Occupational Participation Research Articles

Worldwide Survey on Digital Assistive Technology (DAT) Provision.

Occupational therapists have long been involved in assistive technology (AT) provision worldwide. AT is recognized by the World Health Organization (WHO) to enhance functioning, independence, and autonomy and ultimately promote well-being for people living with disabilities. With the digitalisation of societies, the everyday lives and occupations of individuals are changing, becoming more reliant on digital solutions. The development of digital assistive technology (DAT) also offers opportunities for people with disabilities to access, interact, and pilot the digital world. However, we do not know how occupational therapists are involved in DAT provision worldwide. A survey was conducted in the global occupational therapist's community in June 2022 to describe DAT provision and the factors influencing it. Occupational therapy practitioners were included (n = 660) in the analysis. In DAT provision, occupational therapists mostly provide advice to people, assess their needs, provide instruction or training, prescribe DAT, and fit DAT to people and their environment. The clients served through DAT provision are most frequently people with neurological impairments, chronic illnesses, sensory impairments, and older people. The reasons for providing DAT focus on education, work, school, and leisure. It is expected that DAT provision will enhance independence, self-esteem, occupational participation, and social relationships. Issues faced by occupational therapists when providing DAT are costs of product and funding schemes, sufficient knowledge, and access to knowledge sources. Survey respondents are mostly from Western countries with access to the Internet and the digital world, including having digital literacy, highlighting the digital divide that exists between world regions and countries, but also within countries worldwide. There is a need to continue research to better understand the issues related to digitalisation and the digital participation of people living with disabilities.

Occupational Therapy’s Role in Return to Occupations Post-Concussion in High School Athletes

Aim This study was designed to explore experiences of high school athletes in order to understand their occupational engagement after sustaining a sports-related concussion. The study explored the role occupational therapists (OTs) can play in post-concussion care while supporting adolescents in returning to meaningful occupations. Methods The study utilized a qualitative, phenomenological approach by conducting interviews with high school athletes to understand their participation in occupations during recovery. Six student-athletes from 14–18 years of age were interviewed. Results The five identified themes from the study included impacts on ADL performance, school performance, sleep, mental health, and driver safety. Student-athletes reported feelings of loneliness and loss of identity. Dressing, showering, grooming, and driving were disturbed due to balance deficits, headaches, and nausea. Participants reported decreased participation in social, sports, and leisure occupations due to heightened symptoms. Conclusions Due to the considerable variability of disturbance in occupational participation post-concussion, occupational therapists can assist in creating and implementing individualized treatment plans to support high school athletes while recovering from a sports-related concussion.

Occupational Therapy’s Opportunity to Impact Care at the End of Life

Navigating and managing the end of life can be difficult. The focus of occupational therapy in care at the end of life is to aid the patient and caregiver through these challenges by facilitating improved safety, comfort, and quality of life through the participation in meaningful occupations. Despite the ways that occupational therapy benefits these patients, occupational therapy involvement in care at the end of life is misunderstood, under-researched, and underutilized. There is a general lack of awareness regarding this topic and a stigma that occupational therapy focuses only on rehabilitation and therefore does not belong in care at the end of life. To combat these issues, there needs to be additional education and training for all healthcare professionals, including occupational therapy practitioners, about occupational therapy’s role in care at the end of life. Occupational therapy professionals in this area of practice must strive to educate others and advocate for their role to improve the understanding of this practice area and thus positively impact more patients and families.

Does joint land ownership empower rural women socio-economically? Evidence from Eastern Nepal

Joint Land Ownership (JLO) is increasingly important for empowering women and improving their socioeconomic well-being. However, there is a lack of empirical research on this topic. Utilizing panel data from 2015 to 2020 and employing the Binary Logit Model, this study examines the socioeconomic and empowerment status of rural women who have JLO in the Sunsari district of Nepal. Particularly, we used a quasi-experimental research design and pretest and posttest research models to assess the empowerment status of rural women before and after the implementation of JLO. The results indicate a significant increase in monthly savings (270%) among women who have a JLO, as well as improved access to credit (241%), income (87%), participation in cooperatives (69%), entrepreneurship (56%), decision-making (56%), occupation (22%), and overall improvement in their socioeconomic conditions (16%). The women's participation in the JLO program also has increased by 77% in rural areas and 23% in urban areas. Furthermore, logistic regression results show that Rural Women Empowerment (RWE), resulting from JLO, varies significantly across different ethnic groups (β = −0.724, P < 0.01), land sizes (β = 0.117, P < 0.01), household sizes (β = 0.886, P < 0.01), household decision-making (β = −1.814, P < 0.05), and occupations (β = −0.868, P < 0.01). Our findings suggest that JLO significantly impacts rural women's empowerment, gender equality, and overall development, thereby assisting in the achievement of several UN Sustainable Development Goals. It emphasizes the need for policy interventions, legal reforms, and awareness-raising efforts to promote and support JLO to empower women and promote inclusive and sustainable rural development.

