Background: Stroke is the third leading cause of permanent disability worldwide. It is associated with difficulties in occupational performance, an area targeted by the Cognitive Orientation to daily Occupational Performance (CO-OP).

Objective: To investigate the evidence available for the effectiveness of the CO-OP in addressing adults’ performance of activities of daily living.

Data Sources: Randomized controlled trials (RCTs) or pilot RCTs of the CO-OP written in English and published through December 2021 were retrieved from PubMed, SCOPUS, ScienceDirect, OTseeker, and EBSCO.

Study Selection and Data Collection: The studies’ participants were adults with stroke, evaluated on occupational performance before and after CO-OP administration. The American Occupational Therapy Association Evidence-Based Practice Project methodology was followed. Quality appraisal was conducted using the Cochrane Collaboration’s Risk of Bias 2 tool.

Results: Four RCTs and 3 pilot RCTs met the inclusion criteria. Inconsistent results are presented for trained and untrained goals, with the last ones being scarcely investigated.

Limitations: The limited number of studies, combined with the methodological limitations observed, did not allow for definite conclusions to be reached.

Conclusions and Relevance: The CO-OP is a promising client-centered, occupation-based approach, but future adequately powered studies addressing the potential for generalization are needed.

Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance is a relatively new treatment method that uses cognitive techniques to guide patients into discovering ways to perform activities of daily living independently. This systematic review presents the available evidence regarding CO-OP’s effectiveness when used with adults after stroke. The findings showed that CO-OP has a positive impact in this population, but further research is needed to reach more concrete conclusions. Stroke patients may benefit from CO-OP because it can be a cost-effective, short-duration, task-oriented treatment.

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