The role of occupational therapy in the rehabilitation of adults with persistent post‐concussion symptoms in Australia and New Zealand: A qualitative study

Abstract

Introduction

Following mild traumatic brain injury, people can experience persistent post‐concussion symptoms (PPCS) that lead to the need for rehabilitation, including occupational therapy services, to support recovery. There is, however, limited literature documenting the occupational therapy role in adult PPCS rehabilitation. This study aimed to explore the role of occupational therapy, including the assessments and interventions used, in the rehabilitation of adults with PPCS in Australia and New Zealand.

Methods

A qualitative descriptive research design was employed. Occupational therapists working with adults with PPCS in Australia or New Zealand were recruited via advertisements on professional email listservs and via social media. Semi‐structured interviews were undertaken via videoconference, transcribed verbatim, deidentified, and underwent member checking and reflexive thematic analysis.

Consumer and community involvement

No consumers were involved in the study design or analysis.

Findings

Fifteen occupational therapists were recruited from Australia (n = 11) and New Zealand (n = 4). The majority were women (n = 14). Interviews ranged from 48 to 127 minutes (M = 74 minutes), with four main themes identified: timing and reasons for occupational therapy referral; assessments and interventions used in practice; current and future occupational therapy practice opportunities; and occupational therapy practice resources that are utilised or needed.

Conclusion

Given that occupational therapy is increasingly being included in multi‐disciplinary PPCS programs, this research provides evidence of the current and potential future scope of occupational therapy practice in adult PPCS rehabilitation. Further research exploring occupational therapy roles in other countries, and including perspectives of people with PPCS, will be of benefit to guide rehabilitation service design.

PLAIN LANGUAGE SUMMARY

Concussion symptoms that remain for 4 weeks or more following mild brain injury are sometimes called persistent post‐concussion symptoms. These symptoms may affect a person's ability to function in their roles and activities of daily life. Occupational therapists can help people manage their daily lives despite their persisting symptoms. We wanted to understand what it is like for occupational therapists who work with people (aged 18 to 65 years) who experience persistent post‐concussion symptoms. To do this, we interviewed 15 occupational therapists across Australia and New Zealand. The information occupational therapists shared with us showed four main points: timing and reasons for occupational therapy referral; assessments and interventions used in practice; current and future occupational therapy practice opportunities; and occupational therapy practice resources that are utilised or needed. Study participants discussed their use of a broad range of things to help people recover. They talked about the things that they use to help them with their work at present and plan to use in the future. The findings of the study may be helpful to occupational therapists in their practice. They may also provide support for the role of occupational therapy within health‐care teams that support adults with persistent post‐concussion symptoms. Even though there were some limitations, such as more therapists identified as women than men, study participants were from two countries and a variety of work settings.

Key Points for Occupational Therapy.

• PPCS recovery is complex and requires tailored occupational therapy assessment and intervention.

• Occupational therapists provide a unique functional perspective within adult PPCS rehabilitation teams.

• Future practice requires occupational therapy‐specific PPCS guidelines, stronger advocacy, and improved education and network initiatives.

1. INTRODUCTION

Globally, around 69 million cases of traumatic brain injuries (TBIs) occur each year (Dewan et al., 2019), and of these, up to 90% are classified as concussion or mild traumatic brain injury (mTBI) (Maas et al., 2017). Worldwide, concussion incidents are on the rise—at times described as being of ‘epidemic’ proportions—with an increase of up to 250% of reported cases over previous years in Canada, New Zealand, and the United States of America (USA) (Cancelliere et al., 2017; Feigin et al., 2013; Gordon & Kuhle, 2018). In the Australian context, recent sources report annual health system costs of concussion at more than AU$50 million, highlighting implications for clinical health‐care services, which aim to address this significant public health issue (Lefevre‐Dognin et al., 2021; Thomas et al., 2020).

