The purpose of this study is to investigate the use of occupation-based intervention by occupational therapists (OTs) in diverse practice areas and to determine the facilitators of and barriers to using occupation-based interventions.

Research has demonstrated that occupation-based practice (OBP), using occupation-based intervention, was effective in treatment of impairments, which supports its use as an evidence-based practice. Moreover, this supports the American Occupational Therapy Association’s (AOTA’s) 2017 Centennial Vision. “Occupation is as essential to life as nutrition or other needs, and having occupation as a focus throughout the therapy process impacts and makes the process different than other approaches” (Bauerschmidt & Nelson, 2011). OBP is a central tenet of the profession, essential to the history and foundation of the profession of occupational therapy: “That man, through the use of his hands as they are energized by mind and will, can influence the state of his own health” (Reilly, 1962, p. 81). These factors should result in a high percentage of therapists reporting interventions being occupation based.

A recent practice pattern survey was distributed using SurveyMonkey to understand practice patterns regarding OBP as well as inquire about the factors that OTs believe affect its use. The participants were a selected stratified random sample of 1,000 OTs generated by the AOTA member sampling database. A total of 121 therapists responded to the survey for a response rate of 12.1%. Quantitative and qualitative data were collected in an effort to truly establish the key demographics and factors that influence the current use of OBP. Quantitative data were analyzed using IBM SPSS and the qualitative data were analyzed using Dedoose™.

On average, OTs reported 33% of their interventions were purposeful; 30%, occupation based; and 25%, preparatory. Some common themes identified and seen as both facilitators and barriers included the following: 25% of the respondents identified the types of clients as a barrier, and 33% of the respondents identified the types of clients as a facilitator. In addition, 16% identified the setting as a barrier, and 21% identified the setting as a facilitator.

Respondents were also asked to suggest any aspects of OBP that they believe should be included in further research. Some of the themes suggested surrounded the idea of increasing productivity expectations, decreasing funding, and still being able to carry out occupation-based interventions. In addition, therapists are looking for standardized measures measuring the value of OBP and more credible evidence of the effectiveness of OBP in contrast to purposeful or preparatory interventions

As a part of the study, there was an effort to establish a definition of OBP; the Occupational Therapy Practice Framework (2nd ed.; AOTA, 2008) was chosen to provide the definitions embedded in the survey for preparatory, purposeful, and occupation-based interventions. It is unfortunate that a similar definition is not in the third edition of the Framework (AOTA, 2014), and our review of the literature continues to reveal that many terms are used interchangeably.

Future research into the use and effectiveness of OBP in addition to a common definition will both contribute to our profession’s getting back to its roots and also contribute significantly to the body of knowledge in occupational therapy to support our profession as occupation and evidence driven.

American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683. http://dx.doi.org/10.5014/ajot.62.6.625

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), 1–48. http://dx.doi.org/10.5014/ajot.2014.682006

Bauerschmidt, B., & Nelson, D. L. (2011). The terms occupation and activity over the history of official occupational therapy publications. American Journal of Occupational Therapy, 65, 338–345. http://dx.doi.org/10.5014/ajot.2011.000869

Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th century medicine. American Journal of Occupational Therapy, 16, 1.