Review Article

The Global Status of Occupational

Therapy Workforce Research
Worldwide: A Scoping Review
Tiago S. Jesus, Karthik Mani, Claudia von Zweck, Sutanuka Bhattacharjya,
Sureshkumar Kamalakannan, Ritchard Ledgerd

Importance: To fulfill their societal role, occupational therapists need to exist in sufficient supply, be equitably
distributed, and meet competency standards. Occupational therapy workforce research is instrumental in reaching
these aims, but its global status is unknown.

Objective: To map the volume and nature (topics, methods, geography, funding) of occupational therapy
workforce research worldwide.

Data Sources: Six scientific databases (MEDLINE/PubMed, Scopus, CINAHL, Web of Science Core Collection,
PDQ–Evidence for Informed Health Policymaking, OTseeker), institutional websites, snowballing, and key informants.

Study Selection and Data Collection: Research articles of any kind were included if they involved data regarding
occupational therapists and addressed 1 of 10 predefined workforce research categories. Two reviewers were
used throughout study selection. No language or time restrictions applied, but the synthesis excluded publications
before 1996. A linear regression examined the publications’ yearly growth.

Findings: Seventy-eight studies met the inclusion criteria, 57 of which had been published since 1996. Although
significant (p < .01), annual publication growth was weak (0.07 publications/yr). “Attractiveness and retention” was
a common topic (27%), and cross-sectional surveys were frequent study designs (53%). Few studies used
inferential statistics (39%), focused on resource-poor countries (11%), used standardized instruments (10%), or
tested a hypothesis (2%). Only 30% reported funding; these studies had stronger methodology: 65% used
inferential statistics, and just 6% used exploratory cross-sectional surveys.

Conclusions and Relevance: Worldwide occupational therapy workforce research is scant and inequitably
distributed, uses suboptimal methods, and is underfunded. Funded studies used stronger methods. Concerted
efforts are needed to strengthen occupational therapy workforce research.

What This Article Adds: This review highlights the opportunity to develop a stronger, evidence-based strategy for
workforce development and professional advocacy.
Jesus, T. S., Mani, K., von Zweck, C., Bhattacharjya, S., Kamalakannan, S., & Ledgerd, R. (2023). The global status of occupational therapy workforce
research worldwide: A scoping review. American Journal of Occupational Therapy, 77, 7703205080. https://doi.org/10.5014/ajot.2023.050089

he health workforce refers to all people engaged in
T actions whose primary aim is to enhance health
(World Health Organization [WHO], 2006). It in-
cludes health professionals such as, but not limited to,
nurses, pharmacists, physical therapists, physicians,
and occupational therapists.
Occupational therapists are needed to meet the
health, rehabilitation, and occupational needs of the
population worldwide (World Federation of Occupa-
tional Therapists [WFOT], 2021). According to WFOT
(2013), occupational therapists aim to improve the
health and well-being of individuals and communities
through the promotion of meaningful occupational en-
gagement. Occupational therapists address the
occupational needs of people experiencing a wide range
of health conditions and disabilities, and they also as-
sume health promotion roles (American Occupational
Therapy Association, 2020). In addition, occupational
therapists address health, human rights, and occupa-
tional injustices arising from socioenvironmental
factors (Bailliard et al., 2020; Serrata Malfitano et al.,
2016; WFOT, 2019).

THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2023, VOLUME 77, NUMBER 3 1
 To fulfill their societal role, occupational therapists
need to be in sufficient supply, equitably distributed
(e.g., across geographical or practice areas), and moti-
vated in their everyday practice, and they need to meet
key competency standards (WFOT, 2021). One strat-
egy for assessing, meeting, or improving performance
of these requirements is to develop and use occupa-
tional therapy workforce research. In particular, this
research can identify current and future supply short-
ages; determine inequitable workforce distribution
(e.g., scarcity in rural areas); and study the impact of
policy, management, and regulations on workforce
recruitment, retention, and performance (Campbell,
2013; Campbell et al., 2013; George et al., 2018;
Kuhlmann et al., 2018). Overall, health workforce re-
search is key to providing evidence to inform and
evaluate population-centered workforce policies and
practices, as well as development and professional ad-
vocacy activities (Buchan et al., 2020; George et al.,
2018; Kuhlmann et al., 2018).
The World Health Organization’s (WHO’s; 2016b)
Global Strategy on Human Resources for Health pro-
vides global guidance for health workforce research
and development as a whole. At the health professions
level, the WHO (2016a; Ajuebor et al., 2019) also
launched the Global Strategic Directions for Strength-
ening Nursing and Midwifery, a profession-specific
framework used to guide global, concerted develop-
ments for this workforce.
With respect to the rehabilitation field, strategies to
guide workforce development have been reported
(Gimigliano & Negrini, 2017; Jesus et al., 2017), and
WHO recently launched the Rehabilitation Competency
Framework to provide a cross-professional, cross-national
tool for framing, studying, and developing the competen-
cies of the rehabilitation workforce (Mills et al., 2021).
Finally, WFOT (2021) recently published a position
statement endorsing the role and value of workforce
research and development activities for the occupa-
tional therapy profession, including identifying and
reducing workforce disparities to improve access to
occupational therapy. Little is known, however, about
occupational therapy workforce research, warranting
the need to map workforce research at the global level.
The aim of this scoping review was to identify and
map the extent, range, and nature (e.g., volume, topics,
geographical focus, funding status, study design, and
methods) of occupational therapy workforce research
worldwide. An assessment of the global status of such
research can help inform strategic directions for further
investigations in this area.
Method
Design
Scoping reviews often address exploratory research
questions with the aim of mapping concepts, research
methods, and types of evidence; they also identify gaps
in the literature or in a research area. In short, scoping
reviews determine the volume and nature of research
THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2023, VOLUME 77, NUMBER 3
activity on a broad topic to inform policy, practice,
and research (Colquhoun et al., 2014; Levac et al.,
2010; Peters et al., 2021; Tricco et al., 2018).
In addition to the traditional Arksey and O’Malley
(2005) framework and subsequent refinements
(Colquhoun et al., 2014; Daudt et al., 2013; Levac et al.,
2010), we followed the recent Joanna Briggs Institute’s
guidance for the conduct of scoping reviews (Peters
et al., 2020). Although the review protocol is not regis-
tered (the PROSPERO database does not accept
scoping review protocols), it has been peer reviewed
and published a priori (Jesus et al., 2021). The protocol
provides a detailed description of the review proce-
dures and methodological options; here, we provide a
synthesis of the methodology we used.
In this article, we provide the first part of our scop-
ing review results: a quantitative map of the volume,
yearly distribution, topics, geographical focus, study
design and methods, and funding status of the in-
cluded literature. The types of findings and reported
recommendations or limitations—largely a qualitative
synthesis—will be published in a separate article.
Database Searches
Systematic searches of six electronic databases
(MEDLINE/PubMed, Web of Science Core Collection,
Scopus, CINAHL, PDQ–Evidence for Informed Health
Policymaking, OTseeker) were conducted in June
2021. The full details of the search strategy for the
MEDLINE/PubMed database, which was used to guide
the searches of the other databases, can be found in
Jesus et al. (2021). The search strategy was built by
Tiago S. Jesus, who has an extensive track record in
bibliometric research and in designing database search
strategies for the rehabilitation and health workforce
fields, and it was appraised with the Peer Review of
Electronic Search Strategies guidelines (McGowan et al.,
2016). Web of Science and Scopus cover multidisciplin-
