The Cognitive Orientation to daily Occupational Performance approach in childhood-onset disabilities

The Cognitive Orientation to daily Occupational Performance (CO-OP) approach, a goal-oriented intervention focused on participation, is designed to improve performance by addressing personal goals important to children and their families. Introduced in 2001, CO-OP involves client-chosen functional goals, identifying performance issues through a process of dynamic performance analysis, and guiding the discovery of cognitive strategies to enhance skill acquisition, all within a problem-solving framework. The objectives of the approach are skill acquisition, strategy use, generalization, and transfer of learning. Developed within a research paradigm, a review of the literature indicates that CO-OP research has expanded, documenting its use across various paediatric populations, including children with neurodevelopmental disorders, cerebral palsy, and movement disorders, addressing a myriad of functional goals. In this review we illustrate the iterative development of CO-OP from single-case experimental designs to randomized controlled trials to evaluate the approach. The Canadian Occupational Performance Measure and the Performance Quality Rating Scale are the most common outcome measures. Methodological advancements, limitations, and an initial exploration of mechanisms of action are discussed, providing a foundation for further research and clinical application. Recommendations include the use of consistent measures, robust longitudinal studies, implementation research, and health economic analyses.