CO-OP approach improves individualized occupational performance compared to inactive controls in children with disabilitiesCO-OP Approach Improves Occupational Performance for Children with Disabilities

Australian occupational therapy journal Published October 7, 2026 Study authors: Zengin Yazıcı Gülşah, Yıldırım Kardelen, Tanrıverdi Müberra PubMed ↗ DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway

Note that CO-OP improves performance over inactive controls but lacks proven superiority over other active interventions.

This meta-analysis evaluates the effectiveness of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach for children with disabilities. The study synthesized data on primary outcomes including occupational performance and secondary outcomes such as COPM Satisfaction, generalized motor capacity, and executive functioning.

Findings indicate that the CO-OP approach leads to improvements in individualized occupational performance when compared to inactive controls or when added to background rehabilitation. However, the meta-analysis found no clear superiority for CO-OP over active alternative interventions for both COPM Performance (MD = 1.03; 95% CI [-0.38, 2.44]) and COPM Satisfaction (MD = 1.53; 95% CI [-0.13, 3.19]).

Several limitations were noted, including very low certainty of evidence for active intervention comparisons. Evidence for generalized motor capacity, functional status, and executive functioning was reported as limited or inconsistent. Neuroimaging findings were exploratory. Clinicians should note that while CO-OP is effective against inactive benchmarks, its superiority over other active therapies is not established by current evidence.

How this fits prior evidence

This meta-analysis addresses a gap in evidence regarding specific intervention efficacy for neurodevelopmental conditions. While previous coverage noted that serotonergic signaling in neurodevelopmental conditions lacks quantitative data, this study provides a quantitative meta-analysis of the CO-OP approach. It also relates to the context of children with disabilities, though it does not specifically address the impact of the COVID-19 pandemic on service utilization or the role of Minor Neurological Signs.

Researchers looked at how the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach helps children with neurodevelopmental conditions. This method focuses on helping children perform daily tasks better. The study compared the CO-OP approach to other active treatments, as well as to no treatment or standard care.

The results showed that the CO-OP approach led to improvements in individual performance when compared to no treatment or when added to standard care. However, the study did not find that the CO-OP approach was clearly better than other active types of therapy. Because the evidence for comparing it to other active treatments was of low certainty, it is hard to say if it is the best choice over other options.

Some areas, like motor skills and executive function, had limited or inconsistent data. This means the results for those specific areas are not yet clear. For families, this means the CO-OP approach is a helpful tool for goal-oriented tasks, but it may not be significantly different from other active therapies available today.

What this means for you:

The CO-OP approach improves daily performance for children with disabilities compared to no treatment or standard care.

Common questions

What is the CO-OP approach and how does it help children?

The CO-OP approach stands for Cognitive Orientation to Daily Occupational Performance. It is a method used to help children with neurodevelopmental conditions improve their daily performance. The study found that this approach leads to improvements in individual performance when compared to no treatment or when added to standard care.

Is the CO-OP approach better than other types of therapy?

The study did not find a clear superiority for the CO-OP approach when compared to other active interventions. Because the evidence for this specific comparison was of very low certainty, it is not yet clear if it works better than other active therapies available for children with disabilities.

What specific areas of development did the study look at?

The study looked at several areas, including occupational performance, satisfaction, motor capacity, and executive functioning. While the CO-OP approach showed improvements in individual performance, the evidence for motor capacity and executive functioning was limited or inconsistent.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedOct 2026

PMID42834626

View Original 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], I = 77.7%) or Satisfaction (MD = 1.53, 95% CI [-0.13, 3.19], I = 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.

CO-OP approach improves individualized occupational performance compared to inactive controls in children with disabilitiesCO-OP Approach Improves Occupational Performance for Children with Disabilities

How this fits prior evidence

Common questions

Study Details

Evaluating Text Message Video Interventions for Improving Infant Sleep Safety Practices

Text message videos for safe sleep show mixed results

Clinical research that matters. Delivered to your inbox.

CO-OP approach improves individualized occupational performance compared to inactive controls in children with disabilitiesCO-OP Approach Improves Occupational Performance for Children with Disabilities

How this fits prior evidence

Common questions

More on neurodevelopmental conditions

Study Details

Evaluating Text Message Video Interventions for Improving Infant Sleep Safety Practices

Text message videos for safe sleep show mixed results

Clinical research that matters. Delivered to your inbox.

Related in Pediatrics

From Other Specialties