JMIR Publications

ABSTRACT

Background:

Stroke is a major cause of long-term disability, and upper extremity (UE) impairment frequently limits independence in daily activities and community participation. In Thailand, although acute stroke care has improved, continuity of rehabilitation in community settings remains uneven. Limited empirical evidence describes how occupational therapy (OT) services for UE rehabilitation are delivered in practice.

Objective:

This study aimed to examine current OT practices for UE rehabilitation among community-dwelling stroke survivors in Thailand, identify barriers affecting service delivery, and explore therapists’ perspectives on future development of community-based rehabilitation.

Methods:

A sequential mixed-methods design was used. Phase I involved an online survey of 59 occupational therapists to describe service patterns and perceived barriers. Phase II comprised semi-structured interviews with 7 experienced occupational therapists to obtain deeper insight into practice contexts and challenges. Quantitative data were analyzed descriptively, and qualitative data were analyzed using thematic analysis.

Results:

OT services were primarily individualized and focused on functional activities, particularly basic ADLs, cognitive, and sensorimotor training. Service frequency was generally limited, and non-standardized assessments were commonly used alongside policy-required measures such as the Barthel Index. Barriers were identified at organization, therapist, and client levels, including resource shortages, transportation constraints, administrative workload, limited-service accessibility, and low public awareness of OT. Therapists described adapting practice through client-centered and culturally responsive approaches, with active caregiver involvement. A proposed home-based “Stroke Rehabilitation Box Set” emerged as a potential strategy to support continuity of rehabilitation.

Conclusions:

Community-based OT in Thailand operates within structural constraints while maintaining occupation-centered practice. Strengthening services may require system-level support and practical strategies to enhance continuity of care.