An exploration into the occupational identity of women following breast cancer and treatment: A qualitative study

Introduction: The number of women surviving after breast cancer is increasing, along with the length of time they are living with the after-effects of treatment. Although the treatment’s effects are known to impact occupational participation, little is known about how breast cancer could affect occupational identity. This study aims to illuminate the lived experience of women long-term after breast cancer treatment through an occupational perspective in order to explore how they perceive their occupational identity. Methods: A qualitative study with semi-structured interviews was conducted with six women, who had all received a diagnosis of breast cancer and treatment for longer than a year. Reflexive Thematic Analysis was used to analyse the data. Findings: Three intertwined themes describe the participants’ experience. (1) ‘Disruptions in daily life and Environmental support’, (2) ‘Be able to do’ and identity, and (3) ‘Doing what matters and is possible’. Findings revealed that the occupational identities of the participants were maintained. Cancer treatment effects appear to impact occupational competence that corresponded to participants’ occupational identities, suggesting difficulties in the order of occupational adaptation. Conclusion: Our findings contribute to understanding the challenges to occupational participation related to the occupational identity of women following breast cancer and treatment.

Trends in health care of patients with vasculitides, including giant cell arteritis, Takayasu arteritis, ANCA-associated vasculitis and Behçet’s disease: cross-sectional data of the German National Database 2007–2021

The aim of this study is to present the current care situation of patients with giant cell arteritis (GCA), Takayasu arteritis (TAK), ANCA-associated vasculitis (AAV) and Behçet’s disease (BD). Trends over the last 15 years will reflect improvements and remaining deficits in the management of vasculitides. Consecutive cross-sectional data from patients with vasculitides from the German National Database (NDB) of the Collaborative Arthritis Centres between 2007 and 2021 were included. Medication, physician- and patient-reported outcomes on disease activity and disease burden, inpatient stays and occupational participation are compared for different vasculitis entities and over time. Employment rates were compared to German population rates. Between 502 and 854 vasculitis patients were annually documented. GCA and AAV were the most common vasculitides. Median disease duration ranged from 2 to 16 years. Over the years, glucocorticoids decreased in proportion and dose, most markedly in GCA and TAK, while biologic therapies increased up to 27%. Physicians rated disease activity as low for the vast majority of patients, while patients-reported moderate outcomes in many dimensions. PROs remained largely unchanged. The proportion of employed patients (< 65 years) increased from 47 to 57%. In recent years, biologics are increasingly used in patients with vasculitides, while glucocorticoids decreased significantly. PRO’s have not improved. Work participation increased but remains lower than that in the German population.

Mexican American Intergenerational Research: Transformative Model of Occupational Therapy.

Thirty-seven interviews of Mexican American women who crossed the border into the United States during the era of the Mexican Revolution of 1910 were analyzed using constructivist grounded theory methods. The intent is to expand the occupational therapy profession's occupational consciousness and cultivate cultural humility. Four themes emerged from the data: suffering, work, yearning for an education, and compassion for others. The findings suggest that environmental barriers such as hierarchy (patriarchy and discrimination) and physical barriers (limited access to built environments, lack of nonexploitative work opportunities, and hostile educational institutions) prevented occupational participation. Small acts of resistance through everyday living (finding joy, playing, self-sufficiency, and community organizing) were identified as facilitators of occupational participation. The research findings challenge proposed assumptions found within the occupational therapy literature: (1) humans and occupations exist as separate from their environments, and (2) work, productivity, and leisure contribute positively to health. The Transformative Model of Occupational Therapy is introduced as a decolonized framework that inextricably links individual health to community and global health. The model centers play, social participation, work, and education as occupations that contribute to the common good. These occupations are kept in equilibrium within the Four Pillars of Culture (self-determination, compassion, sustainability, and language) or the cultural values identified and derived from the stories.

Path Analysis to Assess Diversity of Occupational Opportunities Within Walking Distance and Community Health.

