The Cognitive Orientation to daily Occupational Performance approach in childhood-onset disabilities.
Hortensia Gimeno, Helene Polatajko
PMID 40033547WHAT IT FOUND
A review of 38 studies finds the Cognitive Orientation to daily Occupational Performance (CO-OP) approach helps children achieve personal goals, but evidence is weak.
Most studies were small, had unblinded raters, and rarely measured if skills transferred to new tasks. Large trials are needed.
Key findings
01The review screened 136 papers and included 38 studies with primary data on children and young people.
02A major limitation in the available evidence is small sample sizes, with a median of 8.5 participants per study.
03Transfer of skills to untrained tasks was addressed in 25 studies, but the methods used varied widely, limiting comparisons.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The review is a narrative synthesis, not a systematic review or meta-analysis, so it does not provide pooled effect sizes. Most included studies had very small sample sizes, limiting the reliability of the findings. Blinding of outcome assessors was frequently missing or not achieved, raising the risk of bias. There is high variability in how 'transfer' of skills was measured, making it difficult to compare results across studies.
Declared interests
The study was funded by the Research Trainees Coordinating Centre. The text does not list specific author conflicts of interest.
The easy way to misread this
Do not assume CO-OP is proven to be superior to other goal-oriented therapies. The review highlights that the evidence is largely from small, pilot, or single-case studies with significant methodological limitations, such as lack of blinding and inconsistent outcome measures.