Occupational Therapy Services Research Articles

Occupational therapy and chronic pain - the didactic experience at academic pain league at the University of São Paulo medical school

Occupational Therapy interventions for people with chronic pain focus on promoting independence/autonomy and rescuing meaningful activities (interrupted after the limitations brought about by illness). Various strategies can be used, such as: guidance on energy conservation and joint protection techniques, prescription and/or manufacture of positioning devices, prescription and/or manufacture of assistive technology equipment, development of creative and expressive activities, training activities of daily living, environmental assessment, guidance for family members and caregivers. This article aims to present the implementation of the Occupational Therapy Service at the FMUSP Pain League, developed since 2023. The work focused on implementing Occupational Therapy as one of the professions that make up the FMUSP Pain League, on a permanent and continuous basis; and, in addition, allow undergraduates teaching opportunities (theoretical and practical) related to the multidisciplinary care of people with chronic pain, as well as promoting research actions in the area of ​​Occupational Therapy and Chronic Pain. In OT, a student and the supervising teacher work, together with the multidisciplinary team. Activities are weekly and take place at night. Remote and in-service supervision is carried out. The implementation took place in 3 stages. In the first stage, we sought to understand the dynamics of the league, as well as characterize the patients and their specific demands, through participant observation. The second stage was structured around the specific OT intervention; evaluations of league users were carried out, with the application of evaluation and recording instruments. The third stage focused on monitoring patients and families, with new assessments carried out when necessary. Interventions follows through individual plan care, family guidance, development of educational material, prescription and/or production of assistive technology devices. The service uses a specific evolution form and the data feeds into a service database. We consider that the results obtained are satisfactory, as theoretical and practical learning was possible for the participating student. Currently, Occupational Therapy is already part of the League's routine activities, with participation in the Introductory Course, in the Board of Directors and in planning activities for 2024.

"Why is it not bringing me meaning and purpose?" Former occupational therapists' narratives of leaving the profession.

The demand for occupational therapy services in Australia has experienced considerable growth in the last decade. Despite an increase in occupational therapy numbers, there remains a substantial workforce shortage. One reason for this shortage is difficulty with the retention of occupational therapists and subsequent workforce attrition. The literature attributes planning to leave as being influenced by high workloads, insufficient time, a negative workplace culture, and stress impacting well-being. However, much of this research is specific to a practice area, such as mental health, and does not explore the experiences of those who have already left. Knowing why people leave occupational therapy will inform our understanding of how to support and retain our occupational therapy workforce. A qualitative study was undertaken using narrative inquiry in an Australian context. In 2022, stories were gathered from six former occupational therapists who left within the previous 5 years. Data were collected via semi-structured in-depth interviews using Zoom. Interviews were recorded and transcribed verbatim. The data were analysed using narrative and thematic analysis. Four themes were developed: "I just want to help this person"; "there was no real understanding"; "Trying to find where occupational therapy fits for me"; and "I'm not able to continue … anymore." Participants experienced dissonance between enacting their occupational therapy values and the expectations of their management. They were challenged by unsupportive workplace cultures and leadership styles that undermined their autonomy. They responded with resilience, and trying new ways to continue being occupational therapists, but became increasingly uncomfortable and stressed until they reached a tipping point where they decided to leave. Increasing leadership development within the profession is essential, along with creative strategies for meeting funding requirements and fulfilling occupational therapy values. Workplaces that provide autonomy and respect the occupational therapy role are likely to support retention.

Occupational therapy assessments and interventions for patients with ankylosing spondylitis: a scoping review protocol.

