Challenges in accessing and implementing innovative interventions in occupational therapy

Abstract

Objective

This study aimed to identify the main barriers to accessing and implementing innovative treatment approaches in occupational therapy from the perspectives of expert practitioners.

Methods

A descriptive and cross-sectional design was adopted using the Delphi method. Twenty expert occupational therapists in Türkiye, each with at least two years of clinical experience, participated in the first round, while 17 completed the second round. Data were collected through two rounds of online questionnaires. In the first round, participants responded to open-ended questions, and their answers were analyzed using content analysis to generate themes. In the second round, these themes were rated on a 7-point Likert scale to assess the level of consensus among participants.

Results

A total of 67 distinct statements were collected in the first round and synthesized into seven themes. In the second round, the highest level of consensus was reached on high training costs, therapists’ lack of knowledge, and difficulties in accessing technology and equipment. Conversely, themes such as lack of standardized protocols, regulatory compliance issues, and insufficient multidisciplinary collaboration showed lower levels of agreement.

Conclusion

The findings indicate that limited technological infrastructure, restricted accessibility, high educational costs, and absence of standardized guidelines are the primary barriers to the clinical integration of innovative interventions in occupational therapy. Addressing these barriers is critical to promoting technology-based, client-centered, and evidence-driven practices in the field.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-026-14151-8.

Introduction

In this study, innovative interventions in occupational therapy refer to technology-based therapeutic approaches that rely on advanced technological infrastructure, including virtual reality (VR), augmented reality (AR), robot-assisted rehabilitation, telerehabilitation, and emerging artificial intelligence (AI) –supported applications. These approaches are often characterized by high implementation costs, increased technical and infrastructural requirements, and limited accessibility, which may constitute substantial structural and practical barriers to their adoption in routine clinical practice [1, 2].

Within rehabilitation processes, such technology-based applications have the potential to enhance treatment outcomes by improving individuals’ quality of life [3]. Moreover, these technological advancements influence not only the content of therapeutic interventions but also the equipment and clinical processes used by health professionals. In this context, the integration of innovative methods into occupational therapy practice has become increasingly important [4].

Previous studies have reported that technology-based interventions, including virtual reality (VR), augmented reality (AR), and robot-assisted rehabilitation, may enhance motivation, participation, and functional outcomes across rehabilitation settings [5]. Evidence from pediatric and neurological rehabilitation further suggests that these approaches can support motor performance, upper extremity functions, and engagement in daily life activities [6, 7].

However, despite these documented benefits, the integration of technology-based interventions into routine clinical practice remains limited. The literature consistently reports multiple barriers to implementation, including infrastructural constraints, limited access to appropriate technological resources, high implementation and training costs, and insufficient professional training [8]. In addition, informational and instructional inadequacies—such as restricted access to formal education opportunities, insufficient professional development, and the absence of structured guidance for technology use—further hinder effective clinical integration [9]. Beyond these structural and educational barriers, differences in professional attitudes also play a critical role. In this context, therapists’ self-view, including their perceived professional competence, role adequacy, and confidence in using technology, may substantially influence their willingness and readiness to adopt innovative interventions in occupational therapy practice [10, 11] .

Such barriers may become more evident across healthcare systems that differ in terms of financial resources, technological infrastructure, and levels of institutional support. In countries such as Turkey, where healthcare services are rapidly developing, these contextual factors may influence occupational therapists’ access to technology-based innovative interventions and their integration into routine clinical practice.

These observed alterations in the field of occupational therapy improve treatment efficiency across multiple disciplines such as pediatrics, neurology, and orthopedics, as well as clinical processes [12]. Furthermore, healthful utilization of these approaches are dependent not only on the availability of technical structure, but also on the proficiency of health professionals in terms of their self-efficacy with technology, as well as their attitude and usage of it [13, 14]. The featured shortcomings include insufficient use of advanced technologies such as robotic rehabilitation and sensor-based assessment, particularly virtual reality, in clinical decision-making processes, alongside factors related to therapists’ self-view, including perceived professional competence, role adequacy, and attitudes toward the use of technology in occupational therapy practice [15]. Although there is research in the literature that focus on the accessibility and applicational limitations of treatment techniques, there are few studies that focus directly on occupational therapist experiences [11] .