Built environment structures affect a population's occupational participation and health outcomes. To examine how occupational opportunities available within walking distance are related to a community's overall health. Secondary data analysis. Community. Community-dwelling adults. Data from the AARP Livability Index and Walk Score® for 78 zip codes were used for path analysis and multiple regression analysis to investigate the relationship between various community factors and the health of the community. Path analysis for 78 zip codes revealed that the primary determinants of health score were destination diversity and social walk score. Multiple regression analysis revealed that destination diversity (β < .001) and exercise opportunity (β < .001) were significant factors for health score. Multiple regression analysis revealed that destination diversity (β < .001) was a significant factor for social score. The results suggest that increased diversity of destinations in a community and opportunities available for social participation within walking distance are associated with better health of residents in the community. Plain-Language Summary: This study highlights how the built environment and opportunities for social participation are associated with a community's overall health. This study found that participation in a variety of group activities contributes to community members' well-being. Understanding how the built environment is related to health outcomes may better equip occupational therapy practitioners to improve the health of an individual, group, or population.

Análise sob a perspectiva ocupacional do uso da telesaúde na terapia ocupacional em tempos de confinamento

Abstract Introduction The actions adopted with the purpose of avoiding community infections, during the COVID-19 pandemic, meant an occupational interruption since these measures prevented or restricted the participation in significant occupations of people. At the same time, the different health institutions and health professionals had to resort to telehealth to provide continuity of care. Objective To analyze from an occupational perspective the use of telehealth in Occupational Therapy in confinement contexts. Methodology Qualitative. Information is produced through focus groups and individual interviews. 9 students, 10 teachers, 5 users and/or family members and 5 members of the care teams participate in this study. An analysis of the thematic content is carried out through the triangulation of actors to integrate the opinions of all the participants, later in order to deepen the use of telehealth from an occupational perspective, theoretical triangulation is included. Results Telehealth as an occupation materializes the possibility of having socio-emotional support and allows collaboration in search of well-being in times of social isolation. It is also an occupation that allowed recognizing the home as a territory, in which the appropriation of material and relational resources occurs in a collaborative way between the treatment team and the users. Conclusions Telehealth is a collective occupation that allows re-existence in times of occupational interruption and new forms of occupational dislocation.

코로나19 이후 겪게 된 작업참여의 변화에 대한 질적 연구: 80세 이상 초고령 노인을 대상으로

Objective : The purpose of this study is to qualitatively analyze the changes in occupational participation experienced after COVID-19 focusing the oldest old living in the community. Methods : A total of 10 oldest old were selected through a intentional sampling method, and in-depth interviews were conducted with them. Framework analysis was used as a design method for qualitative research, and the analysis framework was constructed centering on the occupational performance area of the OTPF-4. The collected data was analyzed according to the 5 stages of the framework analysis presented by Ritchie and Spencer, and Lacey and Luff's thematic mapping model was used. Results : As a result of the analysis, four themes were derived: ‘changes in daily life’, ‘changes in rest, sleep, leisure and health management’, ‘changes in social participations’, and ‘acceptance of reality and pursuit of meaning in life’. The participants did not feel a big change in their daily life, but they experienced a role change that made them feel their presence in the family. While going through COVID-19, intimacy with family was strengthened, but community gatherings were still afraid. Participants said they had a new mindset to focus on what they could do, appreciate the reality, and take better care of their health rather than being uncomfortable with the situation. Conclusion : Through the analysis of this study, we were able to learn about the difficulties that oldest old living in the community may experience after COVID-19 and how they deal with the current situation, and based on the results of the study, we expect to find ways to provide various help.

PROMOTING PARTICIPATION IN OCCUPATIONS AMONG OLDER ADULTS LIVING WITH NEUROCOGNITIVE DISORDERS AND CAREGIVERS

Abstract Participation in meaningful occupations promotes self-confidence, self-esteem, overall health, and healthier life transitions. Due to significant life changes brought by neurocognitive disorders older adults living with neurocognitive disorders as well as caregivers may undergo some disruption in their occupational participation. Few interventions have focused on their ability to engage in meaningful occupations independently and together to successfully orchestrate their life to meet their own occupational needs. The goal of this study was to document the priority needs of older adults living with neurocognitive disorders and caregivers to promote occupational participation, to guide us in the development of an intervention. To this end, a rapid literature review was conducted. Three databases (Medline, PsycInfo and CINAHL) were searched. Studies were included if they used qualitative methods, included community-based individuals and were available in English or French. A total of 20 studies met the inclusion criteria. Two needs were prioritized in the literature by both older adults living with neurocognitive disorders and caregivers: 1) to continue participating in daily activities and social roles (e.g., maintain the connection with the community, use everyday technology), 2) to educate the public about the disease (e.g., bring awareness, knowledge, and understanding of dementia among the community at large). In the presentation we will discuss how the results will inform the development of an occupational-based intervention to promote meaningful occupations.