The proposed scoping review aims to explore the literature on the occupational therapy (OT) scope of practice for patients with ankylosing spondylitis (AS), including assessment methods and intervention approaches used by OT practitioners, areas of impairment addressed, and practice settings where OT practitioners provide services. AS is a type of spondyloarthritis primarily involving inflammation of the spine. Studies have begun to examine the role of OT in addressing pain, function, and disability among AS patients. Given the increased recognition of OT services for this population, a comprehensive understanding of the assessment methods and intervention approaches used by OT practitioners when working with AS would benefit clinicians, providers, and patients and support future research efforts. The review will consider studies that include participants of any age diagnosed with AS and any form of OT assessment and intervention. All relevant published and unpublished studies will be considered, without date or language limitations, including all primary studies, gray literature, text and opinion papers, and clinical guidelines. The review will follow the JBI methodology for scoping reviews. Searches will be conducted in MEDLINE (PubMed), Embase, CINAHL (EBSCOhost), Scopus (EBSCOhost), PsycINFO, ProQuest Dissertations and Theses Global, SportDiscus (EBSCOhost), OTDBase, OTSeeker, and Google Scholar. Two independent reviewers will extract data from selected papers using a standardized tool modified for the review. The results will be presented using frequency tables and will be accompanied by a narrative summary. https://doi.org/10.17605/OSF.IO/VPY56.

Impacts of social media use on occupations of youths with hearing disability in a special education school in upper northern Thailand

Background: Social media have been used increasingly in the daily lives of the global population. Youths with hearing disability participate in many activities through social media, as do those in general. However, due to their hearing loss, they may experience different impacts, particularly in the special education context. Objective: The purpose of this study was to investigate the impacts of social media use on occupations of youths with hearing disability, and the relationship of activity limitation and participation restriction in the special education school context. Materials and methods: The participants comprised 92 youths with hearing disability, who were studying in a special education school. The research instrument was a questionnaire in two forms: paper-based and a sign language video clip. It was presented with acceptable content validity (IOC=0.60-1.00), good internal consistency reliability (α=0.88) and moderate stability reliability (ICC=0.70). Results: Results showed that most of the participants had their own smart phone and used a hearing aid for access to social media. Frequency of social media use was daily for 1-3 hour(s) per day. Overall, most of the participants had no activity limitation or participation restriction in their occupations, but they showed a minimal level of limitation and restriction in education. In terms of social media use, most of the youths presented a positive impact on occupations, particularly in social participation. The overall results indicated the relationship between activity limitation and participation restriction and impacts of social media use on occupations (r= -0.293, p=0.005). When considering each type of occupation, the results indicated the relationships of education, work, and social participation significantly. Conclusion: The findings of this study revealed the relationship between activity limitation and participation restriction and overall impacts of social media use on occupations. These findings were applied to social media use, particularly in parts of the text and virtual networks, as an optional channel for providing occupational therapy services and accessing meaningful occupations for youths with hearing disability.

Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan.

Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel etal., 2021; Kenny etal., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.

A Profile of Occupational Therapists Working in School-Based Practice in Australian Primary Schools.

Inclusive education has increased the demand for school-based occupational therapy services and has reconceptualised the practice in mainstream schools. Therapists are now expected to work collaboratively with teachers within tiered intervention models to support access and participation of all students, including those with disabilities, within the natural classroom context. School-based occupational therapy has become a specialised area of practice, as therapists work within educational, rather than health, systems and processes. While the growth in demand and expanded scope of practice is positive for the profession, predicted workforce shortages and the necessity for specialised and enhanced practice present significant challenges. The ability of the profession to fully support the demands of an inclusive education system remains unclear. As accurate, up-to-date information on the school-based therapy workforce is the foundation for planning future personnel needs, knowledge of the current state of the workforce is critical. There is a paucity of national data regarding this growing area of practice. The aim of this study is to describe a current profile of school-based occupational therapists to better understand the workforce, practice patterns, and the funding landscape in Australia. A convenient and purposive sample of 108 Australian paediatric occupational therapists working in mainstream primary schools in New South Wales, Queensland, and Victoria was surveyed in this quantitative study, which was analysed using descriptive statistics. Results provide some insights into the workforce and practice of school-based therapy in Australia offering preliminary data for future planning in this important and growing area of paediatric practice. While specific to the local context, results invite cross-national and global comparison to reveal universal trends and localised nuances across diverse settings.

Person and Environment Factors Supporting Self-Care Performance and Social Participation After Mild Stroke.

