Date Presented 04/01/2022
This study compared a Cognitive Orientation to daily Occupational Performance (CO-OP) group for adults who had a stroke with standard care. Quantitative and qualitative data were collected. There was no statistical difference in outcomes; a large effect size was noted for the Assessment of Motor and Process Skills and the Canadian Occupationl Performance Measure. Themes included benefits of group process, awareness of changes in performance, reflections on recovery, importance of social support, and value in client-chosen goals. Findings indicate that participants found the CO-OP group valuable and used the approach in their lives.
Primary Author and Speaker: Sarah M. Zera
Additional Authors and Speakers: Eileen M. Brodecki
PURPOSE: Cognitive impairment after a stroke has been linked to limitations in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and participation (Stolwyk, et al. 2021). In fact researchers have found that more than half of people who have experienced a stroke and were considered to have made excellent recoveries continue to have cognitive impairments and participation restrictions (Kapoor et al. 2017). The Cognitive Orientation to Daily Occupational Performance (CO-OP) ApproachTM is an evidenced based intervention for adults who have experienced a stroke. Occupational therapy services in the clinical day rehabilitation setting are typically provided using a group model. Exploration of A CO-OP group for adults who have experienced a stroke has been limited. The first aim of the study was to standardize the CO-OP group curriculum used in the feasibility study examining the adult CO-OP group (Zera et al., 2021). The second aim of the study was to examine initial data comparison of two groups.
METHOD: This randomized control pilot study compared the CO-OP group for adults who have experienced a stroke to those receiving standard day rehabilitation occupational therapy. Those receiving standard OT received both group and individual interventions. Eleven day rehabilitation participants were recruited through fliers and word of mouth from their occupational therapists over two rounds of recruitment. Each intervention cohort participated in six CO-OP group sessions, provided one to two times per week at the day rehabilitation. Each participant in the CO-OP group focused on self-identified goals in the group. Quantitative data was collected through pre- and post-test measures using the Canadian Occupational Performance Measure (COPM), the Assessment of Motor and Process Skills (AMPS), and the Community Participation Index (CPI). Qualitative data was collected using focus groups. Quantitative data was compared between the two groups using nonparametric statistics. The focus groups were transcribed and analyzed using inductive content analysis (Elo and Kyngas, 2008).
RESULTS: There was no statistical difference in outcome measure between the two groups. A large effect size was noted for the AMPS and the COPM. A small effect size was found for the CPI. The intervention group appeared to be trending toward a higher level of performance on the AMPS and the COPM than the control group. Themes from the qualitative data include: benefits of the group process, awareness of changes in performance, reflections on recovery process, importance of social supports, and value in self-selected goals.
CONCLUSION: This study builds upon the first author’s feasibility study applying this CO-OP group intervention in the clinical day rehabilitation setting. Findings from this study indicate adult participants who have experienced a stroke find the CO-OP group intervention in the clinical day rehabilitation setting valuable. Participants found it meaningful to work with peers and to use the CO-OP ApproachTM in their daily lives. Further investigation of the effectiveness of this intervention is warranted.
References
Dawson, D.R., McEwen, S.E., & Polatajko, H.J. (Eds.) (2017) Cognitive Orientation to Daily Occupational Performance in Occupational Therapy: Using the CO-OP Approach to Enable Participation Across the Lifespan. Bethesda, MD: American Occupational Therapy Association, Inc.
Polatajko, H. J., McEwen, S. E., Ryan, J. D., & Baum, C. M. (2012). Pilot randomized controlled trial investigating cognitive strategy use to improve goal performance after stroke. The American Journal of Occupational Therapy, 66(1), 104-109. https://doi.org/10.5014/ajot.2012.001784
Skidmore, E. R., Dawson, D. R., Butters, M. A., Grattan, E. S., Juengst, S. B., Whyte, E. M., Begley, A., Holm, M., & Becker, J. T. (2015). Strategy training shows promise for addressing disability in the first 6 months after stroke. Neurorehabilitation and Neural Repair, 29(7), 668-676. https://doi.org/10.1177/1545968314562113
Stolwyk, R. J., Mihaljcic, T., Wong, D. K., Chapman, J. E., & Rogers, J. M. (2021). Poststroke Cognitive Impairment Negatively Impacts Activity and Participation Outcomes. Stroke, 52(2), 748–760. https://doi.org/10.1161/STROKEAHA.120.032215