Mothering occupations: A review identifying mothering occupations.

This review aimed to retrieve and collate a list of culturally relevant mothering occupations in the New Zealand context with mothers positioned as experts of their experience. Mothering occupations influence wellbeing and this study aimed to better inform on the daily occupations mothers participate in that contribute to feelings of maternal confidence. Two main sources were used to identify mothering occupations: A systematic search of mothering literature, and participant additions. The first step involved mothering literature being searched, collated and condensed. The second step involved presenting the compiled list of mothering occupations to a panel of mothers for review and to invite additions. Mothers were asked to consider the occupations they participate in that evoke feelings of confidence and mastery in their mothering. Fifteen mothers with infants 12 to 18 months old were recruited, eight contributed to the mothering occupations list. A list of 203 items was collated then condensed based on the inclusion criteria for the participant group, and was tracked in a table. The list was reduced to 36 items. Eight participants added to the mothering occupations list, bringing the total number of items to 47. Mothers indicated through their contributions to the list that some types of mothering occupations are more relevant to them when considering feelings of maternal confidence and mastery. The mothers of this study indicated that connecting with their infant, their culture and nature are of high value to them. Developing a list of culturally relevant and relatable mothering occupations is a significant undertaking, highlighting the subjective experiences of mothers. Mothering occupations are vast and influenced by context. Mothers valuing some types of occupation more in relation to maternal confidence indicates a role for occupational therapy with this population to support with engagement and participation in occupations that promote wellbeing.

Occupational performance and participation in children with developmental coordination disorders before and during Covid-19.

Developmental coordination disorder (DCD) is a neurodevelopmental disorder that affects children's occupational performance and participation. It is known that the Covid pandemic has adversely affected the whole world in many areas. We aim to investigate the occupational performance and participation of children with DCD before and during the COVID-19. Sixty-five children aged 5-12 years included in the study were assessed by the Canadian Measure of Occupational Performance and the Participation and Environment Measure for Children and Youth. Statistically significant differences were detected in occupational performance and satisfaction scores (p < 0.01). Additionally, except for 'involvement in the home environment' (p > 0.05), there were statistically significant differences in all other areas of participation (p < 0.01). The occupational performance and participation of children with DCD are impacted during COVID-19. In addition, it is seen that the desire of families to change regarding participation has increased due to COVID-19. It would be beneficial to include strategies to improve these areas in the rehabilitation processes.

OCCUPATIONAL THERAPY INTERVENTIONS TO IMPROVE OCCUPATIONAL PARTICIPATION AND REDUCE THE RISK OF FALLS IN ELDERLY PEOPLE WITH OSTEOARTHRITIS

