Occupational Therapy

Moral treatment and the early profession

A historical article on work in occupational therapy states that the concept of work has been close to the core of occupational therapy theory and practice since the profession was founded in the early part of the twentieth century. Its authors describe a holistic view inherited from moral treatment as the base on which the emerging profession was built, and they argue that the surrounding medical model pushed the field toward reductionist approaches in order to gain validation.

Other historians place the precursors earlier. A Spanish-language article, available with an English abstract, argues that the earliest evidence of occupational therapy lies in the humane care given in Spanish neurological and psychiatric institutions in the fifteenth century, and that this care influenced Pinel's moral treatment. The authors treat moral treatment as one of the main forerunners of the profession. The fifteenth-century claim is their interpretation, and the abstract does not show how widely it is accepted.

Work, pre-vocational training and rehabilitation

Lohman and Peyton describe a struggle that contributed to pre-vocational training becoming the domain of occupational therapy while vocational training became the domain of vocational rehabilitation. They chronicle the profession's attempts to keep a holistic view in work-related practice. The abstract does not give dates for these developments, so the sequence is not described further on this page.

Occupation and activity as shifting terms

Bauerschmidt and Nelson examined how the words occupation and activity were used across nine decades of the American Journal of Occupational Therapy and its predecessors, scanning three years of each decade from the 1920s to the 2000s. Occupation was widely used in the 1920s, declined until the 1980s, and then rose so sharply in the 2000s that it appeared more often than in the 1920s. Activity was infrequent in the 1920s and gained popularity from the 1930s to the 1960s, and both terms were used little from the 1970s to the 1990s.

The authors conclude that basic terminology in the field has fluctuated dramatically, and they argue that these shifts reflect changing viewpoints on the profession's fundamental nature. The study counts word frequency in one journal family and does not measure how clinicians used the terms in practice.

What occupation means in current usage

The Royal College of Occupational Therapists, the professional body in the United Kingdom, describes occupations as the everyday tasks and activities people need or want to do, covering self-care, productive activities such as work or caring, and leisure. The same page says the profession looks beyond diagnoses to a person's goals and environment, and it presents occupational therapy as a science-based health and social care profession.

The American Occupational Therapy Association publishes the Occupational Therapy Practice Framework, fourth edition (2020), an official document intended for practitioners, students, other health care professionals, educators, researchers, payers, policymakers and consumers. A 2025 survey study that drew on the framework lists its nine categories of occupation as activities of daily living, instrumental activities of daily living, health management, rest and sleep, education, work, play, leisure and social participation. Only the abstract records were read for these two sources, so the list comes from the secondary study.

Assessment and goal setting

The Royal College of Occupational Therapists says that occupational therapists work with people of all ages who have difficulties with everyday tasks, including people with mental health conditions and physical or learning disabilities. According to the page, therapists look at a person's goals and environment and build practical, personalized plans. It lists health, social care, housing and voluntary organizations among the settings where they work.

A home-based program as an example

The English COTiD-UK trial gives a concrete picture of one program. People with mild to moderate dementia living at home were recruited with a family carer, and the intervention comprised 10 hours of occupational therapy delivered over 10 weeks in the person's home. Pairs set activity-based goals, and the trial authors report that 91% of those goals were fully or partially achieved by the final session. Goal achievement was reported descriptively and was not a primary outcome of the trial.

Practice in acute hospital settings

A scoping review of 24 publications on occupational therapy philosophy and practice in acute hospitals found that therapists value occupation as an important part of practice but experience environmental and personal challenges in putting it first. Strategies that the included publications described for overcoming these challenges involved therapists changing their own practice to be more occupation-focused and changing the practice context, for example by adapting environments, documentation and intervention protocols.

Populations and conditions in the sources reviewed

Professional descriptions present occupational therapy as relevant across ages and conditions, including mental health conditions and physical or learning disabilities. The research sources reviewed for this page concentrate on a narrower set of uses: personal activities of daily living after stroke, daily functioning and carer outcomes in dementia, sensory processing difficulties in children with autism spectrum disorders, and the reduction of fall hazards in the homes of older adults.

