Pilot randomized controlled trial investigating cognitive strategy use to improve goal performance after stroke.

OBJECTIVE The authors compared changes in client performance on three goals poststroke after the Cognitive Orientation to daily Occupational Performance (CO-OP) intervention or standard occupational therapy (SOT) to determine the magnitude and direction of change. METHOD Eight people living in the community following a stroke were randomly assigned to receive CO-OP (n = 4) or SOT (n = 4). CO-OP is a 10-session, cognitive-oriented approach to improving performance that uses client-driven cognitive strategies. SOT was therapist driven and combined task-specific and component-based training. Goal performance was measured by the therapist-rated Performance Quality Rating Scale (PQRS) and the participant-rated Canadian Occupational Performance Measure (COPM). RESULTS Using Mann-Whitney U test, we found that CO-OP participants showed significantly greater improvement in performance (PQRS, p = .02; COPM Performance, p = .02) compared with SOT but no improvement in satisfaction (COPM Satisfaction, p = .38). CONCLUSION The CO-OP group demonstrated larger performance improvements than the SOT group. Because of the promising results, an investigation using a larger sample is warranted.