Global trends show an increase in life expectancy. A similar trend in life expectancy growth is typical for Ukraine. However, even a positive trend towards an increase in average life expectancy cannot stop the inevitable process of aging, which leads to a decrease in the functional and physiological capabilities of all body systems.&#x0D; Osteoarthritis is the most common disease of elderly. Osteoarthritis of the joints of the lower extremities is a risk factor for falls syndrome. Falls lead to a decrease in physical functioning, independence and occupational participation, increase the fear of the next fall, and bring serious injuries, even depth. The role of an occupational therapist in falls prevention is undeniable. It helps maximize the ability to participate in the occupational activity that is meaningful to the client, and modifies the client's lifestyle and living environment for safe occupational performance.&#x0D; The aim of the research. To scientifically justify and develop a comprehensive program of occupational therapy interventions to reduce the risk of falls for elderly women with osteoarthritis of the lower extremities by means of occupational therapy.&#x0D; Materials and methods. In order to fully solve the tasks and study the activity of elderly women with osteoarthritis of the joints of the lower extremities, the following research methods were chosen: analysis of special and scientific and methodical literature; content analysis of medical records, interviews, observations; WOMAC Osteoarthritis Index and assessment of fear of falling according to Falls Efficacy Scale International.&#x0D; 48 women aged 62 to 89 took part in the ascertainment experiment. Women were divided into 2 groups - main (MG) and control (CG), 24 people in each. The main group included women with osteoarthritis of the lower extremities. In the control group people were without damage to the joints. The program lasted for 6 (six) months. The people of CG received recommendations about general physical activity with reference to WHO guideline. The people of MG received therapeutic exercises on strength, balance, coordination, endurance, improvement of walking skills and occupational therapy interventions with: training to perform occupations safely; creation of a new stereotype of behavior to avoid falling; modification of the environment; review of medications which can provoke a fall; learning to use assistive equipment; techniques to get up safely and effectively after a fall.&#x0D; Research results. Based on the obtained data, it is evident that both groups experienced an increase of independence level in functioning, less of pain, stiffness and fear of falling.&#x0D; Conclusions. Both falling and the fear of falling significantly reduce the ability to lead a full and independent life, bring undesirable consequences, including serious injuries, and interfere with the ability to do what is most important for a person. In the foreign literature, there is a lot of evidence about the contribution of occupational therapy to the prevention of falls. The results of the conducted research give grounds for asserting that the application developed by us a multi-component program of occupational therapy interventions developed for elderly people with osteoarthritis of the joints of the lower extremities is an effective means of reducing the risk of falls in this category of people. The advantages of the developed program are confirmed by the results of own research.

Testing feasibility of relevant outcome measures in an inpatient setting to demonstrate the value of occupational therapy.

Measures of participation restrictions in daily life occupations are not typically used and may aid discharge planning and demonstrate the impact of occupational therapy services in inpatient settings. The overall aim of this mixed-methods study was to test the feasibility of relevant outcome measures by (1) investigating which of the three identified measures-the Home Support Needs Assessment, the Personal Care Participation Assessment and Resource Tool, and the Functional Autonomy Measurement System-best identifies meaningful changes in participation restrictions in daily life occupations required for community life; and (2) investigating the acceptability, usefulness, and feasibility of each measure to support inpatient practice. Occupational therapists (n = 3) completed the three measures with patient participants (n = 12) at admission and discharge. Each occupational therapist participated in a semi-structured interview. Outcome measure responses were summarised statistically. Qualitative data were analysed using reflexive thematic analysis. Total scores on all three measures changed significantly between admission and discharge (P < 0.002). Three themes reflected the occupational therapist participants' perceptions of the acceptability, usefulness, and feasibility of the outcome measures: 'Clinically and Professionally Meaningful Tools', 'Becoming Familiar', and 'Fostering My Daily Work'. Each measure demonstrated a meaningful change. Selection and successful implementation of an outcome measure depends on its local acceptability to occupational therapists and organisational practices. All three measures are promising tools to address a measurement gap in occupational therapy practice. Future research could embed one measure into practice using knowledge translation methods, with a large-scale evaluation of the value of occupational therapy.

Experiences of long-term unemployment from an occupational perspective: A scoping review

ABSTRACT Long-term unemployment impacts a person’s life and opportunities for participating in occupations. Despite the frequent occurrence of short-term unemployment, the proportion of long-term unemployment in Western contexts remains high and is growing, which particularly affects vulnerable groups and thus is an issue of relevance for occupational science. Research into the lived experiences of being long-term unemployed and how it affects daily life is limited, although the need to look more closely into unemployment has been recognized. The aim of this study was to describe people’s experiences of long-term unemployment from an occupational perspective. Due to the dearth of studies in this area, a scoping review methodological framework was used, resulting in nine relevant studies reported in English to be included in a thematic analysis. Results revealed three analytical themes: Experiences of occupations during and due to long-term unemployment; Experiences of occupational obstacles; and Experiences of occupational enablers. The daily lives of long-term unemployed people consist largely of occupations they perform for obligatory reasons, that is, to be eligible for economic subsidies for their survival, and less of anything related to what they want or need. People also experience obstacles that limit and restrict their opportunities of engaging in meaningful occupations. These obstacles could be seen as occupational injustices. Enabling factors also exist, but they are not available or possible for all. Being long-term unemployed changes people’s participation and engagement in occupations. By understanding the experience of long-term unemployment, it is possible to plan and implement better services.

