JMIR Publications

ABSTRACT

Background:

Occupation-based practice (OBP) has been demonstrated to enhance occupational performance and goal attainment in stroke rehabilitation. However, existing evidence is predominantly derived from hospital-based settings, with limited investigation of OBP implementation in community contexts. In Thailand, particularly in rural areas, there remains a need to establish effective OBP service delivery models and to evaluate their outcomes across diverse client populations receiving community-based rehabilitation services.

Objective:

This study aimed to develop an occupation-based practice service delivery model for community-based stroke rehabilitation and to examine the effects of this approach on occupational performance, goal attainment, and quality of life among stroke survivors in the Doi Lor community, Chiangmai Province, Thailand.

Methods:

This study employed mixed-methods single case research consisting of model development, implementation, outcome evaluation, and qualitative inquiry. The OBP service delivery model was developed through the integration of the Dynamic Model of Occupation-Based Practice, the Occupational Therapy Process guided by the Occupation Therapy Practice Framework, Fourth Edition (OTPF-4), and evidence-based stroke rehabilitation principles. The intervention protocol consisted of 14 sessions delivered over seven weeks, with each session lasting approximately 60 minutes. One community-based occupational therapist was trained to implement the OBP service delivery model through a structured education and implementation package. A trained therapist subsequently delivered the intervention to stroke clients at the Doi Lor community rehabilitation center. Quantitative outcomes were assessed pre- and post-intervention using the Canadian Occupational Performance Measure (COPM), the Goal Attainment Scale (GAS), and the World Health Organization Quality of Life–BREF (WHOQOL-BREF). Seven stroke survivors participated in the intervention. In addition, a semi-structured interview was conducted with the occupational therapist to explore experiences and perceptions regarding the implementation of the OBP service delivery model.

Results:

Quantitative analysis demonstrated statistically significant improvements across all outcome measures. Participants showed significant gains in occupational performance and satisfaction as measured by the COPM (p < 0.05), higher levels of goal attainment on the GAS (p < 0.05), and improved overall quality of life as assessed by the WHOQOL-BREF (p < 0.05). Qualitative findings from the therapist interview indicated that the OBP service delivery model was practical, feasible, and beneficial for all participating clients. The therapist reported that the structured and client-centered nature of the model facilitated effective identification of meaningful goals and responsive intervention planning tailored to individual client needs.

Conclusions:

This preliminary study suggests that an OBP service delivery model grounded in therapist preparation, client-centered goal setting, and outcome-focused intervention can effectively enhance occupational performance, goal attainment, and quality of life among stroke survivors receiving community-based rehabilitation. This approach demonstrates how to strengthen long-term stroke care, particularly in rural communities where access to hospital-based rehabilitation services is limited. Clinical Trial: -