Although many adults recover from a concussion injury, approximately 35% go on to experience persistent post‐concussion symptoms (PPCS) lasting weeks, months, or years (Moller et al., 2021; Suwaryo et al., 2024). Post‐concussion symptoms remaining for more than 4 weeks after injury are classified as PPCS (Patricios, Schneider, et al., 2023). Described as heterogeneous in nature, PPCS typically fall within physical, cognitive, sensory, and emotional domains. Symptoms may include attention, concentration or memory problems, headaches, fatigue, vision changes, vestibular dysfunction, sleep disturbances, and emotional changes (Permenter et al., 2023). Individuals who experience these enduring symptoms can also encounter challenges with participation in meaningful daily activities, including tasks requiring higher order thinking skills such as driving and working (Bottari et al., 2017). Recent reports indicate up to one in three adults who sought healthcare interventions following concussion experienced disability 3 to 6 months post‐injury (Cancelliere et al., 2022). Further, the presence of PPCS may lead to a cascade of secondary consequences, such as economic and community‐related impacts (Bottari et al., 2017; Thomas et al., 2020).

Although literature has highlighted the importance of an individualised biopsychosocial approach to PPCS management, limited evidence exists about treatment addressing individual symptom profiles and functional difficulties (Faulkner & Snell, 2023; Lew & Waskiewicz, 2020). Multidisciplinary concussion rehabilitation services that provide collaborative input of various health professionals have reported benefits in supporting the recovery trajectory of adults with PPCS (Cooksley et al., 2018; Mashima et al., 2021; Moore et al., 2024). In particular, the importance of a multidisciplinary approach to address the heterogenous symptomatology of concussion injuries, often including occupational therapy assessment and intervention, has been recommended (Jennings & Islam, 2023; Sharp & Jenkins, 2015).

Occupational therapy is one health profession that may be included in concussion rehabilitation services. The profession promotes ‘… health and wellbeing by supporting participation in meaningful occupations that people want, need, or are expected to do’ (World Federation of Occupational Therapists, 2025). Occupational therapists can identify functional impairments experienced by a person following their concussion injury using an occupation‐based approach, making their contribution unique to the multidisciplinary rehabilitation team (Harris et al., 2019; Heinekamp et al., 2024). However, studies that describe how to facilitate the return‐to‐functioning are limited (Boone, Perry, & Henderson, 2024; Harris et al., 2019), as is specific guidance about the assessments and interventions used by occupational therapists to treat adults with PPCS (Licciardi et al., 2025; Roelke et al., 2022). Although the identity and offerings of occupational therapy are continuing to evolve within concussion rehabilitation teams, advances in published evidence that increase understanding about occupational therapists' roles—particularly adult PPCS rehabilitation—are needed (Roelke et al., 2022; Strate & Ullucci, 2023).

Although the recent release of clinical practice guidelines—including the Australian and Aotearoa New Zealand ANZ Concussion Guidelines (Barlow et al., 2025) and the NZ Accident Compensation Corporation Sport Concussion Guidelines (Accident Compensation Corporation, 2025)—may assist health professionals in their work with adults with PPCS, there is only limited detail within these sources to inform the knowledge, skills, and confidence of occupational therapists in practice. Moreover, previous research that has investigated assessments and interventions used by occupational therapists with the adult PPCS population has predominately originated from USA (Eisses et al., 2021; Jaber et al., 2019; Reiser et al., 2020; Roelke et al., 2022)—with calls for more research about the occupational therapy practice in other countries, including Australia and New Zealand (Boone, Henderson, & Zenoozi, 2024; Licciardi et al., 2025; Marwaa et al., 2023). Further, literature has highlighted the diversity of outcome measures reported, making it difficult for researchers to synthesise findings at the present time (Heinekamp et al., 2024; Licciardi et al., 2025). Research that explores the specific role of occupational therapy—including the provision of evidence‐based assessment and intervention approaches in adult PPCS rehabilitation programs—remains limited (Jaber et al., 2019; Licciardi et al., 2025; Roelke et al., 2022). Research that explores the assessment and intervention approaches used by therapists with adults with PPCS is indicated (Heinekamp et al., 2024; Lew & Waskiewicz, 2020; Licciardi et al., 2025), including considerations about country‐specific practice contexts and countries in the southern hemisphere, is needed (Jackson et al., 2024; Licciardi et al., 2025). This is due to the specific region and health service differences that exist across the globe (Schütte et al., 2018).