In this context, technology-based approaches such as virtual reality, augmented reality, robot-assisted systems, and sensor-based technologies offer promising opportunities for occupational therapy practice. However, the translation of these approaches into routine clinical settings remains challenging, suggesting the need for further examination of the systemic and professional factors influencing their implementation [12].

Previous studies have demonstrated the potential benefits and expanding use of technology-based interventions, such as virtual reality, in rehabilitation settings [16]. In parallel, growing evidence has highlighted multiple barriers to the adoption and implementation of these technologies, including financial constraints, infrastructural limitations, insufficient training, and professional attitudes, as reported among rehabilitation professionals and healthcare providers [17, 18]. However, despite this growing body of literature, there remains a limited understanding of occupational therapists’ perspectives on access- and implementation-rabarelated barriers to technology-based innovative interventions, particularly within low- and middle-income country contexts. Moreover, studies directly focusing on occupational therapists’ experiential knowledge and expert consensus regarding these challenges are scarce.

Therefore, the aim of this study was to explore occupational therapists’ perspectives on access-related and implementation-related barriers associated with technology-based innovative interventions in occupational therapy practice in Turkey, using a Delphi consensus approach.

Method

Research design

This study was designed as a descriptive, cross-sectional study employing the Delphi technique to identify barriers related to accessing and implementing innovative treatment approaches in occupational therapy practice. The Delphi technique is a structured, iterative research strategy that aims to achieve consensus among experts through a series of sequential questionnaires, while maintaining participant anonymity and providing controlled feedback between rounds [19].

Core methodological principles of the Delphi technique include anonymity of expert responses, iterative data collection, and structured feedback, which collectively reduce interactional biases such as dominance effects, social pressure, and authority influence that may arise in face-to-face group discussions [19]. These features enable experts to express independent and objective opinions, particularly when addressing complex, ambiguous, or insufficiently explored topics. In addition, previous methodological studies emphasize that the Delphi technique is especially suitable for systematically synthesizing expert knowledge in emerging or rapidly evolving research areas where empirical evidence is limited, such as the implementation of technology-based interventions in occupational therapy practice [20, 21] .

Within the scope of this study, the first Delphi survey was conducted between March 3 and 17, 2025, and the second-round survey was conducted between April 7–9, 2025, and the data collection procedure completed.

Participants

In Delphi research, expert status is typically defined based on advanced professional training and relevant clinical experience rather than solely on years of practice. In the study, occupational therapists were considered “experts” if they had determined characteristics. In detail, inclusion criteria were: (1) being a licensed occupational therapist, (2) having completed a postgraduate (master’s) degree in occupational therapy or a related field, (3) having active clinical experience in occupational therapy practice, with a minimum professional experience threshold of at least two years, and (4) current involvement in clinical areas where innovative or technology-based interventions may be relevant (e.g., pediatric, neurological, orthopedic, or geriatric rehabilitation). Occupational therapists who did not meet these criteria were not invited to participate in the study. So that participants were recruited using a purposive sampling strategy.

In accordance with methodological recommendations for Delphi studies, the target sample size was determined based on the principle of information power rather than statistical representativeness. Previous literature indicates that expert panels consisting of 10–30 participants are sufficient for achieving meaningful consensus in homogeneous expert groups [22, 23]. Accordingly, the planned sample size for this study was considered adequate to capture diverse expert perspectives relevant to the study objectives.

Recruitment process

Eligible experts were invited to participate via an online survey distributed using Google Forms. The invitation included detailed information regarding the study aims, procedures, and the voluntary nature of participation. Written informed consent was obtained electronically from all participants prior to their inclusion in the Delphi process.

Data collection

Data collection was conducted using a two-round Delphi process. In the first Delphi round, expert occupational therapists were asked to respond to an open-ended question regarding barriers to accessing and implementing innovative treatment approaches in occupational therapy. Participants provided their responses independently. Following the first round, responses were compiled and subjected to content analysis. A total of sixty-seven raw statements were generated from the open-ended responses, all of which are presented in detail in Supplementary Material 1. These statements informed the development of the second Delphi round. The overall stages of the Delphi process, including data collection and analysis steps, are summarized in Table 1.

