Does training in a top-down approach influence recorded goals and treatment plans?

Five stroke rehabilitation teams were supported in the implementation of Cognitive Orientation to daily Occupational Performance (CO-OP) as part of a knowledge translation (KT) project called CO-OP KT. Medical record auditors noted there was occasionally a disconnect between client goals and treatment plans, revealing a need to better understand the characteristics of each and their relationship to each other.

This study aimed to examine the characteristics of goals and treatment plans in occupational therapy before and after CO-OP KT.

A descriptive secondary analysis of medical record data was employed.

Post intervention, there was a change in goal specificity (p = .04) and therapist-client goal alignment (p = .05). Occupation-based goals were often paired with a bottom-up, impairment-based treatment. Top-down treatments, when present, lacked the same detail given to bottom-up plans.

CO-OP KT seemed to lead to more specific goals, but matching top-down treatment plans were not found.