Eficácia da Cognitive Orientation To Daily Occupational Performance Approach (Co-Op) com e sem adição de Occupational Performance Coaching em grupos para pais no desempenho ocupacional e na participação de crianças com transtorno do desenvolvimento da coordenação: ensaio clínico aleatorizado

Abstract

Children with developmental coordination disorder (DCD) often have difficulty performing daily activities at home and at school. Participation restrictions in active play and physical activities can have repercussions on physical and mental health, causing sedentary lifestyle, low self-esteem, low motivation and social isolation. Activity- and participation-oriented approaches have robust evidence of effectiveness. The Cognitive Orientation to Daily Occupational Performance Approach (CO-OP) is focused on teaching cognitive strategies for the children to improve performance in activities of their choice. One of its essential elements, the involvement of parents, has not yet been systematically investigated. Adding a specific support routine to parents contributes to better outcomes for the child post intervention? The main purpose of this thesis was to compare the effects of the addition of parent group coaching sessions to CO-OP Approach on activity performance and participation of children with DCD. The first paper presents the detailed description of the study protocol. The second paper presents the randomized clinical trial (RCT) with 22 children aged 7-12 years with DCD and their families, randomly assigned either to the experimental group (E-group) or active group (ACgroup), to compare the efficacy of CO-OP with and without the addition of coaching sessions in groups for parents. CO-OP with and without additional parental coaching resulted in statistically significant and clinically relevant gains on activity performance according to children, parents and external evaluators. Children improved on motor performance and cognitive flexibility. Participation measures did not change. There was no difference between groups in the main outcomes investigated. The third paper deals investigated the characteristics of children and parents, measured at baseline, that influence outcomes, that is, possible predictors of occupational, motor and cognitive flexibility post CO-OP. Exploratory analysis of ECA data indicated that optimal parental style, leads to better occupational performance and according to children and their parents and better cognitive flexibility. Better motor performance, leads to better occupational performance for parents and external examiners. The results demonstrated that participation and engagement in more intervention sessions as well as the support given during traditional CO-OP may be sufficient to support children's performance. Optimal parental style contributed to better children's occupational performance. Positive parenting practices may be predictive of better intervention outcomes in real-life contexts.