ary literature beyond the health sector, which
accommodates the diverse practice fields (e.g., educa-
tional and social sectors) in which occupational
therapists work, in addition to the health sector.
The gray literature, here only official research-based
reports, was searched through screening and keyword
searches of the websites of the following select interna-
tional institutions: WFOT, the rehabilitation and
health workforce subsections of WHO, the Health
Workforce Research section of the European Public
Health Association, and the member organizations of
WFOT, as planned in the protocol (Jesus et al., 2021).
Finally, we also used snowballing techniques (e.g.,
searching reference lists of included articles, author
tracking), and we consulted with representatives of 105
WFOT member organizations. We supplied them with
a preliminary list of inclusion criteria and asked them to
identify any additional references that potentially fit the
criteria and were missed from the combination of search
strategies. Sixteen member-organization representatives
2
responded and collectively generated 15 additional
articles considered for inclusion.
Eligibility Criteria
We included occupational therapy workforce research
fitting at least one category of workforce research de-
fined a priori in the study protocol (Jesus et al., 2021).
Table 1 describes each inclusion category as synthe-
sized from the protocol. The design of the inclusion
categories was informed by a WFOT (2021) position
statement; a review of the rehabilitation workforce lit-
erature (Jesus et al., 2017); the Global Strategy on
Human Resources for Health (WHO, 2016b); and a
reader on health policy, systems, and services research
falling into the spectrum of health workforce research
(George et al., 2018).
Although Table 1 includes workforce production
topics (e.g., number of new graduates entering the pro-
fession), studies on the education of occupational
therapists from a curriculum or pedagogical perspective
were excluded. Students contribute to workforce devel-
opment, but educational research is a gigantic field and
a subject on its own; this scoping review focuses on the
workforce of those in practice, ready to practice, or in
transition from or to practice. Similarly, studies of oc-
cupational health (e.g., prevalence of burnout) were
excluded, unless they involved explicit human resour-
ces practices such as recruitment, retention, or
productivity. Revisions of or updates to scope of prac-
tice or competency standards were also excluded,
unless their development or evaluation is framed as a
study (e.g., with a given, replicable methodology).
Methodologically, we included any quantitative, qual-
itative, or mixed-methods research, including secondary
analyses, case studies, and systematic or scoping reviews,
as long as it was published in a peer-reviewed journal or
an official institutional venue (e.g., governmental or
nongovernmental agencies) at the global, regional, na-
tional, or provincial or state level. We planned to review
articles available in English, Spanish, and Portuguese. To
avoid language restrictions, we also planned to obtain
translated versions of documents published in other lan-
guages, when available (Jesus et al., 2021), although no
such articles emerged in the review process. We ex-
cluded editorials, letters, conference abstracts, posters,
study protocols, peer-reviewed articles without an ab-
stract, perspective papers, narrative reviews, and broad
raw databases or papers that did not address a study
question, have replicable methods, or include analysis,
interpretation, or implications of the results.
Articles on the occupational therapy workforce or
with occupational therapists as participants were in-
cluded, even if they included other professions or
workers—including associate professionals, such as oc-
cupational therapy assistants. To be included, however,
articles needed to report either comparative or stratified
results for occupational therapists. Articles were ex-
cluded when the data or results were fully aggregated
with those of other health workers.
Using these criteria, two independent reviewers
(Jesus and Karthik Mani) conducted title and abstract
screening and full-text review to determine eligibility.
This process was conducted after the two reviewers
reached 80% or greater agreement in pilot tests on at
least 5% of the references. For the full-text screening,
one or two rounds of discussions were needed for the
reviewers to reach consensus on papers rated differ-
ently on eligibility. Although we planned to consult a
third reviewer to resolve disputes, there was no need
to do so.
As defined in the protocol, we reviewed the litera-
ture from all geographical areas with no time
limitation, but we could have applied a temporal cutoff
a posteriori as collectively determined by the authors in
the face of saturation (Jesus et al., 2021). We did not

