Abstract / Summary
Background: The Cognitive Orientation to Daily Occupational Performance (CO-OP) approach is a cognitive strategy-based, occupation-focussed intervention designed to improve functional performance in children with neurodevelopmental conditions. Although CO-OP has been increasingly used in paediatric rehabilitation, evidence from randomised controlled trials examining its effectiveness across different populations and outcomes has not been comprehensively synthesised. This systematic review and meta-analysis examined the effects of CO-OP on occupational performance and related outcomes in children with disabilities.
Method: Randomised controlled trials involving children aged 3-18 years were identified through PubMed, Scopus, and CENTRAL. Seventeen eligible reports representing 13 distinct trial cohorts were included. Risk of bias was assessed using RoB 2. Where clinically appropriate, COPM Performance and Satisfaction outcomes were synthesised using random-effects meta-analysis; other outcomes were synthesised using a SWiM-informed approach. Certainty of evidence was assessed using GRADE.
Consumer and community involvement: There was no consumer or community involvement in the conduct of this systematic review.
Results: In five trials comparing CO-OP with active alternative interventions, meta-analysis did not demonstrate clear superiority for COPM Performance (MD = 1.03, 95% CI [-0.38, 2.44], I2 = 77.7%) or Satisfaction (MD = 1.53, 95% CI [-0.13, 3.19], I2 = 75.1%); certainty was very low. Low-certainty evidence from inactive/waitlist comparisons and trials adding CO-OP to background rehabilitation suggested improvements in individualised occupational performance. Evidence for generalised motor capacity, functional status, broader participation-related outcomes, and executive functioning was limited or inconsistent. Neuroimaging findings were exploratory.
Conclusion: CO-OP may improve individualised, goal-oriented occupational performance compared with inactive controls or when added to background rehabilitation. However, current evidence does not establish clear superiority over other active interventions. Further adequately powered trials examining participation, generalisation, and longer term outcomes are needed.