Occupational therapy and participation in activities of daily living following cardiothoracic surgery in acute care: A retrospective study

Introduction: Patients recovering from cardiothoracic surgery in acute care experience physical and psychosocial challenges impacting participation in activities of daily living. Occupational therapists are well positioned to address these needs; however, there is little evidence exploring occupational therapy’s role in this area. Method: This retrospective study of electronic medical records examined changes in activities of daily living participation for adult patients ( n = 37) who received occupational therapy in acute care while recovering from cardiothoracic surgery via median sternotomy. Wilcoxon signed-rank tests and paired t-tests compared patients’ scores on the Functional Independence Measure (FIM) and Activity Measure for Post-Acute Care “6-Clicks” Daily Activity Inpatient Short Form at occupational therapy evaluation and discharge from their inpatient stay. Results: Patients showed statistically significant improvements on both assessments in activities of daily living participation while receiving occupational therapy services following cardiothoracic surgery. Lower body dressing, toileting, and bed mobility showed the greatest increases in the FIM categories. Conclusion: Occupational therapists are valuable in addressing the complex needs of patients recovering from cardiothoracic surgery in acute care. Continued research is needed to provide further evidence supporting occupational therapy’s unique role in this setting.

Mapping Effectiveness Studies of Occupational Therapy in Africa: A Scoping Review.

Contextual relevance is an important consideration for evidence-based practice, especially in low- and middle-income countries where the nature of practice may differ from high-income countries. Resources and access to rehabilitation are constrained, and service-users face a range of intersecting challenges to activity and participation. To evaluate the body of evidence for the effectiveness of occupational therapy in Africa, and to determine if systematic reviews with meta-analysis and/or meta-synthesis are feasible. Methods and Analysis. We conducted a systematic scoping review of published and grey literature by following PRISMA-ScR guidelines across 13 databases and through personal contact with occupational therapists across Africa. Covidence software was used to manage a blind review process by at least three reviewers per included article. The McMaster Quantitative Review Form, NHMRC levels of evidence, the Cochrane PROGRESS-Plus health equity criteria, and the TIDieR checklist informed data extraction using Microsoft Forms. The search yielded 4199 articles, of which 45 were included. Evidence in six fields of practice included paediatrics, mental health, physical rehabilitation, hand therapy, work practice, and community development, although the evidence was largely limited to South Africa (93% studies). Levels of evidence varied but included 13 RCTs. In all, 1957 participants were included, ranging in age from 25 days to 99 years, with a wide range of health conditions. Most studies reported a positive outcome for occupational therapy. Findings suggest a moderate body of evidence to support occupational therapy in Africa. Systematic review with meta-analysis, assessment of risk of bias, and in-depth analysis of specific areas of practice are now required. All effectiveness studies in occupational therapy should include measures of occupational performance or participation, minimum reporting standard checklists should be used more consistently, and effect sizes should be consistently calculated and reported in effectiveness research.

Virtual Reality Intervention and Its Impact on Upper Extremity Function in the Stroke Population: A Scoping Review.

The aim of this scoping review was to examine virtual reality (VR) interventions used within rehabilitation and their effect on the functional outcomes of individuals with stroke. Specifically, this study sought to determine the impact of VR on the upper extremity (UE) use of participants as it relates to body function, occupational participation, and overall UE function (UEfxn). Twenty-six articles were selected for inclusion and results were extracted to determine common themes of outcomes among the effects of VR intervention (VRI). Thematic analysis included details about the VRIs used, as well as the change in UE outcomes post-VRI. Overall, positive change in UEfxn was found across many of the studies, indicating that VR technologies may be an effective intervention technique for individuals, poststroke. Findings of this review encourage clinicians to conduct further research regarding VR technology for UE rehabilitation poststroke.

Inclusivity in Occupational Participation: Life Stories of Bangladeshi With Spinal Cord Injury.

This research aimed to describe the process of occupational participation among persons with spinal cord injury (SCI) discharged from the only SCI rehabilitation hospital in Bangladesh. We analyzed seven participants' interview transcripts and observations using the trajectory equifinality model. Study participants demonstrated the following occupational participation trajectories: (a) employing a strategy or difficulty in occupational participation; (b) performing solidarity or experiencing deprivation; (c) creating identity or divergence; and (d) being included in or excluded from everyday life. There are four pathways: (I) discouraging conditions that minimized daily performance; (II) reinforcing obligatory connections to optimization of daily performance; (III) reciprocity to facilitate social activities; and (IV) manipulating mastery in occupational participation. Occupational therapists can consider the trajectory phases and pathways of occupational participation when facilitating the inclusion of service users after discharge from the hospital.