Table 1. Inclusion Categories for the Major Workforce Research Topics Included in the Scoping Review, Synthesized From
the Review Protocol (Jesus et al., 2021)
Inclusion
Category Category Type
1 Workforce supply (e.g., supply of practicing therapists or mapping their profile)
2 Workforce production (e.g., supply of graduates or entry-level requirements)
3 Workforce needs, demands, or supply–demand shortages, forecasts
4 Employment trends (e.g., employment or unemployment patterns, unfilled vacancies)
5 Workforce distribution (e.g., geographical, practice area, public vs. private sectors)
6 Geographical mobility (e.g., emigration, immigration; internationally trained workers)
7 Attractiveness and retention (e.g., salaries, incentives, job satisfaction, intention to leave the profession,
recruitment determinants)
8 Staff management and performance (e.g., human resources management, workload management, managerial
recruitment practices, staffing and scheduling, burnout associated with performance or productivity)
9 Regulation and licensing (e.g., continuing education requirements, task shifting, evaluating the impact of
licensing or regulatory changes)
10 Systems-based or systematic analysis of workforce policies

THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2023, VOLUME 77, NUMBER 3 3
apply the temporal cutoff to the eligibility determina-
tion, but data extraction was subsequently conducted
only for articles published since 1996. In the face of
more recent publications, we determined that there
was no benefit to extracting and analyzing data from
articles published more than 25 yr ago.
Data Extraction
Citation elements such as journal titles and dates were
extracted from the reference management software
(EndNote). We extracted data relating to methodology
or study design, participants (number and type), data
sources, data types, study aim or research questions,
use of standardized instruments, and use of inferential
statistics. Also, we extracted the geographical areas ad-
dressed (type and specific location) and the existence
of funding support. We conducted a pilot test of the
data extraction process with two independent reviewers
(Jesus and Mani) for 10% of the included references.
Then, one experienced reviewer (Jesus) extracted the
information, which was then fully verified by another
research author (Mani, Sutanuka Bhattacharjya, or
Sureshkumar Kamalakannan). As is typical in scoping
reviews (Colquhoun et al., 2020; Peters et al., 2015),
quality appraisals were not performed.
Data Synthesis
The findings incorporate a summative description of
the extent and range of the literature for the extracted
information. For each type of information, we used de-
scriptive statistics, such as percentage of the included
studies with a given characteristic (e.g., those who fo-
cused on a given country) or grouped characteristics
(e.g., those focused on low- and middle-income coun-
tries [LMICs]). We also used inclusion categories (see
Table 1) to provide the structure to report on the num-
ber and percentage of papers per large topic type. To
determine the growth trend of publications over the
years, we used a simple linear regression analysis with
years as the independent variable and number of publi-
cations as the dependent variable. The analysis was
conducted in Excel, with an add-in for statistical analy-
sis (XLMiner Analysis ToolPak) to compute the simple
linear regression. Finally, for the free-text quotations
extracted on the aims of each study (i.e., qualitative
data), we developed a summative content analysis ap-
proach (Hsieh & Shannon, 2005) to determine more
specific topics addressed by the included studies.
Results
Figure 1 shows the Preferred Reporting Items for Sys-
tematic Reviews and Meta-Analyses flowchart for this
scoping review. Of 1,246 deduplicated articles initially
assessed for eligibility, 141 were subject to full-text re-
view, and 78 met the inclusion criteria. Of these, 57
articles were published after the temporal cutoff (i.e.,
THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2023, VOLUME 77, NUMBER 3
they had been published since 1996). We extracted and
analyzed data from these publications.
Figure 2 provides the distribution of articles for the
primary category alone and for both primary and
secondary categories combined. The categories of
“attractiveness and retention” and “workforce distribu-
tion” were those most frequently addressed as a
primary or secondary topic, at 27% and 16% of the
occurrences, respectively.
Table A.1 in the Supplemental Appendix (available
online with this article at https://research.aota.org/ajot)
provides the key data extracted from each article by
primary inclusion category. A total of 28 papers (49%)
met more than one inclusion category.
The scope of the literature is summarized next, using
various categories of analysis.
Annual Volume and Growth
An analysis of the annual volume and growth of occupa-
tional therapy workforce research indicated an erratic
evolving trend (r 2 5 .26), with no more than 7 articles
published worldwide in a single year and, in some recent
years (2011, 2012, 2016, 2017), fewer than two publications
per year. Although we found a statistically significant
growth trend for the total number of articles published
each year (p < .01), the slope of the linear regression model
(b 5 0.07) indicates that it will take 14 yr to increase the
annual publication rate by one additional article.
Study Design
Cross-sectional surveys accounted for most of the pub-
lications (n 5 30; 53%), and secondary analyses (n 5
10), qualitative research (n 5 5), and systematic re-
views (n 5 4) accounted for 18%, 9%, and 7% of the
included articles, respectively. Three studies had
unique study designs, which included 1 pilot experi-
ment study (Rodger, Thomas, et al., 2009).
Participants
A total of 5,813 occupational therapy participants were
directly involved in the primary research (i.e., excluding
systematic reviews and secondary analyses of databases).
Among the articles included, 75% (n 5 43) focused only
on occupational therapists, whereas 25% (n 5 14) in-
cluded data from occupational therapists compared with
or disaggregated from other types of health workers.
Geographical Areas
A total of 9% (n 5 5) of the articles had a transnational or
worldwide focus. Most focused on specific countries, ei-
ther the country overall (58%; n 5 33) or a region,
province, or state (18%; n 5 10); rural or remote area
(9%; n 5 5); or metropolitan area of a given country (7%;
n 5 4). Among the articles focused on specific countries
(n 5 52), Australia accounted for 31% (n 5 16), followed
by the United States (30%; n 515), Canada (12%; n 5 5),
and the United Kingdom (6%; n 5 3). Four articles
4
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart for the selection of
studies for the scoping review.

