Does a Cognitive Orientation to daily Occupational Performance (CO-OP) treatment approach benefit adults with Parkinson’s Disease?

Participants will be randomly assigned to either the CO-OP intervention or a waitlist control group with a blocked allocation, stratified by scores on Addenbrooke's Cognitive Evaluation, third edition (ACE-III), by a computer-generated randomization schedule. One-to-one CO-OP training will be carried out by a CO-OP certified occupational therapist in the participant’s home environment, as per the CO-OP intervention protocol. The intervention group will receive 20 hours of CO-OP intervention based on the adapted intensive protocol for use with adults with traumatic Brain Injury (TBI),delivered over 10 weeks. Two one-hour appointments will be scheduled each week for the ten-week intervention period. Intervention will focus on the three top priority goals identified by the participant during completion of the Canadian Occupational Performance Measure (COPM) and sessions will follow the session plan outlined. The intervention protocol will be standardized to ensure consistency between participants and within intervention conditions. A client binder will be provided to each participant to keep in their homes over the duration of the intervention. The client binder contains study information, intervention schedule, goal tracking sheets, generalisation sheets and a daily activity log. Once the individualised goals have been established, baseline performance established and the global strategy taught, each session proceeds in generally the same format. Each session will involve working on the participant's goals through practice and using the global strategy 'Goal, Plan, Do, Check' to increase awareness of deficits in performance, develop skills in making plans to compensate for these deficits, and appraise performance. The therapist takes on a coaching role and uses guided discovery to help participants realise for themselves what is going wrong, instead of telling them, then encouraging then to try different options (such as hand position, gaze direction, using reminders) to improve performance. Each session can be divided into 3 sections: Introduction, where introductions/greetings occur and the client binder is provided (session1) or reviewed (subsequent sessions), the session content, which varies from session to session but follows the basis above with practicing goal activities and using the global strategy, and closure where the key session items are summarised, Goal-Plan-Do-Check is reviewed, participants rate their levels of effort and enjoyment and homework activities are outlined. Homework is carrying out plans developed to support goal activities, and checking whether they worked, and modifying the plan to make more effective if not. Session documentation will occur following each intervention session. The therapist field notes and CO-OP fidelity scales will be completed each session and will be used for feasibility aspects of the study and qualitative analysis.