Which OT approach to use with residual motor deficits following stroke

Treating patients with residual motor deficits following stroke can be challenging.

This smaller, but OT specific study, compared two approaches: The Cognitive Orientation to Daily Occupational Performance (COOP) (see below for description), and a more ‘conventional’ OT component based approach.
 

The Paper
Comparison of Cognitive Orientation to daily Occupational Performance and conventional occupational therapy on occupational performance in individuals with stroke: A randomized controlled trial. S.-N. Ahn, E.-Y. Yoo, M.-Y. Jung, H.-Y. Park, J.-Y. Lee and Y.-I. Choi (2017)


The Problem
As an OT working with residual motor deficits from stroke, is it best to take a direct component based approach, or use a self-management based approach with the COOP model?


Methods

  • Study type: Randomized Control Trial (RCT)  

  • Population: 43 adults with stroke

  • Randomization: Yes (coin toss)

  • Sessions: 12 OT sessions over 5 weeks

  • Outcome measures: The Canadian Occupational Performance Measure (COPM) and the Performance Quality Rating Scale (PQRS)


The Interventions

1. The Cognitive Orientation to daily Occupational Performance -COOP approach is a multi-step framework that helps patients attain chosen performance based goals. It does so by using performance based assessment and meta-cognitive problem solving through (primarily) a Goal-Plan-Do-Review (GPDR)  framework.


2. The study considered “conventional OT” as component skills training (Example: passive ROM exercise of wrist and finger joint; pulling a rubber band to increase the power to hold chopsticks (flexor muscle of wrist and finger joint strength);  tying ribbon and placing marbles to increase coordination with fine motor between fingers; and putting in one coin at a time using in-hand manipulation skill to promote selective movement between fingers.


The Bottom Line

Performance and satisfaction increases were higher in the COOP group, and generalized better to non-trained activities.
 

Furthermore, patients found more benefit from being able to select their goals and use meaningful therapeutic activities, as opposed to the use of conventional component based activities.
 

A key take-away for your practice: Given it’s small sample size you of course still have to use your professional judgment on what will work best for your patient(s), but this study reinforces the value of shared-decision making, self-management and occupation-as-means rather than solely treating component based factors such as ROM, strength and sensation.