# Comparing the CO-OP ApproachTM to Usual Occupational Therapy for Adults with Executive Dysfunction Following Acquired Brain Injury: A Randomized Controlled Trial

## TL;DR

This study compares a new occupational therapy method called CO-OP with usual therapy for adults with brain injuries, finding short-term improvements in daily tasks but no long-term retention.

## Contribution

The study introduces the CO-OP Approach as a novel contextualized strategy training intervention for improving everyday performance in individuals with chronic ABI.

## Key findings

- CO-OP participants showed significant improvements in performance and satisfaction for both trained and untrained goals post-treatment.
- Improvements were not retained at the three-month follow-up.
- CO-OP outperformed usual occupational therapy in the short term for individuals with chronic ABI.

## Abstract

Impairments of executive function following acquired brain injury including stroke (ABI) contribute significantly to long-lasting everyday difficulties in life. Pilot work on the CO-OP ApproachTM (Cognitive Orientation to daily Occupational Performance Approach), a contextualized strategy training intervention, with ABI adults with executive dysfunction showed improved performance on untrained everyday life tasks and cognitive flexibility. Objective: Our objective was to determine the efficacy of the CO-OP Approach relative to usual occupational therapy (UOT) for community-dwelling adult survivors of ABI with executive dysfunction. Methods: Eighty-seven participants were randomized to receive CO-OP (n = 45) or UOT (n = 42) in their homes. All participants identified five personally meaningful, everyday life goals (using the Canadian Occupational Performance Measure (COPM)) and received up to 15 one-hour treatment sessions twice per week. Three goals were trained, and two were untrained. Interventions were provided by occupational therapists registered with their regulatory college. The CO-OP group was trained to apply a meta-cognitive strategy to three goals. The UOT group received therapy based on the clinicians’ (experienced in community settings) determination. Testers were masked to the participants’ group. Analysis at the primary outcome (Post-test, ~10 weeks following baseline) was on an intent-to-treat basis. Results: Participants in the CO-OP group had a mean age of 57.5 years, a mean time post-ABI of 5.3 years, and were 57.8% men. Those in the usual OT group had a mean age of 54.7 years, a mean time post-ABI of 6.2 years, and were 69.0% men. The CO-OP group reported statistically significant higher improvements on COPM performance and satisfaction scores post-test for untrained and trained goals. However, these benefits were not retained at follow-up (three months post-baseline). Conclusions: The CO-OP ApproachTM shows promise for improving performance in everyday life goals for individuals with chronic ABI relative to usual community occupational therapy. Achieving retention of these benefits remains a challenge.