Table 1.

Study flow

Stage	Statement	Model/ Output
1st Round Question	The participants were asked an open-ended question.	“What are the obstacles to the application of innovative treatments in occupational therapy?”
1st Round Data Collection	Experts provided comprehensive feedback using an online Google Form.	Collection of qualitative responses from 20 occupational therapists. (March 3–17, 2025)
Content Analysis	Open-ended responses were coded using content analysis, and related expressions were combined to produce themes.	Coding → Subcategories → Themes
Established Themes	Common opinions collected from the first set of replies were thematized.	Limited access to technology and equipment- Insufficient administrative assistance- Regulatory compliance concerns- A lack of multidisciplinary teamwork- Expensive training costs- A lack of therapist expertise and training- A lack of standard protocols / universal design incompatibility
2nd Round Survey Preparation	The obtained themes were converted into items and structured according to the 7-point Likert scale.	1 = strongly disagree − 7 = strongly agree
2nd Round Application	The same group of experts (17 people) sent the second survey via Google Forms.	Likert scoring was collected for each theme. (April 7–9, 2025)
Consensus Evaluation	Each item has its interquartile width (IQW) determined. Items having an IQW of < 1.2 were considered to have consensus.	Of the items, 42.8% reached a consensus. The third round did not take place.

In the second round, participants were invited to evaluate the identified issues using a structured questionnaire. The second-round survey was also administered online via Google Forms. All responses were recorded to allow systematic comparison across rounds and to determine whether an additional Delphi round would be required.

Data analysis

Qualitative data obtained from the first round of the Delphi process were analyzed content to identify common barriers related to accessing and implementing innovative treatment approaches in occupational therapy [24]. All open-ended responses were reviewed, and meaningful units were coded. Similar codes were compared and grouped based on shared meanings, leading to the emergence of seven themes that reflected the experts’ shared perspectives. The themes identified in the first round were as follows:

(1) access to technology and equipment,

(2) lack of administrative or managerial support,

(3) challenges related to regulatory compliance,

(4) lack of multidisciplinary collaboration,

(5) high educational and training costs,

(6) insufficient training and knowledge of therapists, and.

(7) absence of standard protocols and incompatibility with universal design principles.

These seven themes, derived directly from the qualitative analysis of the first-round data, were subsequently transformed into structured items and used to develop the questionnaire for the second Delphi round.

In the second round, participants were asked to rate their level of agreement with each item using a 7-point Likert scale, ranging from 1 (strongly disagree) to 7 (strongly agree). Quantitative analysis was conducted using descriptive statistical methods, including calculation of the median and interquartile range (IQR) for each item.

Consensus was evaluated based on the interquartile width criterion. In Delphi studies employing Likert-type scales, the IQR is widely used to determine the extent of agreement among experts, with lower values indicating greater convergence of opinions. Previous methodological studies have suggested that an IQR threshold of ≤ 1.2 represents an acceptable level of consensus [20, 23]. Based on the second-round analysis, consensus was reached for 42.8% of the items according to the predefined interquartile range criterion. As this level of agreement was considered sufficient within the scope of the Delphi methodology, a third Delphi round was not conducted.

Results

Information about participants

Twenty participants contributed to the first round of the research and 17 participants contributed to the second round. The reduction in the number of participants in the second round was due to non-response within the specified timeframe. Detailed information about the participants is shown in Table 2.

Table 2.

Descriptive information concerning participants

Variable	1st Round		2nd Round
	n	%	n	%
Gender	Male: 6 Female: 14	Male: 30% Female: 70%	Male: 4 Female: 13	Male: 23,5% Female: 76,5%
Field of Study	Academia Pediatrics Hand Rehabilitation Mental Health/Psychiatry Adult/ Geriatric	20% 55% 5% 10% 10%	Academia Pediatrics Hand Rehabilitation Mental Health/ Psychiatry Adult/ Geriatric	20% 55% 5% 10% 10%
Age	Average ± SD	(Min-Max)	Average ± SD	(Min-Max)
	27,9 ± 3,8	24–35	22,17 ± 2,01	24–28
Professional Experience	4,6 ± 2,5	2–12	3,4 ± 1,2	2–10

Conformity of materials

There are differences in the responses to the questions provided to the participants. In fact, content analysis led to the grouping of multiple concepts used to signify comparable barriers or factors influencing implementation.

