Intervention with the CO-OP Approach leads to a transfer effect over time to untrained goals for children with cerebral palsy or spina bifida

Figures & data

Table 1. Participants’ demographics.

Characteristics	Total n = 34
Age
Mean (SD)	12y 5 mo (2 y 3 mo)
Range	7–16 y
Sex
Boys	20
Girls	14
Spina bifida	9
Shunt-treated hydrocephalus	5
Ambulation (Hoffer)
1 – in community	3
2 – in household	1
3 – for training, non-functional	0
4 – non-ambulator	5
Cerebral palsy sub-type	25
Unilateral spastic CP	14
Bilateral spastic CP	6
Dyskinetic CP	4
Ataxic CP	1
MACS level
I	12
II	9
III	4
GMFCS level
I	14
II	7
III	3
IV	1

MACS: manual ability classification system.

GMFCS: gross motor function classification system.

Figure 1. Flow chart showing the children invited and the participants recruited, the number of participants assessed at baseline and immediately after the CO-OP intervention and at the 3-month follow-up.

Flow chart for recruitment and assessment of an intervention using the CO-OP Approach in children with cp or spina bifida. It shows that 38 children were invited, 34 accepted to participate and were assessed at baseline and immediately after the intervention. At the three-month follow-up, 33 of them were assessed.

Table 2. Goal achievement after CO-OP intervention; pairwise comparison of children’s three trained goals and the untrained goal between timepoints T1, T2 and T3, n = 33.

		T1	T2	T3	T1–T2	T1–T3	T2–T3
		range	Range	range
Goal Type	Outcome	mean of ratings for 3 goals	mean of ratings for 3 goals	mean of ratings for 3 goals	p-value^a	p-value^a	p-value^a
Trained	COPM performance	1.0–6.3	2.7–10.0	3.7–10.0	<0.001***	<0.001***	0.655
	COPM satisfaction	1.0–6.5	4.0–10–0	4.7–10.0	<0.001***	<0.001***	1.000
	PQRS	1.3–6.0	4.3–9.3	4.0–10.0	<0.001***	<0.001***	0.804
		range 1 goal	range 1 goal	range 1 goal
Untrained	COPM performance	1–7	1–10	1–10	0.003**	<0.001***	0.471
	COPM satisfaction	1–10	1–10	1–10	0.005**	<0.001***	1.000
	PQRS	1–9	1–10	1–10	0.005**	<0.001***	1.000

COPM: Canadian occupational performance measure; PQRS: performance quality rating scale.

** = p ≤ 0.01; *** = p ≤ 0.001.

a = p-values have been adjusted by means of Bonferroni corrections for multiple tests.

Table 3. Number of children with a clinically relevant increase in at least two or all three trained goals and in their untrained goal, immediately after the intervention and at follow-up after three months.

		Children with a clinically relevant increase (≥ 2 points) in two or more trained goals
Trained goals
COPM performance	T1–T2 (n = 34)	30
	T1–T3 (n = 33)	31
PQRS	T1–T2 (n = 34)	30
	T1–T3 (n = 33)	29
Untrained goal		Children with a clinically relevant increase (≥ 2 points) in their untrained goal
COPM performance	T1–T2 (n = 34)	20
	T1–T3 (n = 33)	28
PQRS	T1–T2 (n = 34)	19
	T1–T3 (n = 32)	23

COPM: Canadian occupational performance measure, performance scale; PQRS: performance quality rating scale.

Table 4. Tests of executive function: results from the Friedman test, pairwise comparisons T1–T2, T1–T3 and T2–T3 for Trail making Test 2 (TMT 2) and the Tower Test.

		T1–T2			T1–T3			T2–T3
		Mdn (IQR)			Mdn (IQR)			Mdn (IQR)
Executive test	N	T1	T2	p-value^a	T1	T3	p-value^a	T2	T3	p-value^a
TMT 2	32	6 (1.5–10)	8.5 (4.3–11.8)	0.062 ns	6 (1.5–10)	8 (3.3–12)	0.003**	8.5 (4.3–11.8)	8 (3.3–12)	.952 ns
Tower Test	33	9 (7–11)	10 (9–12)	0.049*	9 (7–11)	10 (8.5–12)	0.049*	10 (9–12)	10 (8.5–12)	1.0 ns

Mdn: median; IQR: interquartile range; * p ≤ 0.05; ** = p ≤ 0.01; ns: not statistically significant.

^a = p-values have been adjusted by means of Bonferroni corrections for multiple tests.

Table 5. Children’s (n = 32) ratings on the COSA-S competence scale, compared between T1–T2 and T1–T3.

	COSA-S competence scale
	Increase >1%	Unchanged	Reduction >1%
T1–T2  →	22	3	7
T1–T3 →	23	1	8

COSA-S: child occupational self-assessment, Swedish version.

POMP: percentage of maximum possible score.

Table

Activity areas	Frequency		Types of goals Examples:
	Trained Goals (n=102)	Untrained Goals (n=34)
Preparing meals	14	3
being able to perform, but also getting it done			Making an afternoon snack Preparing a full meal, such as pasta and meat Cutting fruits, vegetables, or meat
Self-care	32	11
being able to perform, but also getting it done.			Hygiene Hair grooming Eating with fork and knife Dressing and tying shoelaces Putting on make-up/grooming nails Put on a necklace
Home-life	9	3
being able to perform, but also getting it done.			Home chores Keeping my things in order
Organization of school and homework	16	7
being able to perform, but also getting it done, or daring to do (not avoiding)			Doing homework Writing with pencil/computer at a good pace Speaking in the classroom or with the teacher or friends Submitting school assignments on time Concentrating for an entire lesson Finishing a book started
Leisure	13	6
being able to perform, but also getting it done			Bike riding Improving details in sports that a participant already engaged in (e.g., dribbling, kicking, shooting baskets, serving) Swimming Computer games Gym work-out Creative activities
Orienting oneself in one’s environment	7	3
being able to perform, or daring to do (not avoiding)			Using public transport Finding my way to … Moving about freely in my home Driving a wheelchair from school
Societal life	11	1
being able to perform, or to daring to do (not avoiding)			Talking to peers Shopping, handling money Being in time for …