To assist in addressing this gap, this study aimed to explore the role of occupational therapists, including the assessments and interventions they use, in the rehabilitation of adults with PPCS in Australia and New Zealand. Research questions posed were as follows:

1. What are the reasons for referral of adults with PPCS to occupational therapy concussion rehabilitation services?

2. What are current occupational therapy practices, including assessments and interventions, offered to adults with PPCS to address activity and participation outcomes?

3. What are emerging or future occupational therapy practice trends or opportunities, including assessments and interventions, that occupational therapists identify could be offered to adults receiving rehabilitation services for PPCS?

4. What practice‐based resources are useful to occupational therapists now and into the future?

2. METHODS

2.1. Study design and ethical approval

A qualitative descriptive study design was used to provide a rich description about the phenomena of interest (Doyle et al., 2020). This approach was grounded in a critical realist ontology. It sought to understand the reality experienced by occupational therapists through exploration of their perspectives. A constructivist epistemology was also applied. This recognised that knowledge is co‐constructed through researchers' interpretation of these perspectives (Braun & Clarke, 2021a). This study did not enlist consumer or community involvement as participants were occupational therapists. Ethical approval was obtained by the Monash University Human Research Ethics Committee (ID: 44739).

2.2. Positionality and reflexivity

2.2.1. Positionality

The first author is a Caucasian woman who is an occupational therapist and Doctoral Candidate. Two other research team members are Caucasian women, who are occupational therapists, each with Doctorate degrees. One research team member is a Caucasian man who also holds a Doctorate degree and is a retired rehabilitation medicine physician. All team members have substantial clinical and research experience within the fields of acquired brain injury, concussion, rehabilitation, and disability. All four team members have demonstrated track records designing and conducting ethically approved prospective research with people with acquired brain disorders, including concussion. The researchers acknowledge their positionality and its influence on how participants' experiences are understood and interpreted in the present study (Bourke, 2014). One study participant was known to the research team in a professional capacity due to their work in the field of brain injury rehabilitation prior to the study, whereas all other participants had not previously met the researchers

2.2.2. Reflexivity

The research topic was identified by the research team following their clinical experience and previous research (Licciardi et al., 2024, 2025) highlighting the existing evidence gap. Throughout the study, particularly data collection and analyses phases, the researchers made conscious efforts to minimise any potential bias from these assumptions and/or their positionality. Strategies included the use of field notes and reflexivity journaling throughout data collection and a declaration of the interviewers' (LL) positionality at the commencement of each interview.

2.3. Participants and recruitment

Purposive sampling was used. Eligible participants were Australian and New Zealand occupational therapists who could speak and read English and had worked within the 2 years prior to study recruitment in either private/community practice or privately/publicly funded health‐care settings with adults (18–65 years of age) who had PPCS following mTBI. Two rounds of recruitment advertising were undertaken (January 2025 and May 2025) on two Australian and New Zealand health professional listservs and one closed occupational therapy Facebook group. The advertisement invited interested prospective participants to email the research group if they wanted to learn more about the study. An explanatory statement and consent form were then emailed to those who expressed interest. Twenty‐three expressions of interest were received; however, two occupational therapists who responded to study advertisements were ineligible (as they had not worked in the past 2 years with adults with PPCS), and six did not respond to follow‐up after being sent the project explanatory statement following their initial expression of interest. Fifteen occupational therapists met the study inclusion criteria and consented to study participation.

2.4. Data collection

Data were collected through individual semi‐structured interviews, which included a brief set of demographic questions followed by open‐ended questions (Patton, 2002). Informed by published literature and clinical experience, the interview schedule was iteratively developed across the research team. Following development, the interview schedule was piloted with an occupational therapist working in adult concussion rehabilitation in December 2024 and then finalised for use (see Table 1 in Findings section). Data were collected between January 2025 and May 2025. The recruitment process and interviews were conducted by the first author (LL).