For example, the theme “Lack of Multidisciplinary Collaboration” was established based on the following statements by the participants:

• “Lack of multidisciplinary cooperation”.

• “Absence of multidisciplinary collaboration”.

• “Insufficient multidisciplinary collaboration”.

• “Absence of multidisciplinary collaboration”.

• “Lack of multidisciplinary teamwork”.

• “Failure to establish transdisciplinary collaboration.”

Results of the Delphi process

In the first round, twenty participants provided sixty-seven distinct opinions. A second round of the survey was developed based on seven different themes as due to of the study of feedback in these opinions. Table 3 indicates the survey results from the second round.

Table 3.

Delphi survey second round results

Factors	Average	SD	Quartile Range Value
Issues in Access to Technology and Equipment	5,3529	1,11474	1,00*
Lack of Managerial Support	4,8824	1,57648	1,50
Regulatory Compliance Issues	4,9412	1,19742	2,00
Lack of Multidisciplinary Collaboration	4,3529	1,36662	1,50
High Training Costs	6,0000	0,80896	1,00*
Insufficient Therapist Knowledge	5,4706	1,32842	1,00*
Lack of Standardized Protocols	5,2353	1,67815	2,00

* <1.20 Consensus Items

The results of the second-round Delphi survey demonstrated an elevated level of consensus among participants on certain issues. Especially, the factors of high training costs (Avg.= 6.00, SD: 0.81), insufficient therapist knowledge (Avg.= 5.47, SD:1.33) and issues in access to technology and equipment (Avg.=5.35, SD:1.11) had a quartile range value of < 1.20, indicating a strong consensus. In contrast, a wider distribution was observed in the factors for a lack of standardized protocols (Avg.= 5,23 SD:1,68), regulatory compliance issues (Avg.= 4,94 SD:1,20) and a lack of multidisciplinary collaboration (Avg.=4,35, SD:1,37), indicating the existence of different opinions among the participants.

Discussion

According to the results of this study, the most prominent obstacles to the integration of innovative treatment methods into clinical practice were identified as a lack of technological infrastructure, accessibility constraints, and high educational costs. Innovative approaches such as virtual reality (VR), augmented reality (AR), robot-assisted rehabilitation, and telerehabilitation have become widespread in the field of occupational therapy in recent years, and the literature reports that these technologies strengthen participation by increasing patient motivation and making therapy processes more interactive [5]. Despite their documented clinical benefits, the effective integration of these innovative approaches into routine occupational therapy practice remains challenging.

Studies in pediatric and neurological rehabilitation demonstrate that virtual reality and robotic systems are effective in improving motor performance, upper extremity functions, and participation in daily life activities [6]. Similarly, the systematic review by Demirtaş and Yalçın (2022) indicates that augmented reality (AR) and virtual reality (VR) technologies are effective in enhancing communication, social interaction, daily living skills, and academic performance in individuals with special needs. However, many existing studies are based on small sample sizes, and the absence of standardized protocols limits the generalizability of these findings [7] .

Consistent with this limitation, the findings of the present study suggest that barriers to the implementation of innovative treatment approaches are primarily related to working conditions, infrastructural limitations, and the professional competencies of therapists. Although these themes may initially appear to reflect general service delivery barriers, experts participating in the Delphi process particularly emphasized challenges related to the practitioner role. Barriers such as limited access to technology and equipment, high educational costs, insufficient therapist knowledge, and lack of managerial support indicate that the clinical integration of innovative treatment methods is closely linked to institutional capacity and therapists’ professional readiness.

