'There's a real plan here, and I am responsible for that plan': participant experiences with a novel cognitive-based treatment approach for adults living with chronic stroke.

PURPOSE: This study was part of a larger mixed methods project aimed at adapting the Cognitive Orientation to daily Occupational Performance (CO-OP) treatment approach, originally designed for children with performance problems, for use with adults with stroke. In CO-OP, the client focuses on learning strategies and skills, rather than on remediating impairments. Therapists use guided discovery to teach cognitive strategy use. The purpose of this study was to explore participants' experiences with the approach.
METHOD: Semistructured interviews were conducted with five participants. Transcriptions were coded by two members of the research team. Data analysis was conducted in two distinct phases: Directed content analysis was conducted to apply codes to predetermined categories; Thematic analysis was conducted to allow themes grounded in the data to emerge.
RESULTS: Participants reported learning and transferring the strategies taught, and made suggestions for modifications to the approach, such as increasing the number of sessions. One theme emerged, Balancing the need for autonomy with the need for support.
CONCLUSIONS: The findings suggest the cognitive strategies were well learned and effectively used. CO-OP was able to provide participants with increased decision-making autonomy, but may require modifications to better support their transition to higher levels of independence.