TABLE 1.

Study participants' demographic characteristics (n = 15).

Participant identifier	Age (years)	Gender	Country of practice	Highest level of qualification	Total work experience (years)	PPCS‐specific work experience (years)	Composition of health care team
OT1	66	Woman	Australia	Postgraduate	44	26	Physician, physiotherapist, neuropsychologist, speech pathologist, exercise physiologist
OT2	43	Woman	Australia	Undergraduate	20	20	Sole practitioner
OT3	37	Man	New Zealand	Undergraduate	11	3	Physiotherapist (vestibular), physiotherapist (musculoskeletal), occupational physician/neurologist, neuropsychologist, clinical psychologist, exercise physiologist, rehabilitation coach (allied health assistant)
OT4	56	Woman	Australia	Undergraduate	35	5	Physicians (3), neuropsychologists (2), speech pathologist, psychologist, exercise physiology
OT5	50	Woman	New Zealand	Undergraduate	23	5	Physiotherapist (vestibular), physiotherapist (musculoskeletal), medical specialist/neurologist, psychologist, neuropsychologist
OT6	34	Woman	New Zealand	Postgraduate	9	3	Not reported
OT7	46	Woman	Australia	Undergraduate	18	8	Physiotherapy, speech pathology, rehabilitation physicians, clinical psychology, neuropsychology, social work
OT8	51	Woman	Australia	Undergraduate	33	5	Sole practitioner
OT9	28	Woman	Australia	Undergraduate	6	3	Physician, physiotherapist, neuropsychologist, speech pathologist, clinical psychologist, recreation coordinator, allied health assistant, social worker, vocation coordinator, driver occupational therapist
OT10	58	Woman	Australia	Undergraduate	38	25	Sole practitioner
OT11	52	Woman	New Zealand	Undergraduate	29	1	Neurologist, physiotherapist, neuropsychologist, clinical psychologist
OT12	36	Woman	Australia	Undergraduate	15	14	Physician, physiotherapist, neuropsychologist, speech pathologist, psychology, recreation coordinator, education tutor, exercise physiologist, allied health assistants, nurse
OT13	37	Woman	Australia	Undergraduate	7	3	Physiotherapist, speech pathologist, exercise physiologist, social worker
OT14	44	Woman	Australia	Undergraduate	20	3	Sole practitioner
OT15	41	Woman	Australia	Undergraduate	18	2	Neurologist, nurse practitioner, neuropsychologist

Each interview was recorded and transcribed verbatim using Zoom videoconferencing software. Fieldnotes were taken by the researcher during interviews, with further reflective notes documented after each interview. All participants continued with the study following consent. One interviewee (OT5) had a non‐participant present, who was a student of theirs on clinical placement; however, they did not contribute data to the interview (however consented for them to be present). The first author cleaned all transcriptions against the original recording for accuracy, at which time unique identifiers were applied. The cleaned interview transcript was then emailed to each participant for member checking, at which point they were invited to add any additional points or correct or clarify any information, if required (Birt et al., 2016). Fourteen participants reviewed their interview transcript. Among these participants, four suggested some additions to their responses, which were edited directly onto the transcript for inclusion in data analysis.

2.5. Data analysis

Data analysis was undertaken using NVivo (Lumivero, 2023) and Microsoft Excel. Reflexive thematic analysis was used to inductively construct themes and subthemes (Braun & Clarke, 2021a). The first author (LL) coded the data set in NVivo by interview and then examined codes across the 15 interviews, examining the fieldnotes and reflexive journaling that had been recorded during interviews throughout the analyses and undertaking additional journaling during the analysis process. The first author then used charting methods to visualise and aggregate codes and quotes to facilitate theme development. At this point, coded data and key quotes were exported to Microsoft Excel, mapped to the preliminary themes identified. Codes, quotes, and preliminary themes were then presented to and discussed with the research team. This process was used both for reflexivity purposes (to critique, appraise, and evaluate how the lead researcher's subjectivity and context may influence the research processes) (Olmos‐Vega et al., 2022) and to draw on consensus work to finalise the themes. Researchers also used this process as a means of determining if information‐rich saturation was achieved, whereby agreement was reached that findings captured both the breadth and depth of participants' experiences, demonstrating meaningful information saturation (Braun & Clarke, 2021b; Saunders et al., 2018). Details reported by participants regarding their use of published measures when working in adult PPCS rehabilitation were noted and counted by frequency of reporting across participant interviews. Participants reported various terms to represent the people they treated during interviews—patients, consumers, and clients. Client has been selected throughout the paper to represent adults with PPCS receiving occupational therapy services. Additionally, themes and subthemes have been numerically ordered to assist with readability of the findings.