Our study results revealed that limited access to technological infrastructure is a significant obstacle. The literature also states that factors such as device supply, internet infrastructure, and software costs limit access to telerehabilitation applications [7, 25]. The literature further emphasizes that clients living in rural areas are particularly disadvantaged in accessing digital health services, which makes it difficult to use technology-based interventions effectively. Therefore, the dissemination of innovative technologies without providing adequate infrastructure support may not yield the expected results.

Another important finding of the present study is that economic accessibility issues play a decisive role in the clinical integration of innovative treatment approaches. Consistent with this finding, the Delphi study conducted by Allers et al. (2024) identified device costs, investments required for professional training, and the lack of sustainable funding models as major barriers to the implementation of innovative health technologies [26]. These financial constraints create significant challenges for integrating innovative interventions into clinical budgets, particularly in small clinics and public healthcare institutions. Moreover, the absence of reimbursement systems that adequately support technology-based interventions further limits their routine clinical use.

On the other hand, given that the Delphi method is based on expert consensus rather than objective measurement, the findings of this study should be interpreted within their contextual and systemic framework, taking into account institutional conditions, professional roles, and healthcare system characteristics.

Similarly, a recent survey study by Segal and Doyle (2024), focusing specifically on occupational therapy practitioners, reported that therapists’ confidence, prior training, and perceived professional competence in using technology significantly influenced the extent to which innovative technologies were integrated into routine clinical practice. The authors further emphasized that limited technological preparedness and uncertainty regarding clinical applicability remained key barriers among occupational therapists, despite the increasing availability of digital tools [10] .

Occupational therapists’ knowledge levels, attitudes toward technological tools, and perceived self-efficacy have emerged as key determinants in the integration of innovative treatment approaches into clinical practice. In a study by Hoffman et al. (2025), limited knowledge of advanced technologies such as artificial intelligence, alongside negative perceptions and concerns regarding the potential substitution of professional roles by technology, were found to contribute to healthcare professionals’ hesitation to adopt these innovations [8].

Similarly, Harper et al. (2022) reported that insufficient therapist knowledge, challenges in evaluating patient motivation, and a lack of organizational support negatively affected the translation of recommended home-based occupational therapy assessments into clinical practice [9]. These findings indicate that the adoption of technological innovations in occupational therapy is influenced not only by infrastructural availability but also by therapists’ professional competencies and preparedness.

In addition, the absence of standardized protocols represents a significant limitation affecting the consistency and comparability of clinical practices. Considerable variability in session duration, intervention frequency, and total treatment dosage across virtual reality, robotic rehabilitation, and other innovative interventions—particularly in pediatric cerebral palsy populations—makes it difficult to identify optimal application parameters and limits the generalizability of existing evidence [7]. Therefore, the development of evidence-based standardized guidelines is essential to support the effective and consistent integration of innovative treatment approaches into occupational therapy practice.

Additionally, other factors influencing the clinical integration of innovative treatment methods include regulatory compliance, multidisciplinary collaboration, and executive support. The literature emphasizes that the successful adoption of innovative technologies in healthcare is not solely dependent on technical infrastructure and individual professional competence, but is also closely linked to existing legal regulations, effective coordination among multidisciplinary teams, and internal leadership support [14].

Compliance with regulatory frameworks enhances the reliability and acceptability of clinical practices, while multidisciplinary collaboration facilitates the integration of diverse professional knowledge and skills, enabling more comprehensive and effective interventions. Furthermore, executive support contributes to the sustainability of innovative approaches by promoting the efficient use of both financial and organizational resources [14].

In line with the findings of the present study, experts emphasized that the perceived benefits of innovative technologies extend beyond client outcomes and also influence therapists’ workload, clinical efficiency, and decision-making processes.

Additionally, the impact of innovative technologies on the professional processes of therapists is also an important dimension. These technologies not only increase client engagement; they also reduce therapists’ workload, enhance the objectivity of assessment processes, and support data-driven intervention planning [5]. For example, sensor-based feedback systems enable real-time monitoring of motor performance, while robot-assisted tools reduce repetitive physical demands on therapists, allowing them to deliver effective interventions to a larger number of clients. Thus, technological systems contribute not only to clinical outcomes but also to the overall management of the therapeutic process [7, 8]. Similar findings have been reported in the international literature. In the systematic review by Banyai et al. (2024), robotic systems were shown to improve healthcare efficiency by reducing therapist workload in motor rehabilitation [27]. In addition, social support robots (SSRs) have been reported to enhance adherence to rehabilitation programs, support motor skill development, and increase patient motivation [28].

