BRIEF REPORT Pilot Randomized Controlled Trial Investigating Cognitive Strategy Use to Improve Goal Performance After Stroke Helene J. Polatajko, Sara E. McEwen, Jennifer D. Ryan, Carolyn M. Baum KEY WORDS  cognition  goals  problem solving  stroke  task performance and analysis 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 5 4) or SOT (n 5 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 5 .02; COPM Performance, p 5 .02) compared with SOT but no improvement in satisfaction (COPM Satisfaction, p 5 .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. Polatajko, H. J., McEwen, S. E., Ryan, J. D., & Baum, C. M. (2012). Brief Report—Pilot randomized controlled trial investigating cognitive strategy use to improve goal performance after stroke. American Journal of Occupational Therapy, 66, 104–109. doi: 10.5014/ajot.2012.001784 Helene J. Polatajko, PhD, is Professor, Departments of Occupational Science and Occupational Therapy, Graduate Department of Rehabilitation Science, Neuroscience Program, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON. Sara E. McEwen, PT, PhD, is Research Scientist, St. John’s Rehab Hospital, and Assistant Professor, Department of Physical Therapy, University of Toronto St. John’s Rehab Hospital, 285 Cummer Avenue, Room S340, Toronto, ON M2M 2G1 Canada; sara.mcewen@utoronto.ca Jennifer D. Ryan, PhD, is Senior Scientist, Rotman Research Institute at Baycrest, and Associate Professor, Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON. Carolyn M. Baum, PhD, is Professor, Occupational Therapy and Neurology, and Elias Michael Director, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO. S troke is the most serious disabling condition in the United States and the developed world (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006; Murray & Lopez, 1997). Long-term outcomes fol- lowing stroke are poor. About two-thirds of patients living in the community 6 mo after the event report participation re- strictions (Mayo, Wood-Dauphinee, Co ˆte ´, Durcan, & Carlton, 2002), and about half remain dependent in activities of daily living (Appelros, Samuelsson, Karlsson- Tivenius, Lokander, & Tere ´nt, 2007; Mayo et al., 2002); patients report still further decline in participation over the following 2 to 4 yr (Desrosiers et al., 2006). Even after inpatient rehabilitation, most people do not achieve their functional goals following a stroke (Brock et al., 2009). To improve functional outcomes for people with stroke, a new intervention paradigm must be found that shifts the focus from traditional component-focused rehabilitation to more comprehensive, ho- listic approaches that, at a minimum, support maintenance of therapeutic gains postrehabilitation and, optimally, support the generalization and transfer of skills that will lead to continued improvement, rather than further deterioration, over time. To address this need, our research group explored the utility of a goal-oriented, cognitive-based approach, Cognitive Ori- entation to daily Occupational Performance (CO–OP; Polatajko & Mandich, 2004), to improve performance in self-selected func- tional goals in people living with the effects of stroke. CO–OP is a complex treatment ap- proach that combines task-specific training and cognitive strategy use in a novel, client- centered manner. Clients self-select three skills to be the focus of treatment. An ad- aptation of Meichenbaum’s problem- 104 January/February 2012, Volume 66, Number 1 Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/929905/ on 06/21/2017 Terms of Use: http://AOTA.org/terms