2.6. Data reporting and rigour

This paper is written following the 32‐item Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong et al., 2007). Lincoln and Guba's (1985) criteria for establishing trustworthiness in qualitative research were used to guide the research process: credibility, transferability, dependability, and confirmability. Credibility was employed through inviting participants to review, edit, and verify their interview transcripts, to ensure the data truly captured their perspectives in a manner they endorsed. Further, the reflexive thematic analysis ensured the study upheld a robust data analysis process including an audit trail (Braun & Clarke, 2021a). Participant triangulation was achieved through recruitment from various areas across Australia and New Zealand. Researcher triangulation was sought through the engagement of multiple researchers throughout data analysis (Lincoln & Guba, 1985). Transferability was considered throughout data analyses and writing phases. Specifically, the authors were cognisant that descriptions were comprehensively describing the human experience, and this could enhance applicability to other adult concussion rehabilitation contexts and enable consideration of research findings in the context of others' situations and experiences (Tracy, 2010). Dependability was enhanced via the documentation of field notes and journalling throughout the data collection and analysis phases of the research process. Confirmability was achieved through the integration of deidentified quotes within the results section of the manuscript, to illustrate authentic data reported by the therapists who were willing to share their work experiences and knowledge (Krefting, 1991).

3. FINDINGS

3.1. Demographic characteristics

Fifteen participants were interviewed, with interview duration ranging from 48 to 127 minutes, with an average duration of 74 minutes. Across the 15 participants, 11 (73%) were based in Australia and four (27%) in New Zealand. Seven (47%) worked in publicly funded settings, two (13%) in privately funded settings, and six (40%) across both public and private organisations. Eight (53%) reported they worked in concussion‐specific rehabilitation programs, which offered assessment and interventions provided by various health professionals, including occupational therapists. Five (33%) participants identified as working in another service or program that was not concussion‐specific, including private practice. Two (13%) participants described working in both program types. Most participants (n = 8, 53%) received professional supervision from another occupational therapist, of which two reported also having input from another health professional (n = 1 neurologist; n = 1 physiotherapist). Ten participants (67%) reported they agreed and five (33%) strongly agreed with the statement: ‘I feel my role and work as an occupational therapist is valued and understood by the health professionals I work with’. See Table 1 for additional demographic details.

3.2. Qualitative findings

Four themes and 11 subthemes were identified from the data (Figure 1).

FIGURE 1.

Themes and subthemes identified. Note: PPCS is an abbreviation that represents persistent post‐concussion symptoms.

1. Early timing and varied reasons for occupational therapy referral

Participants reported various reasons that adults with PPCS may be referred to occupational therapy services. This theme consisted of two sub‐themes: importance of early referral and occupational therapy referrals focus on return to functioning.

• 1.1Importance of early referral

The timing of referral to occupational therapy services was described as an important factor in terms of outcome for this population. Early referral and subsequent intervention were preferred by occupational therapists. One participant stated:

And this group [PPCS], I think particularly because its time is of essence, sort of thing. We know that if we get in there, start the work as early as possible, then it's gonna be a better outcome at the end […] I think it's just really important that OT [occupational therapy] is involved from early on. (OT4, AUS)

Most participants highlighted the importance of seeing people before symptoms are declared persistent and the notion of leaner service delivery models was considered key element to optimal occupational therapy services for adults with PPCS.