Records idenfied through database search

Idenficaon

Addional arcles idenfied N

through snowballing, website (1,222 aer being deduplicated)
searches, & key informants (PubMed n = 367; Scopus, n = 258; Web of Science–Core Collecon
n n = 259; CINAHL n 558; OTseeker n = 15; PDQ Evidence n = 15)

Records screened aer duplicates removed Records excluded, with reasons

n n )
Screening

No workforce research topic; no

occupaonal therapy; educaon; not
a study (e.g., no methods; no research
study queson)

Full-text arcles assessed for Full-text arcles excluded,

eligibility
Eligibility

with reasons n
(n )
o occupaonal therapy n ;
no workforce research n ;
educaon n ; not a study n
burnout only (no retenon issues n )

s ncluded

(n )
Included

for data extracon ast 25 y )

(n )

Note. Figure format from “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” by M. J. Page, J. E.
McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, . . . D. Moher, 2021, BMJ, 372, 71. https://doi.org/10.1136/bmj.n71

addressed LMICs: two for Brazil and 1 each for India and
South Africa, for a total of 7% of included articles. One
additional article (2%) addressed the anglophone sub-
Saharan Africa as a resource-poor global region.
Publication Venue
All of the articles except 1 were published in peer-
reviewed journals. Aligned with the geographical focus,
the Australian Occupational Therapy Journal was the
publication venue for 24% (n 5 13) of the peer-
reviewed publications; the American Journal of Occu-
pational Therapy published the second highest
number of peer-reviewed articles (9%; n 5 5). In total,
most peer-reviewed articles (57%) were published in
occupational therapy journals. Among the articles
published in non–occupational therapy journals, the
most common choice for publication was Human
Resources for Health (6%; n 5 3).
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Sources of Data or Participants
The sources of data or methods for recruiting partici-
pants were diverse. For example, 19% (n 5 11) of the
included articles used data sourced from licensing or
registration bodies, and 12% (n 5 7) used data from
national associations. A greater percentage of articles
(25%; n 5 14) used more than two sources to obtain
data or recruit participants.
Study Question Type, Data Collection Tools, and
Data Analysis
A total of 77% (n 5 44) of articles focused on either
descriptive or exploratory research questions, and 23%
percent (n 5 13) addressed an analytical type of ques-
tion (e.g., determining statistical associations,
predicting supply–demand shortages, examining the
impact of a new policy or intervention); 2% (n 5 1)
explicitly tested a hypothesis.
5
Figure 2. Distribution of articles in each inclusion category.
Aligned with these findings, 10% of the eligible
articles (i.e., excluding qualitative research and system-
atic reviews) used standardized tools; 39% of articles
with quantitative data applied inferential statistics dur-
ing the analysis.
Funding Status
A total of 70% of papers (n 5 40) reported no form of
funding support. Altogether, 21% of articles (n 5 12)
reported external funding. Four percent (n 5 2) used
intramural funding, and 5% (n 5 3) reported funding
support for specific authors (i.e., not for the specific
research project or program).
Of the 17 articles reporting funding, one was a
cross-sectional survey study with an exploratory study
question (6%), in contrast to the articles without fund-
ing (n 5 40), which relied heavily on cross-sectional
survey studies and exploratory study questions (53%;
n 5 21). Sixty-five percent of the funded articles used
inferential statistics compared with 20% of the un-
funded articles (i.e., 8 of 40).
A total of 47% of the articles reporting funding
(i.e., 8 of 17) focused on data for both occupational
therapists and other workers. In turn, 88% of the 40
nonfunded articles (n 5 35) used data for occupa-
tional therapists only and thereby were less able to
establish cross-professional comparisons.
Content Analysis of Specific Topics
A qualitative analysis of the study aims of the articles
included in this scoping review identified common
topics for occupational therapy workforce research.
Seven articles addressed workforce attractiveness
and retention in mental health (Ceramidas et al., 2009;
Hunter & Nicol, 2002; Rodger, Thomas, et al., 2009;
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Scanlan et al., 2013; Scanlan & Still, 2013; Scanlan &
