certified CO-OP therapist!)
Does the CO-OP Approach™ work?
The CO-OP Approach™ has shown promising evidence of a treatment effect in persons of different ages and diagnoses, including:
There is emerging evidence on the effectiveness of CO-OP in:
CO-OP has also been shown as feasible for adolescents and young adults in a Swedish context. Given its feasibility, it is crucial to investigate CO-OP’s effectiveness—which leads us to this paper.
What was the intent of this research?
The aim of this paper was to investigate the effectiveness of the CO-OP Approach™ in children and adolescents with cerebral palsy and spina bifida.
Specifically, the authors sought to explore CO-OP’s effectiveness in comparison to conventional rehab with respect to:
- Success in achieving self-identified goals
- Generalization and transfer effects
What were their methods?
This was a randomized controlled trial. The intervention took place in a real-life Swedish environment, where children with disabilities can register with a rehabilitation center in their region.
Participants
To be included, participants had to:
- Be 8–16 years old and have a diagnosis of cerebral palsy or spina bifida
- Have challenges performing or organizing activities
- Follow the mainstream curriculum at compulsory school
- Be able to formulate their own goals
- Be able to communicate verbally in Swedish
Assessments
The following assessments were utilized for baseline and follow-up measurements:
Primary outcome measures
Canadian Occupational Performance Measure (COPM)
- Used to set 4 goals.
- One goal was purposefully left “untrained” to enable the study of generalization and transfer.
Performance Quality Rating Scale (PQRS)
- Provides an observable scale designed for the CO-OP Approach.
- In this study, the children’s performance of each goaled activity was documented by video and rated by a certified CO-OP therapist.
Secondary outcome measures
Child Occupational Self Assessment (COSA)
- Used in a structured interview about 25 items related to everyday occupations.
- Used to study transfer effects.
Delis-Kaplan Executive Function System (D-KEFS)
- Used to assess executive abilities.
- Used to investigate whether the intervention had any impact on those abilities.
The intervention
The CO-OP Approach™ was applied over 11 sessions conducted once per week, each lasting 45–60 minutes.
Most sessions occurred in the child’s usual environment. In the initial session, the therapist introduced the child to Goal-Plan-Do-Check, which the therapist then used consistently when working with the child to help them achieve their goals.
The therapist guided the child in discovering their own plan for performance, and the child implemented the plan and checked whether it worked or needed to be modified. Work was focused on a single goal. Once that goal was met, the second and third goals were progressively added.
Treatment as usual
The children in this group had their regular ongoing contact with the team at the regional rehabilitation center. The services there are family-centered. The treating OTs received information that the child had formulated 4 goals using the COPM, but they were not informed on the nature of those goals.
Results
38 children participated in this study.
The goals chosen by the children fell into the following categories:
- Preparing meals
- Self-care
- Home life
- Organization of school and homework
- Leisure
- Orienting oneself to one’s environment
- Societal life
Per the COPM, self-rated goal attainment was significantly higher in the CO-OP group for both trained AND untrained goals.
The scores on the PQRS were also significantly higher for trained goals in the CO-OP group.
Per the COSA, the CO-OP group experienced fewer problems in everyday life after treatment. However, both groups noted a reduction.
Per the D-KEFS, executive function did not vary significantly between groups.
Discussion
The CO-OP group showed higher goal achievement for trained goals in both subjective and objective ratings. The effect sizes were moderate, bordering on large.
A generalization/transfer effect was also seen in subjective ratings of untrained goals. (Transfer is a crucial part of the rehab process, but it is rarely an outcome of rehabilitation interventions.)
One interesting finding:
Both groups perceived that they had fewer problems in everyday life during the follow-up interview. One possible interpretation is that both groups experienced an effect simply from setting their own goals. Perhaps being treated as capable of discussing their individual challenges and what is important to them—and then being trusted as capable of working toward self-identified goals—made an impact.
Another important note:
The study showed no measurable improvement in executive function. This may be because executive function measurements are not sensitive enough to reflect improvements in everyday performance. But, with our current knowledge, it seems to confirm the suggestion made by the International Classification of Functioning and Health (ICF) that an intervention does not necessarily have to affect body functions in order to improve activity and participation.
Conclusion
For children with cerebral palsy or spina bifida, the CO-OP Approach™ is more effective than ordinary treatment in achieving both trained and untrained goals.
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