Mild stroke survivors seldom receive occupational therapy services as their deficits are assumed to be minor enough to not affect their daily occupations. Yet many mild stroke survivors report deficits in self-care performance and social participation. This study investigates person and environment factors influencing self-care performance and social participation among mild stroke survivors, using the Person-Environment-Occupation-Performance (PEOP) model. A retrospective cohort analysis of 736 mild stroke survivors was conducted using electronic health records. Person factors included demographic characteristics and clinical characteristics, and environment factors included the Social Vulnerability Index. The analysis included logistic regression. Approximately, 10% of patients reported deficits in self-care or social participation. Disability level was the only person factor associated with self-care performance. Person factors affecting social participation included mobility and unemployment. Socioeconomic status was associated with both occupation measures. Occupational therapy practitioners must address the person and environment factors affecting mild stroke survivors' self-care performance and social participation.

Using Electronic Health Record Data for Occupational Therapy Health Services Research: Invited Commentary.

Health services research (HSR) is a field of study that examines how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and health and well-being. HSR approaches can help build the occupational therapy evidence base, particularly in relation to population health. Data from electronic health record (EHR) systems provide a rich resource for applying HSR approaches to examine the value of occupational therapy services. Transparency about data preparation procedures is important for interpreting results. Based on our findings, we describe a six-step cleaning protocol for preparing EHR and billing data from an inpatient rehabilitation facility for research and provide recommendations for the field based on our experience. Using and reporting similar strategies across studies will improve efficiency and transparency, and facilitate comparability of results.

Teachers’ Perspectives on Best Occupational Therapy Service Provision in School-Based Practice: A Qualitative Study

ABSTRACT There is currently limited evidence regarding teachers’ perspectives of push-in and pull-out occupational therapy services in the school-based setting. Occupational therapy services can be delivered in different combinations and often vary based on the needs of the student, needs of the teacher and classroom, need for academic time, and need for social interactions. To examine teachers’ perspectives of push-in and pull-out services, a qualitative approach was used. Thirty-nine participants were recruited using a combination of convenience, snowball, purposive, and voluntary response sampling. Data was collected via a multiple choice and open response online survey. Thematic analysis was completed with the identification of six themes. Pros and cons of both push-in and pull-out service delivery, carryover, and modifications were discussed. Conclusively, most teachers preferred a combination of push-in and pull-out services, highlighting the importance of communication, collaboration, carryover, and finding the just-right fit for each student to best support their needs and learning styles. The findings of this study will better provide school-based occupational therapy practitioners with context for selecting the most appropriate service delivery model for each student.

Occupational therapy students' perceptions of their experience in a role-emerging Level II fieldwork within higher education student services

BackgroundRole-emerging settings – those where occupational therapy (OT) services have not traditionally been provided – are common sites for practice placements of entry-level occupational therapy students. A growing body of literature has attempted to determine the value and drawbacks of such practice placements on the professional preparedness of OT students with mixed findings. Benefits have been identified, including increased cultural understanding, advocacy, creativity, initiative, and problem-solving skills. However, OT students have been reported to perceive such placement as limiting their professional growth and preparedness to practice compared to traditional placements.MethodsA phenomenological study was conducted seeking the perceptions of OT students (n = 14) about their clinical placement at a role-emerging site. Recorded semi-structured interviews were conducted by trained interviewers within two weeks of the end of clinical placement. The recordings were transcribed verbatim and then coded using an iterative multi-coder inductive approach. Inter-coder agreement, reflectivity, and audit trail were maintained.ResultsThree themes emerged from the analysis: (1) integrating independence and support, (2) becoming occupational therapists, and (3) filling a gap. These themes reflect students’ positive perceptions of their role-emerging clinical placement. They felt that this placement allowed them to develop self-confidence and professional identity as occupational therapists and learn new skills while simultaneously filling a gap in services for clients. Most importantly, they felt that this placement prepared them for their future OT practice.ConclusionThis finding and their resounding support of the experience suggest that OT students can perceive role-emerging placement as a solid foundation for clinical practice. Factors, included in this placement, that may have contributed to their experience include the level of support provided, time available for learning including space to make mistakes, and freedom from productivity and payor requirements.