Sensory-based approaches for children

A systematic review distinguishes two forms of sensory intervention for children with autism spectrum disorders. The reviewed studies defined sensory integration therapy as a clinic-based intervention that uses sensory-rich, child-directed activities to improve a child's adaptive responses to sensory experiences. Sensory-based interventions were described as classroom-based, single-sensory strategies such as weighted vests or therapy balls that aim to influence a child's state of arousal.

Stroke and personal daily living activities

A 2007 systematic review and meta-analysis in the BMJ included nine randomized trials with 1258 participants that tested occupational therapy focused on personal activities of daily living after stroke. Therapy raised performance scores (standardized mean difference 0.18, 95% confidence interval 0.04 to 0.32) and reduced the odds of a poor outcome defined as death, deterioration or dependency (odds ratio 0.67, 0.51 to 0.87). The authors estimated that for every 100 people treated, 11 (95% confidence interval 7 to 30) would be spared a poor outcome.

The earlier Cochrane version of the review, with searches to March 2006, identified 64 potentially eligible trials and included 10 studies with 1348 participants, and reported the same pooled estimates. Its authors noted that the exact nature of the occupational therapy intervention needed to achieve the greatest benefit still had to be defined. Both reviews are abstract-level reads here, and neither addresses stroke outcomes beyond personal daily living activities.

Dementia: a home-based program

COTiD-UK was a multicenter, assessor-masked randomized trial across 15 English sites that enrolled 468 pairs of a person with mild to moderate dementia and a family carer. The primary outcome, the Bristol Activities of Daily Living Scale at 26 weeks, did not differ between the occupational therapy and treatment-as-usual groups (adjusted mean difference 0.35, 95% confidence interval minus 0.81 to 1.51), and secondary outcomes for cognition, quality of life, mood and carer competence also did not differ. The authors noted moderate and variable intervention fidelity and heavy reliance on proxy data; this single null trial of one program should not be read as a verdict on all occupational therapy in dementia.

Sensory integration for autism

A systematic review of studies from 2000 to 2012 covered 19 studies, 5 of sensory integration therapy and 14 of sensory-based intervention, for children with autism spectrum disorders and sensory processing problems. Two randomized controlled trials found positive effects of sensory integration therapy on child performance measured by Goal Attainment Scaling, with effect sizes from 0.72 to 1.62, and other studies at lower levels of evidence reported reductions in behaviors linked to sensory problems. The authors called the trials small and said more rigorous trials with manualized protocols are needed.

Falls and the home environment

A 2023 Cochrane review of environmental interventions for preventing falls in community-dwelling older people included 22 randomized trials with 8463 participants. Home fall-hazard reduction probably lowered the overall rate of falls by 26% (rate ratio 0.74, 0.61 to 0.91, moderate certainty), with a 38% reduction in people selected for higher fall risk (high certainty) and no reduction when people were not selected for risk. The interventions probably made little or no difference to health-related quality of life. The abstract does not attribute these interventions to one profession, so the findings do not isolate occupational therapy.

Reported harms

The abstracts of the stroke reviews, the dementia trial and the sensory integration review do not report systematic data on harms or adverse events. The falls review reports that two studies of home fall-hazard interventions recorded no adverse events, which is limited information. The absence of reported harms in these abstracts is not evidence that harms do not occur, and no systematic review of harms specific to occupational therapy was found in the searches run for this page.

Fit between approach, person and delivery

Benefit in the evidence reviewed depended on targeting. Home fall-hazard interventions reduced falls in people selected for higher fall risk but not in unselected older adults, and the stroke reviews tested therapy aimed specifically at personal daily living activities. The sensory review found that single-sensory classroom strategies often did not follow recommended protocols, and the dementia trial reported moderate and variable fidelity across sites. These findings suggest that outcomes may depend on how a program is chosen and delivered.

This page is general information and not a recommendation or assessment for any person. Occupational therapy is delivered alongside conventional medical and social care, and it should not be used to delay or replace necessary care. The sources opened for this page do not state training, registration or certification standards, so those are not described here and should be confirmed with the relevant professional body in a given country.