Still, 2019; Scanlan et al., 2010), including 4 articles
that had the same first author. In turn, 5 Australian ar-
ticles addressed the issues of attractiveness and retention
specifically in rural or remote areas (McAuliffe & Barnett,
2009, 2010; Merritt et al., 2013; Mills & Millsteed, 2002;
Millsteed, 2000).
Among other topics addressed by workforce stud-
ies, 4 articles focused on continuing professional
development behaviors and licensing requirements
(Fields et al., 2021; Hall et al., 2016; Vachon et al.,
2018; White, 2005); 4 studies from the United States
determined that there were workforce shortages or
surplus based on supply and demand data (HRSA
Health Workforce, 2016; Lin et al., 2015; Powell et al.,
2005, 2008), and 3 focused on variation in employ-
ment and staffing levels in skilled nursing facilities in
the context of reimbursement policy changes in the
United States (McGarry et al., 2021; Mroz et al., 2021;
Prusynski et al., 2021).
Finally, 3 articles focused on internationally trained
occupational therapists, including 2 from Canada that
investigated workforce integration (Dhillon et al.,
2019; Mulholland et al., 2013; Pittman et al., 2014). No
other topics were addressed by more than 2 articles.
Discussion
This scoping review highlights the global status of oc-
cupational therapy workforce research worldwide. Our
results show a limited volume of such research, with
weak growth over time, little focus on LMICs, a re-
stricted breadth of topics, an overreliance on
exploratory cross-sectional surveys, the limited use of
inferential statistics, a lack of experimental studies, and
low rates of funding support. Furthermore, the review
6
indicates that the studies with funding support tended
to use stronger methodology. All of these findings are
worthy of discussion.
The findings revealed a low volume of occupational
therapy workforce research, coupled with weak annual
growth (i.e., 14 yr to add one additional yearly publi-
cation; 2011 and 2012 without a single publication),
especially when compared with other health workforce
research. As many as 867 research articles were found
for health workforce research topics in 2018 alone,
with a significant and exponential type of growth over
time from 129 yearly publications in 1990 to nearly
900 in 2018 alone (Jesus, Castellini, et al., 2022). In
volume and growth, occupational therapy workforce
research production lags behind expectations.
A few examples of commonly researched topics
were found, including career attractiveness and reten-
tion issues (e.g., mental health as a practice area,
practicing in rural areas) with studies in this area com-
ing predominantly from Australia. Determining
supply–demand shortages and the impact of changed
reimbursement policies on reduced staffing and
employment levels were study topics that came exclu-
sively from the United States. In turn, Canada was the
country with primary research articles studying inter-
nationally trained occupational therapists.
It is possible that country-specific policies, culture,
or the overall landscape of research and its funding
have shaped these country-specific patterns of occupa-
tional therapy workforce research. For example, studies
and research structures for studying or forecasting
workforce shortages for varied health professions are
common in the United States (Juraschek et al., 2019;
Landry et al., 2016; Ricketts et al., 2021; Zhang et al.,
2018, 2020; Zimbelman et al., 2010). Similarly, supply-
ing rural and remote areas of the country with a
needed and capable health workforce is a major policy,
research, and research policy priority in Australia
(Gillam et al., 2021; Russell et al., 2021; Wakerman
et al., 2019). Finally, the Canadian studies on interna-
tionally educated occupational therapists were funded
with sponsorship of governmental bodies in two prov-
inces focused on employment and immigration issues
(Dhillon et al., 2019; Mulholland et al., 2013).
Overall, the trends identified in this scoping review
may be derived more from country-specific policies,
research, or funding priorities than from any particu-
larly needed occupational therapy–specific workforce
topics prevalent across nations. Unlike for other health
professions, such as nursing (WHO, 2016a), no global
guidance exists for the development of occupational
therapy human resources and workforce research. As
a result of these findings, the WFOT aims to use a re-