Therapy deserts—a call to action to address inequitable access to therapy services among pediatric orthopaedic patients

Background"Food deserts" are areas with limited access to affordable and healthy foods, disproportionately affecting low-income and ethnic minority communities in the United States. Analogous disparities exist in other disciplines. Our interprofessional team observed "therapy deserts” in orthopaedic and rehabilitation settings, wherein pediatric patients (particularly those with Medicaid-type insurance) appeared to lack equal access to physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services. Inadequate access to therapy services places patients at risk for worse outcomes. MethodsWe conducted a quality improvement project to assess pediatric patients’ access to therapy care in our region. We surveyed all local PT, OT, and SLP clinics identified from a comprehensive listserv maintained by pediatric therapy teams in our institution. Using a scripted questionnaire, we contacted 113 PT, 38 OT, and 82 SLP clinics external to our institution, collecting data on accepted conditions, appointment waitlist periods, and accepted insurance types. Our primary objective was to determine the percentage of clinics that accepted patients with Medicaid-type insurance. We supplemented our survey with an examination of the Area Deprivation Index (ADI) for each clinic location. Results59 PT clinics (52%), 15 OT clinics (39%), and 36 SLP clinics (44%) completed the survey. Clinics often had limited capacity to care for medically complex conditions. Waitlist times varied, with a median wait of 1 week for PT services, 1 month for OT services, and immediate availability for SLP services. Only 14% of responding PT clinics, 53% of OT clinics, and 22% of SLP clinics accepted patients with Medicaid-type insurance. Insufficient reimbursement rates were frequently cited as the reason for not accepting Medicaid-type insurance. Waitlist times were longer for PT and SLP clinics that accepted Medicaid-type insurance compared to those that did not. Moreover, clinics that accepted Medicaid-type insurance were, on average, in more disadvantaged locations. ConclusionsOur findings suggest the existence of “therapy deserts,” where limited access to therapy services is influenced by insurance type and patient complexity. These restrictions likely exacerbate existing health disparities and illustrate a systemic problem rooted in complex social drivers of health. Addressing "therapy deserts" requires collaborative efforts from multidisciplinary teams. Level of EvidenceLevel III

Quality and Quantity of Occupational and Physical Therapy Services in a Free Interprofessional Primary Care Clinic

Quality and Quantity of Occupational and Physical Therapy Services in a Free Interprofessional Primary Care Clinic

Pediatric Occupational Therapists' Perspectives on Sleep: A Qualitative Descriptive Study.

Insufficient sleep is common among children seeking occupational therapy services but is rarely a focus of therapy despite sleep's critical impact on health. To examine pediatric occupational therapists' experiences, views, and confidence in addressing sleep concerns in their practice as well as barriers to and supports for doing so. A qualitative descriptive study with thematic analysis of data from 1-hr virtual interviews. Rapport building, multiple-coder analysis, and member checking were used to ensure reliability and validity. Interviews were conducted remotely at each participant's preferred time and location. Pediatric occupational therapists (N = 20) practicing across multiple settings in the United States were recruited through emails directed to their place of work and social media posts. A goal of 20 participants was set a priori with the goal of thematic saturation. A semistructured interview guide. Participants were predominately cisgender (95%), female (85%), and White, non-Hispanic (90%). Overall, they voiced the importance of sleep but reported almost never writing sleep-related goals. Reported barriers that affected the participants' ability to fully address sleep in practice included therapists' lack of confidence and knowledge and low caregiver buy-in. The findings identify themes on the basis of which actionable steps toward promoting occupational therapists as sleep champions can be developed. Future implications include increasing sleep education opportunities, enhancing awareness of sleep health's impact on goal areas, and facilitating discussions about occupational therapy's role within the medical system and family system in supporting sleep. Plain-Language Summary: This qualitative study identifies what helps and hinders occupational therapists in addressing the sleep health concerns of their clients. We give occupational therapy clinicians and educators key supports to seek out or barriers to address.

School - base Occupational Therapy Services on Activity Limitation and Participation Restriction in Students with Disabilities

School - base Occupational Therapy Services on Activity Limitation and Participation Restriction in Students with Disabilities

Acute Inpatient Rehabilitation Functional Outcomes and Disposition After Liver Transplant