• 1.2Occupational therapy referrals focus on return to functioning

Participants described several reasons for referral to see adults with PPCS—including impairment, activity, and participation domains. Rehabilitation needs included support to return to work, school, driving, life roles, sport, and study. Participants also reported helping to address specific impairments, such as sleep, cognitive and emotional dysfunction, fatigue, visual issues, general symptom management, and strategy implementation. One participant said:

[…] the referral to you as an occupational therapist is usually around people who may experience some barriers to them implementing recovery strategies within their occupation […] within their actual activities of daily living (OT11, NZ).

Occupational therapists talked about the need to help people integrate strategies and recommendations into their specific life context as part of their role. Nuances to this sub‐theme included the need to address pre‐vocational elements to support the transition back to activities, such as work:

[…] trying to help people manage their home lives so that they could then be in a position to return to work […] they could manage 5 minutes, well, that's not functional for starting on a graded return to work program. (OT1, AUS)

• 2Use of targeted assessments and interventions in current occupational therapy practice

This theme described the range of practice offerings currently provided by participants, including assessments and interventions, and consisted of four sub‐themes: use of formal and informal assessment methods is necessary; there are benefits and challenges in using formal assessments; goal setting is broad; and tailored intervention approaches are needed.

• 2.1Use of formal and informal assessment methods is necessary

All participants reported the use of various published measures as part of their assessment or intervention, with 50 published assessment tools reported. Some participants also stated using non‐standardised approaches, such as activity/fatigue/pacing logs or diaries, biopsychosocial/initial assessments, and sleep/headache diaries. The most frequently reported measures by participants were the Depression, Anxiety, and Stress Scale – 21 items; Rivermead Post‐Concussion Symptoms Questionnaire; Brain Injury Screening Tool; Addenbrookes Cognitive Examination; and Montreal Cognitive Assessment. Participants stated they either used these tools partially or in full in their practice. Table 2 provides a summary of reported measures.

TABLE 2.

Summary of published measures reported by study participants.