search- and consultation-based process to develop a
strategy to provide such guidance.
The rates for funding of workforce research found
in this review were not remarkable. Only 30% of in-
cluded articles reported any form of funding (25%, if
funding that supported only individual authors is
THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2023, VOLUME 77, NUMBER 3
excluded). These values differ from funding levels usu-
ally identified for health workforce research. Since
2010, the percentage of health workforce research with
funding support has been stable at approximately 50%
(Jesus, Castellini, et al., 2022), with rehabilitation-
related health policy, systems, and services research re-
ceiving funding support at a level of 55% (Jesus et al.,
2020). These findings help explain, in part, a subopti-
mal application of more advanced or stronger research
designs and methods in the occupational therapy work-
force literature. Funding occupational therapy
workforce research at more standard rates will likely
improve both the quantity and the quality of the meth-
ods used in occupational therapy workforce research
and thereby provide a stronger evidence base for pro-
fessional advocacy and workforce developments.
Of the 57 included articles, 7% focused on LMICs,
which contrasts with the 77% of the world’s rehabilita-
tion needs coming from LMICs (Jesus et al., 2019).
Although this is a common problem in other areas of
health research (i.e., LMICs account for about 12% of
rehabilitation-related health policy, systems, and services
research; Jesus et al., 2020), the low volume of research
on LMICs may raise global public health concerns.
Existing data indicate scant, limited, or nonexistent
occupational therapy workforces or education pro-
grams in many LMICs (Agho & John, 2017; Ledgerd
& WFOT, 2020). Models of service delivery and work-
force supply to feasibly meet the health and
occupational needs of their populations might differ in
many LMICs. Hence, there is a strong need to develop
and study efficient and feasible means to develop the
workforce in these contexts. This review, however,
shows that occupational therapy workforce research
rarely tackles issues in LMIC contexts.
We found that only 9% of the included articles had
a cross-country focus, which prevents cross-national
comparisons, benchmarks, partnerships, or knowledge
exchange on the so-called North–North (Jesus, Landry,
et al., 2022), South–South (Were et al., 2019), and
North–South (Mwangi et al., 2017) partnerships on
workforce research and developments (here North
equates to high-income nations and South to LMICs).
Greater cross-national partnerships for occupational
therapy workforce research have the potential to ad-
dress existing issues with the lack of data on the
international mobility of occupational therapists. Also,
we found no studies directly looking at the interna-
tional recruitment of occupational therapists or on the
ethical issues that may arise from such recruitment
(WFOT, 2014).
Limitations of this scoping review include the lack
of inclusion of research on the education of occupa-
tional therapists, despite the key importance of
education for the development of the profession. We
included workforce research (i.e., with a study ques-
tion and reported methodology) but not other forms
of reports or databases with workforce data. This
choice reflects a focus on knowledge generation
7
beyond data generation. We did not search the Pro-
Quest Dissertations and Theses Global database
because our focus was on studies published in the
peer-reviewed literature or in institutional venues such
as governmental or nongovernmental agencies. Al-
though we did not have language restrictions on
eligibility and used diverse search strategies (including
key informants from diverse countries), we were un-
able to map literature in languages other than English.
As a result, underrepresentation of literature from geo-
graphical areas using languages other than English in
reporting research cannot be ruled out. Finally, we did
not focus on reporting the findings, recommendations,
and limitations that are a subject for other reports on
this study (Jesus, Mani, Ledgerd, et al., 2022; Jesus,
Mani, von Zweck, et al., 2022).
Implications for Occupational
Therapy Practice
This scoping review uncovered the global status of oc-
cupational therapy workforce research worldwide and
highlights the need for it to be strengthened. It has the