ObjectiveTo describe the outcomes (change in functional independence and discharge disposition) of patients who after liver transplantation received acute inpatient rehabilitation in a freestanding rehabilitation hospital. DesignA retrospective chart review was conducted of patients admitted to an acute inpatient rehabilitation hospital within 6 months of undergoing liver transplantation between January 2014 and December 2018. Change in function from rehabilitation admission to discharge was measured using FIM Change and FIM Efficiency. SettingA freestanding rehabilitation hospital. Participants107 patients who underwent acute inpatient rehabilitation at a freestanding rehabilitation hospital within 6 months after liver transplantation who met inclusion criteria (N=107). Most were men (71.96%), and the mean age of the patient population was 62.15 years. InterventionsAcute inpatient rehabilitation consisting of at least 3 hours of therapy 5 days a week split between physical therapy, occupational therapy, and speech language pathology services. Main Outcome MeasureFIM Change, FIM Efficiency, Discharge Disposition. ResultsParticipants were found to have statistically significant positive FIM Change (P<.00001) and FIM Efficiency (P<.00001). The mean FIM Change and Efficiency were 35.7±11.8 and 2.4±1.0, respectively. 83.2% (n = 89) were ultimately discharged to the community. ConclusionAcute inpatient rehabilitation provides patients who have received a liver transplant with the opportunity to measurably improve their function and independence, with most patients being able to return home.

Lessons learned from an occupational therapy programme needs assessment

Background: A needs assessment identifies the differences between actual and ideal situations to facilitate the development of a new programme or improve existing services.Objectives: This article shares our experiences conducting the needs assessment in a context where people had limited or no understanding of the need being assessed.Method: Adhering to a three-phase model – comprising pre-assessment, assessment, and post-assessment – we employed diverse data collection methods, including quantitative survey, qualitative interviews, and environmental scan.Results: The findings underscored the necessity of expanding rehabilitation services in Ethiopia, with a shift from a purely medical focus to addressing issues associated with daily functioning and community engagement. These issues align closely with the core expertise and responsibilities of occupational therapists. Participants expressed support for the introduction of occupational therapy in Ethiopia and willingness to incorporate the practice of occupational therapists in their settings. The challenges encountered were how to ask about occupational therapy when it is not well known by members of the local population and how to introduce the profession without biasing participants’ responses.Conclusion: Conducting a needs assessment was critical to developing occupational therapy services in Ethiopia. We welcome others to learn from our experiences.Contribution: This manuscript details the assessment process and delves into the challenges we encountered and lessons learned. It extends methodological suggestions to inform future evaluations and contributes valuable insights to the broader discourse on needs assessment and programme development in a context where people have limited awareness of services, such as occupational therapy.

Pre-Implementation Analysis of the Usability and Acceptability of a Poststroke Complex Telehealth Biofeedback Intervention.

Complex telehealth interventions can facilitate remote occupational therapy services and improve access for people living with chronic neurological conditions. Understanding the factors that influence the uptake of these technologies is important. To explore the fit between electromyography (EMG) biofeedback and telerehabilitation for stroke survivors, optimize EMG biofeedback interventions, and, more broadly, support other efforts to develop complex telerehabilitation interventions. Pre-implementation mixed-methods analysis of usability and acceptability data collected during a pilot and feasibility study. Community. Adult stroke survivors with hemiparesis (N = 11; M age = 54 yr). Game-based EMG biofeedback system for arm sensorimotor rehabilitation, delivered via telehealth. Post-Study System Usability Questionnaire, an extended Unified Theory of Acceptance and Use of Technology model questionnaire, and semistructured interview. We coded the interview data using questionnaire constructs. Participants used an EMG biofeedback intervention at home. Quantitative measures show high levels of perceived usability and acceptability, supported by qualitative findings describing specific facilitators and barriers. Pre-implementation studies can improve the design and relevance of complex telehealth interventions. One major conclusion from this study is the influence of therapy providers on acceptability and usability of complex telehealth interventions. Plain-Language Summary: This study contributes to an emerging body of literature that examines the use of complex telehealth interventions with survivors of neurological injury. The findings highlight the value and support the development and use of complex telehealth interventions, which have the potential to improve remote access to occupational therapy for clients living with chronic neurological conditions. Complex telehealth interventions can open doors for survivors of neurological injury who face barriers to accessing occupational therapy and would benefit from technology-enabled therapy at home.

Role of occupational therapy in person-centred dementia care: Exploring family member and clinician perceptions.

