Intellectual Disability, Mild
Conditions
Keywords
adolescents, executive function, metacognition, mild intellectual disability, occupational therapy, occupational performance, person-centered intervention, self-efficacy
Brief summary
Intellectual disability (ID) affects a person throughout life and includes difficulties to manage what is expected in everyday life based on age. One difficulty is to create strategies for and solve problems related to everyday occupations. Treatment options with good evidence to enhance occupational performance for persons with ID are limited. The Cognitive Orientation to Daily Occupational Performance (CO-OP) is an approach with good evidence within other diagnostic groups, i.e. adolescents with cerebral palsy. CO-OP has a unique person-centered approach where the person chooses his/her own goals and creates his/her own strategies to reach them. Initial research shows potential for CO-OP with adolescents with ID, although due to scientific flaws there is still a lack of evidence regarding feasibility and effectiveness for adolescents with ID. Based on the results with other diagnostic groups and clinical knowledge and experience, CO-OP can be assumed to be feasible and effective for adolescents with ID and to have a long term effect transferred to everyday life in a way other treatment options do not. The aim of the project is to describe and evaluate CO-OP for adolescents with mild ID. Participants will be adolescents aged 13-17 and their parents. The project is designed as a feasibility study with two qualitative, one quantitative and one mixed method data collection. The quantitative data will be ordinal and nominal data from observational and self-assessment assessments. The mixed methods include comparison between filmed sessions and the CO-OP manual, use of field notes to analyse fidelity and needs for adaptations, and comparison between the CO-OP manual and policy documents. The qualitative outcome will be experiences by the adolescents and perceptions of CO-OP by parents.
Interventions
OTHERThe Cognitive Orientation to Daily Occupational Performance Approach
CO-OP is a client-centred, performance-based, problem-solving focused, occupation-focused and occupation-based intervention. In CO-OP the person is guided to use a meta-cognitive strategy to find his or her own strategies for specific activities. The main purpose is to enable meta-cognitive thinking in every day activities, leading to enhanced self-efficacy, occupational performance and independency.
Sponsors
Landstinget i Värmland
Göteborg University
Stiftelsen Sunnerdahls Handikappfond
Stiftelsen Sävstaholm
Majblommans riksförbund
Örebro University, Sweden
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Masking description
One of the outcomes will be assessed using video from baseline, post and 6 months post intervention, and the assessor of those videos will be blinded to the order and have no knowledge about the participant.
Eligibility
Sex/Gender
ALL
Age
13 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
Study I-II Inclusion criteria * 13-17 years * Diagnosed mild intellectual disability * Motivation to reach self-selected goals * Ability to identify those goals * Possibility to meet once a week for ten weeks * Access to a parent or significant other for support during intervention
Exclusion criteria
* Movement related diagnosis (i.e. cerebral palsy or neuro muscular diseases) * Diagnosed attention deficit hyperactivity disorder/attention deficit disorder (ADHD/ADD) or autism spectrum disorder * Progressive diagnoses * Need for language interpreting * Need for alternative and augmentative communication (i.e. pictures or signs). Study III Inclusion criteria: * 13-17 years * Diagnosed mild intellectual disability * Completed CO-OP intervention or at lest half way trough the intervention * Opportunity to meet physically for an interview with in a month post and 6 months post intervention. * CO-OP intervention done with high fidelity to CO-OP format with a CO-OP therapist that has written field notes, preferrably recruited from study I-II.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Performance Quality Rating Scale - occupational performance quality | Baseline, up to 4 weeks post intervention and 6 months post intervention | Observed performance quality during performing four chosen goal activities thas is filmed and rated 1-10. |
| Change in Canadian Occupational Performance Measure - performance | Baseline, up to 4 weeks post intervention and 6 months post intervention | Self-rated occupational performance in four chosen goal activities, rated 1-10 |
| Change in Canadian Occupational Performance Measure - satisfaction | Baseline, up to 4 weeks post intervention and 6 months post intervention | Self-rated satisfaction with performance in four chosen goal activities, rated 1-10 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Experiences of CO-OP as a patient - qualitative | Up to 4 weeks post intervention and 6 months post intervention | Qualitative semi-structured interviews analyzed using qualitative content analysis. |
| Change in General Self-Efficacy Scale - self-efficacy | Baseline, up to 4 weeks post intervention and 6 months post intervention | Self-rated self-efficacy, 10 statements rated 1-4. |
| Perceptions of CO-OP as a parent of a patient - qualitative | Up to 4 weeks post intervention and 6 months post intervention | Qualitative semi-structured interviews analyzed using phenomenographic analysis |
Other
| Measure | Time frame | Description |
|---|---|---|
| Feasibility: Acceptability | Up to 4 weeks post intervention and 6 months post intervention | Acceptability will be evaluated by structured interviews. The interview consists of five yes/no questions and a 10 point scale on how much effort the CO-OP intervention required. Data will be on nominal and ordinal level. |
| Feasibility: Adaptation | Up to 1 year after intervention. | Whether the CO-OP approach needs any adaptations in order to be feasible for adolescents with mild intellectual disability will be evaluated. This will be done by collecting field notes written by CO-OP therapists and a text analysis with descriptive comparison between notes and the CO-OP manual. |
| Feasibility: Possible expansion to a new group | 2024-2025 | Qualitative text analysis in which contents of the CO-OP manual will be compared with norms and values in the national policy documents for children and youth habilitation. This is carried out to evaluate whether it would be possible to expand this intervention to a new group of patients (adolescents with mild intellectual disability). The data collection is not related to the individual participants. |
Countries
Sweden
Contacts
Primary ContactElin Widmark, MSc
Backup ContactMarie Holmefur, PhD
Outcome results
None listed