Developing and Implementing an Occupation-Based Practice Service Delivery Model for Stroke Survivors in a Rural Thai Community Rehabilitation Center: Mixed Methods Feasibility Study.

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 investigations into 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 OBP service delivery model for community-based stroke rehabilitation in the Doi Lor community, Chiang Mai Province, Thailand, and to evaluate its effects on occupational performance, goal attainment, and quality of life among community-dwelling stroke survivors. Additionally, the study explored the occupational therapist's experience and perceptions of implementing the model, particularly the practicality of implementation in long-term community-based occupational therapy services. METHODS: This study used an embedded mixed methods feasibility design comprising a 1-group pretest-posttest intervention study and a qualitative descriptive interview. An OBP service delivery model for community-based stroke rehabilitation was developed based on the Dynamic Model of Occupation-Based Practice; the Occupational Therapy Practice Framework, Fourth Edition; and evidence-based stroke rehabilitation principles. The model was implemented by a trained occupational therapist with 7 stroke survivors at a rural community rehabilitation center over 14 sessions spanning 7 weeks. Quantitative outcomes were assessed before and after the intervention using the Canadian Occupational Performance Measure, goal attainment scaling, and the World Health Organization Quality of Life-Brief Version. Qualitative data were collected through a semistructured interview with the occupational therapist to explore experiences of implementing the OBP service delivery model. RESULTS: In the quantitative analysis, participants demonstrated statistically significant improvements in occupational performance and satisfaction as measured by the Canadian Occupational Performance Measure (P=.02), higher levels of goal attainment on the goal attainment scaling (P=.02), and improved overall quality of life as assessed by the World Health Organization Quality of Life-Brief Version (P=.02). Qualitative findings from the occupational therapist interview indicated 2 themes, including facilitating client-centered outcomes through OBP implementation and enhancing professional confidence and supporting the practical implementation of OBP in community-based practice. The occupational therapist described the model as practical and feasible and reported increased confidence in delivering occupation-based interventions. The findings also highlighted the potential applicability of the model within long-term, community-based occupational therapy services. CONCLUSIONS: This preliminary study suggests that an OBP service delivery model grounded in therapist preparation, client-centered goal setting, and outcome-focused intervention may support improvements in occupational performance, goal attainment, and quality of life among stroke survivors receiving community-based rehabilitation. This approach may contribute to strengthening long-term stroke care, particularly in rural communities where access to hospital-based rehabilitation services is limited.