This study aimed to explore the role of occupational therapy in dementia facilities using a person-centred model of care, from the perspective of family members, occupational therapists and multidisciplinary health professionals. A descriptive qualitative approach was adopted, and all data were evaluated using thematic analysis. Semi-structured interviews were completed with eight family members and five multidisciplinary health professionals. Four occupational therapists practising in dementia care also provided qualitative data via an online survey. The analysis identified two key themes around perceptions of occupational therapy in person-centred dementia care. These themes were (1) the poorly defined scope of the occupational therapy role and (2) the perceived features of the occupational therapy role. While the perceptions and experiences of participants varied, the scope of this role is currently poorly defined. Occupational therapists in this setting commonly facilitate positive social interaction and present-oriented occupational engagement with residents and are also recognised as building workforce capacity with multidisciplinary colleagues. Without a clearly defined scope of practice, the role of occupational therapy in enabling health and well-being for people with dementia cannot be coherently articulated. This could lead to underutilisation of occupational therapy services, and lost opportunities for residents to experience improved health and well-being.

Enhancing occupational therapy service provision with military veterans through policy reform: Findings from a national survey.

Almost half a million Australians have served with the Australian Defence Force. Given the high prevalence of physical and mental health conditions and complexity of civilian life adjustment after military service, high-quality occupational therapy services are critical. However, there is limited description of occupational therapy service provision to individuals funded by the Australian Department of Veterans' Affairs to inform government policy. The aim of this study was to describe the practice of Australian occupational therapists working with former service members and identify opportunities to enhance practice and policy. A cross-sectional study using an online survey was conducted to collect information from occupational therapists providing services to Department of Veterans' Affairs clients. Frequency analyses were performed to describe quantitative data. Qualitative data were analysed using thematic analysis. No consumer or community involvement occurred. Participants included 123 Australian occupational therapists residing in metropolitan (47%), regional (28%) and rural/remote (23%) areas. Most occupational therapists (69%) had over 15 years of clinical experience and worked in private practice (87%). Common interventions included home modifications, equipment prescription and assistive technology (77%), goal-oriented rehabilitation (16%) and activities of daily living or function assessments and education (13%). Three themes describing practice issues were identified: (1) Service provision as rewarding yet underfunded, (2) Administrative complexity and lack of understanding of the occupational therapy role and (3) Need for specialist professional development opportunities. Australian occupational therapists are providing a range of services to Department of Veterans' Affairs clients although mostly relating to physical conditions. Occupational therapy practice with former Australian Defence Force members should be expanded to meet their diverse and complex needs. Further research and education are needed to support use of specialist knowledge and interventions. Advocacy by peak associations and policy reform are urgently required to ensure sustainable services, particularly in rural areas.

The Occupational Therapy Profession in Saudi Arabia.

To provide an evidence-based description of how the occupational therapy profession operates in Saudi Arabia. A case study methodology set out an evidence-based description of occupational therapy in Saudi Arabia. Three procedures were used: (1) a structured narrative review of publications on occupational therapy in Saudi Arabia based on searches of seven healthcare databases; (2) an audit of "grey literature" about or referring to occupational therapy education, practice, research, or the profession in Saudi Arabia using Google Scholar, Google search, official documents and websites, and relevant global organisation such as the WFOT website and documents; and (3) consultation with occupational therapists to further discuss emerging evidence from peer-reviewed articles and grey literature about occupational therapy in Saudi Arabia. Data were collected in Arabic and English. Findings. Occupational therapy in Saudi Arabia is a rapidly growing and emerging profession primarily focused on rehabilitation practice. Between 2010 and 2019, seven academic organisations commenced bachelor's degree programmes. Occupational therapy services in Saudi Arabia are concentrated in city-based secondary and tertiary healthcare services targeting rehabilitation and disability support. The practice aims to promote the reduction in impairment and increase activity performance and participation in valued life roles. Despite the increasing demand for occupational therapy services, there needs to be more access to and availability of their services. Enhancement of the awareness of occupational therapy among the public and other healthcare professionals is needed. A consistent definition of occupational therapy in Saudi Arabia would strengthen the profession, along with a national scope of practice, practice guidelines, increased workforce and development, and professional education information. Occupational therapy in Saudi Arabia is growing regarding the size of the workforce and the number of programmes and services provided, thus contributing to the health and well-being of the population primarily through rehabilitation. Further development of the profession is necessary.