following implications for occupational therapy
practices:
䊏 Occupational therapy stakeholders such as those
in practice, academia, research funding, and pol-
icy and professional advocacy roles may collabo-
rate (at the global, country, and regional levels)
to develop systemic, strategic, and methodologi-
cally stronger occupational therapy workforce
research agendas. These agendas may provide a
more solid body of research and evidence to
identify and address workforce gaps and thereby
promote equitable population access to compe-
tent occupational therapy services.
䊏 Funders of occupational therapy research or of
health policy, systems, and services research may
support funding (e.g., earmark a percentage of
funds) for occupational therapy workforce re-
search to align with funding of other health human
resources research. This advancement is likely to
strengthen the quantity, methods, and value of oc-
cupational therapy workforce research and evi-
dence to inform everyday professional advocacy
and workforce development practices.
Conclusion
Occupational therapy workforce research is key in pro-
viding evidence regarding whether and how the
occupational therapy workforce exists in sufficient
quantity, is equitably distributed, and meets key com-
petency standards. The results of this scoping review
map the global status of occupational therapy work-
force research, which was found to be scant, barely
growing, and inequitably distributed by geographical
area; to use suboptimal methods; and to be under-
funded, with stronger methods for the studies that
were funded.
THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY  MAY/JUNE 2023, VOLUME 77, NUMBER 3
Apart from a few examples of research topics,
mostly country specific, we could not find long-term
research programs or agendas for the systematic study
of the occupational therapy workforce. Doing so may
be necessary to generate an evidence base for guiding
and assessing occupational therapy workforce policies,
advocacy, and development practices.
According to gaps identified in this review, con-
certed stakeholder development is required to
strengthen funding mechanisms, provide guidance on
topics and research questions to be addressed, and en-
hance the methodology of the occupational therapy
workforce research within and across nations.
To align with strategic directions for health human
resources (WHO, 2016b) and for specific health pro-
fessions such as the nursing workforce (WHO, 2016a),
there is a need to develop a global strategy and re-
search agenda to strengthen the status of occupational
therapy workforce research. The WFOT is planning to
develop such a strategic guidance at the global level.
Acknowledgments
We thank the WFOT delegates and other member
organization representatives who suggested papers
for inclusion in this scoping review. Tiago S. Jesus
completed this work under a grant from the Na-
tional Institute on Disability, Independent Living,
and Rehabilitation Research (NIDILRR;
90ARHF0003). NIDILRR is a center within the Ad-
ministration for Community Living (ACL), U.S. De-
partment of Health and Human Services (HHS).
The contents of this publication do not necessarily
represent the policy of NIDILRR, ACL, or HHS,
and the reader should not assume endorsement by
the U.S. federal government.
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Tiago S. Jesus, OTD, PhD, is Postdoctoral Fellow, Center for Education in
Health Sciences, Institute for Public Health and Medicine, Feinberg School
of Medicine, Northwestern University, Chicago, IL; tiago.jesus@
northwestern.edu
Karthik Mani, OTD, OTR, FACOT, is Assistant Professor and Academic
Fieldwork Coordinator, Department of Occupational Therapy, School of
Health Professions, University of Texas Medical Branch, Galveston.
Claudia von Zweck, PhD, OT Reg (Ont), is Professional Advisor, World
Federation of Occupational Therapists, Geneva, Switzerland.
Sutanuka Bhattacharjya, PhD, OTR/L, is Assistant Professor, Department
of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health
Professions, Georgia State University, Atlanta.
Sureshkumar Kamalakannan, PhD, is Associate Professor, Department
of Social Work, Education and Wellbeing, Northumbria University,
Newcastle upon Tyne, United Kingdom.
Ritchard Ledgerd, MSc, BScOT, FWFOT, is Executive Director, World
Federation of Occupational Therapists, Geneva, Switzerland.
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