The first aim of this study is to determine the feasibility of delivering CO-OP remotelyto individuals experiencing cognitive impairments that limit everyday activities inpost-COVID-19 syndrome (PCS). The second aim of this study is to assess the effect ofCO-OP on activity performance, subjective and objective cognition, and quality of life ina sample of individuals with PCS. The research team hypothesizes that effect sizeestimations will indicate that CO-OP will have a greater positive effect, compared to aninactive control group, on activity performance, subjective and objective cognition, andquality of life in a sample of individuals who self-report PCS and cognitive impairment.
Post-COVID-19 symptoms (PCS) cognitive symptoms require the rehabilitation community to
investigate ways to: (1) reduce the functional impact of the symptoms on daily life and
(2) support individuals with PCS to establish new habits to improve and maintain health.
While the cognitive impairment associated with PCS has not been well evaluated, it is
similar of cognitive symptoms seen in other conditions. Metacognitive strategy training
(MCST) approaches are an evidence-based practice standard for improving capacity to
self-manage chronic cognitive symptoms and reduce their functional impact on everyday
life activities.
The CO-OP approach is an MCST intervention in which participants are taught a general
cognitive strategy that can be applied in known and novel contexts to devise task
specific strategies for engaging in an activity. Existing evidence with other populations
suggests that CO-OP has more of a positive effect on improving activity performance and
cognition than remediation/retraining-based approaches. These effects have been
demonstrated in individuals with mild cognitive impairment that mirrors that found in
PCS. The overall research hypothesis is that CO-OP can feasibly be administered remotely
and will improve activity performance, subjective and objective cognitive function, and
quality of life in individuals with PCS.
Behavioral: CO-OP Procedures
CO-OP is a metacognitive strategy training intervention that will be used in this study.
First, five functional, everyday life goals are identified collaboratively by the
participant and interventionist. In the second meeting, we introduce the approach to the
subject and teach the global cognitive strategy (i.e., GOAL-PLAN-DO-CHECK). In all
subsequent sessions, this strategy is used as the main problem-solving framework to
facilitate skill acquisition.The subject identifies a GOAL, and then is guided by the
therapist to discover a PLAN to potentially achieve the goal. The subject is then asked
to DO the plan (if feasible during the therapy session otherwise asked to complete at
home prior to the next treatment session), and subsequently to CHECK to see if the plan
worked, i.e. the goal was achieved. This process is repeated until satisfactory
performance is met for each established goal.
Behavioral: Inactive Control Group
An inactive control group will be used to control for maturation and testing effects.
Weekly contact will be made via teleconferencing to (1) maintain study engagement, (2)
introduce weekly social contact with researchers, mimicking some of the potential
incidental effects of the experimental group, and (3) ascertain what, if any, additional
steps participants have taken to reduce PCS symptoms. The content of each of these
meetings will be tracked in intervention notes. Each contact will be recorded for
fidelity monitoring to ensure all active ingredients of the CO-OP intervention are
avoided.
Inclusion Criteria:
- self-reported cognitive symptoms persisting for at least 6 weeks following COVID-19
infection (Cognitive Failures Questionnaire (CFQ) score >43)
- self-identified activity performance goals per the Canadian Occupational Performance
Measure (COPM)
- documented prior diagnosis of COVID-19
- read, write, and speak English fluently
- ability to provide valid informed electronic consent
Exclusion Criteria:
- diagnosis of severe neurological or psychiatric condition(s)
- dementia symptoms as indicated by a score of <23 on the Montreal Cognitive
Assessment (MoCA)
- untreated sleep apnea (≥5 on the STOPBANG)
- prior cancer treatment
- severe depressive symptoms (>21 on the Patient Health Questionnaire-9)
University of Missouri Department of Occupational Therapy
Columbia, Missouri, United States
Investigator: Anna E Boone, PhD, OTR/L
Contact: 573-882-7023
booneae@umsystem.edu
Anna E Boone, PhD, OTR/L
573-882-7023
booneae@umsystem.edu
Juliana H Earwood, OTD, OTR/L
573-884-6681
jmhudson@health.missouri.edu
Anna E Boone, PhD, OTR/L, Principal Investigator
University of Missouri Occupational Therapy