Peer-reviewed article
Effects of the Cognitive Orientation to Daily Occupational Performance approach on occupational performance and related outcomes in children with disabilities: A systematic review and meta-analysis.
Zengin Yazıcı G, Yıldırım K, Tanrıverdi M ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis examined whether the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach helps children with disabilities improve their ability to perform everyday activities. Researchers reviewed 17 studies involving children aged 3-18 years. The results suggest CO-OP may help children achieve their individual goals compared to no treatment, but it does not appear clearly better than other active therapies.
Key points
- CO-OP showed improvements in individualised occupational performance when compared with inactive controls or when added to background rehabilitation (low certainty)
- When CO-OP was compared to other active interventions, meta-analysis found no clear superiority for performance outcomes (MD = 1.03) or satisfaction (MD = 1.53), with very low certainty of evidence
- Evidence for generalised motor capacity, functional status, broader participation outcomes, and executive functioning was limited or inconsistent
- 17 eligible reports representing 13 distinct trial cohorts were included in the review
- Further adequately powered trials are needed to examine longer-term outcomes and whether benefits generalise beyond the specific goals targeted
Limitations
The review does not specify which countries conducted the trials or provide detail on the diversity of disability types studied. The very low certainty of evidence for comparisons with active interventions and inconsistent findings for broader outcomes limit what conclusions can be drawn about CO-OP's effectiveness.
Abstract
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.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Cognitive Orientation to Daily Occupational Performance (CO-OP) approach, a cognitive strategy-based, occupation-focussed intervention
- Population
- Children aged 3-18 years with neurodevelopmental disabilities
Key finding
Compared with active alternative interventions: COPM Performance MD = 1.03 (95% CI [-0.38, 2.44]), COPM Satisfaction MD = 1.53 (95% CI [-0.13, 3.19]) - no clear superiority
G et al. · Europe PMC · 1 Oct 2026