In the Turkish context, the available evidence remains limited; however, existing findings suggest promising outcomes. A systematic review by Demirtaş and Yalçın (2022) demonstrated that augmented reality (AR) and virtual reality (VR) technologies are effective in improving communication, social skills, and daily living skills, particularly among individuals with special needs such as autism spectrum disorder and intellectual disability.

In this regard, strengthening technological infrastructure, expanding therapist training opportunities, and developing supportive policy frameworks are critical for enhancing the effectiveness and sustainability of innovative occupational therapy interventions. These needs are not unique to Turkey but are also shared by many low- and middle-income countries, where limitations in infrastructure and policy support continue to constrain the widespread implementation of technology-based rehabilitation practices [6].

Overall, based on the perspectives of expert occupational therapists, the present study identified several key barriers to the clinical integration of innovative treatment approaches, including insufficient technological infrastructure, access-related constraints, high training costs, the absence of standardized protocols, and limited institutional and regulatory support. This finding highlights that the integration of innovative interventions is influenced not only by technological availability but also by systemic, educational, and organizational factors.

Eliminating these barriers is of critical importance for promoting the sustainable adoption of technology-based, client-centered, and evidence-based practices in occupational therapy. In this regard, coordinated efforts at the institutional, educational, and policy levels are required to enhance therapists’ readiness and capacity to implement innovative interventions in routine clinical practice.

This study has certain limitations. The findings are based on the opinions of a relatively small group of expert occupational therapists and reflect the context of a single country, which may limit generalizability. In addition, as the Delphi method relies on expert consensus, the depth of the data is inherently limited to the scope of the questions posed and the number of Delphi rounds conducted. However, this methodological characteristic also represents a strength, as the Delphi approach enables the systematic identification of shared professional priorities and challenges. Future studies involving larger samples, additional Delphi rounds, or mixed-method designs are recommended to further explore these barriers in greater depth and across different healthcare contexts.

Conclusions

Based on expert opinions, this Delphi study indicated the main challenges and requirements for integrating novel and technology-supported applications into clinical settings in occupational therapy. The results of the two-round process suggest that practitioner competencies, clinical infrastructure facilities, organizational support mechanisms, and vocational training requirements are the most important elements in acceptance of innovative strategies. Experts acknowledge that multidimensional regulations are required at both the individual and institutional levels to sustainably incorporate novel methodologies.

This study provides a framework for the development of innovative occupational therapy practice models and offers to raise awareness of the practical barriers that therapists experience. The results of the study also contribute significantly to development of policy processes with the objective of improving clinical service models, updating professional training content, and strengthening internal support systems. It is recommended that future studies analyze the long-term impacts of novel techniques, assess the applicability of interventions, and test the patterns identified in this study in various clinical contexts.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

VR

Virtual Reality

AR

Augmented Reality

Author contributions

İE: Conceptualization, Methodology, Data Analysis, Writing – Original Draft, and Final Approval. SEE: Data Collection, Writing – Review & Editing, and Final Approval. EG: Methodology, Writing – Review & Editing, and Final Approval.ZB: Formal Analysis, Writing – Review & Editing, and Final Approval.The authors conducted the whole study design, collecting and analyzing data, reporting, and article writing processes. All of the authors read and approved the article’s final form.

Funding

This study has received no funding from any institution or organization.

Data availability

The data obtained in this study is anonymised and can be accessed from the corresponding author upon reasonable request, regardless of confidentiality requirements.

Declarations

Ethical approval and consent to participate

Ethical approval was obtained from the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (Decision Number: E-10840098-202.3.02.-6036, Date: 04/10/2024). The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). Informed consent was obtained from all participants who agreed to take part in the study, and the study strictly adhered to confidentiality rules throughout.

Consent for publication

Not applicable. This study does not include any identifying information, photos, videos, or personal data.

Competing interests

The authors declare no competing interests.