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Background: Multiple sclerosis is the most important cause of non‐injury‐related disability in young adults. The disease has unknown causes and distresses and affects daily activities. While therapeutic interventions mainly focus on body function and structure to reduce impairment, Cognitive Orientation to Daily Occupational Performance (CO‐OP) is a cognitive approach that provides intervention at the level of activity and participation. Purpose: We aim to examine the effects of CO‐OP approach on fatigue, quality of life, occupational performance, and satisfaction in people living with multiple sclerosis; and to examine whether they could transfer strategies and skills learned during CO‐OP to untrained goals. Methods: A pre‐post design was used. Assessment tools included Montreal Cognitive Assessment, Multiple Sclerosis Impact Scale, Fatigue Impact Scale and the Canadian Occupational Performance Measure. Six individuals living with multiple sclerosis participated in 10 CO‐OP sessions twice a week. The sessions were held in an environment of the participants' choice, along with an extra session added to determine the goals. The study was registered in the ethics committee of University of Social Welfare and Rehabilitation Sciences (IR.USWR.REC.1399.089). Results: The performance improved (2‐point positive change) in 12 out of 18 trained goals and in three out of six untrained goals (self‐report). The improvement was maintained at a 3‐month follow‐up assessment. There was a statistically significant difference in Canadian Occupational Performance Measure (χ2 = 11.565, p = 0.003 same for performance and satisfaction scores), Fatigue Impact Scale (χ2 = 7.000, p = 0.030), and Multiple Sclerosis Impact Scale scores over time (χ2 = 9.478, p = 0.009) respectively. Conclusion: The CO‐OP approach has the potential to improve daily activity performance, reduce pain, and improve the quality of life for people living with multiple sclerosis. A definitive randomised controlled trial is required. [ABSTRACT FROM AUTHOR]