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Cognitive Orientation to daily Occupational Performance (CO-OP) Intervention for People with Cerebral Palsy: A Systematic Review with Meta-Analysis

Author(s): Hortensia Gimeno, Michelle Jackman, Iona Novak

Aim: Cognitive Orientation to daily Occupational Performance (CO-OP) was originally designed for children with Developmental Coordination Disorder but has more recently been applied to the cerebral palsy population who also have disorders of motor function and executive function. The aim of this review was to examine the feasibility, acceptability, and effectiveness of CO-OP in the cerebral palsy population.

Methods: A systematic literature review was carried out to identify studies on CO-OP for people with cerebral palsy, using the Medline, CINAHL and ERIC databases between 22 June and 30 June 2021.

Results: The search elicited 44 citations, of which 8 studies met eligibility. Five were observational studies (three of five Single Case Experimental Design), three were randomized controlled trials (RCTs), measuring the effects of CO-OP in 100 people with cerebral palsy. Since CO-OP was repurposed to cerebral palsy, initial studies focused on feasibility, acceptability and preliminary efficacy, and consequently sample sizes were small with high risk of bias. Pooled findings from RCTs indicate CO-OP produces greater gains in goal achievement than to body functions and structure intervention (Standardised Mean Difference 0.86 [95% Confidence Interval 0.20-1.52]).

Conclusions: Findings suggest preliminary efficacy of CO-OP for cerebral palsy compared to body functions and structure interventions for goal attainment, with CO-OP having comparable efficacy to other activities-based interventions. More clinical trials with adequate power and an individual patient meta-analysis are recommended.

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