Published measures	Frequency (n)
Addenbrookes Cognitive Examination (ACE‐III; Hsieh et al., 2013)	3
Adult‐Adolescent Sensory Profile (SP‐2; Dunn, 2014)	1
Assessment of Motor and Process Skills (AMPS; Fisher & Jones, 2014) a	1
Balance Error Scoring System (BESS modified; Echemendia et al., 2017) b	1
Barrow Neurological Institute Fatigue Scale (BNI‐FS; Borgaro et al., 2004)	1
Barry Rehabilitation Inpatient Screening of Cognition (BRISC; Barry et al., 1989)	1
Battery for Dysexecutive Syndrome (BADS; Wilson et al., 1996)	1
Brain Injury Screening Tool (BIST; Theadom et al., 2021) a	4
Brain Injury Vision Symptom Survey (BIVSS; Laukkanen et al., 2017)	1
Brain Tree Training questionnaires (non‐specific; Brain Tree Training, 2026)	1
Brief Cognitive Status Exam (BCSE; Wechsler, 2009)	1
Brief Illness Perception Questionnaire (BIPQ; Broadbent et al., 2006)	1
Canadian Occupational Performance Measure (COPM; Law et al., 2014) a	2
Care and Needs Scale (CANS; Tate, 2003)	1
Concussion Clinical Profile Screening Tool (CCPST; Kontos et al., 2020)	1
Depression, Anxiety and Stress Scale – 21 Items (DASS‐21; Lovibond & Lovibond, 1995)	5
Dizziness Handicap Inventory (DHI; Jacobson & Newman, 1990)	1
Epworth Sleepiness Scale (ESS; Johns, 1991)	1
Fatigue Severity Scale (FSS; Krupp et al., 1989)	2
Functional Assessment Measure (FAM; Hall, 1992)	1
Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES; MacDonald, 2005)	1
Functional Independence Measure (FIM; Keith et al., 1987)	1
General Anxiety Disorder‐7 (GAD‐7; Spitzer et al., 2006)	1
Goal Attainment Scale (GAS; Turner‐Stokes, 2009) a	1
Headache Impact Test (HIT‐6; Kosinski et al., 2003)	1
Insomnia Severity Index (ISI; Bastien et al., 2001)	2
Mental Status Examination (MSE; Martin, 1990) a	1
Modified Fatigue Impact Scale (MFIS; Multiple Sclerosis Council for Clinical Practice Guidelines, 1998)	2
Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005)	3
Occupational Gaps Questionnaire (OGQ; Eriksson et al., 2013)	1
Pain scales (non‐specific; Hawker et al., 2011)	1
Patient Health Questionnaire (PHQ‐9; Kroenke et al., 1999)	1
Patient Specific Functional Scale (PSFS; Stratford et al., 1995)	2
Pittsburgh Sleep Questionnaire (PSQI; Buysse et al., 1989)	2
Post‐Concussion Symptom Inventory (PCSI; Sady et al., 2014)	1
Post‐Concussion Symptom Scale (PCSS; Lovell & Collins, 1998)	1
Rivermead Behavioural Memory Test (RBMT; Wilson et al., 2008)	1
Rivermead Post‐concussion Symptoms Questionnaire (RPQ; King et al., 1995)	5
Sport Concussion Assessment Tool 6 (SCAT6; Echemendia et al., 2023) c	1
Sport Concussion Office Assessment Tool 6 (SCOAT‐6; Patricios, Davis, et al., 2023) a , c	2
Sleep and Concussion Questionnaire (SCQ; Toccalino et al., 2021)	1
The Brain Injury Workbook (Powell, 2017)	1
Trail Making Test (TMT) Part A and B (Reitan, 1958)	2
University of Pennsylvania Smell Identification Test (UPSIT; Doty et al., 1984)	1
Vestibular Screening Tool (VST; Stewart et al., 2018)	1
Vision Coach™ (Vision Coach, 2024)	1
Visual Analog Scale (VAS; Aitken, 1969)	1
World Health Organization's Disability Assessment Scale (WHODAS 2.0; Üstün et al., 2010)	2
World Health Organization's Quality of Life Assessment (WHOQOL‐BREF; The WHOQOL Group, 1998)	1

Note: Measures are listed in alphabetical order; green shading indicates the five most frequently used measures; frequency (n) indicates number of participants who reported the use of a given measure.

Abbreviation: TM, trademark measure.

^a Some participants reported instances of partial use only (e.g., SCOAT‐6 cognitive items only).

^b Subscale contained within the SCAT6/SCOAT6 assessment.

^c Assessment used for sporting injuries only.

Participants reported conducting in‐depth interviews, involving talking and asking questions, and functional assessments, including the use of task observation, as key methods for informal information gathering. One participant stated:

I tend to use a lot of informal assessment […] I may just observe them doing something they're struggling with. So, sometimes it's not the whole activity. Sometimes it's just asking them, if they say, I struggle to reach my coffee cup. Okay, show me, out of the cupboard, or sometimes they make a cup of tea. […] I think oh, this is perfect, because they don't know they're being assessed [laugh], yeah […] most of my work is like that. Most of it is ‘in the moment’ observation. (OT6, NZ)

Environmental and contextual information was deemed key to gathering the necessary information about the person in terms of their functional participation. Some therapists reported the need for in‐situ assessment to gather this information as a means of increasing the sources of information, in addition to self‐report information provided by the clients they work with:

So at home I'm always involved, and I like it because I get to properly see their environments […] So, because we have to get them back into functional activities, we should be able to assess them, I don't know, at home, or at work, on how they tolerate all these activities […] we rely on what they report to us. (OT3, NZ)

Participants also emphasised the ‘occupational therapy approach’ during assessment and recognised the role of task analysis as a means of determining functional performance issues. One participant reported: ‘A lot of that really came down to task analysis, you know, breaking down tasks, environmental analysis […] to try and optimise people functioning despite all their PPCS (OT15, AUS)’.

• 2.2There are benefits and challenges of formal assessments

Whereas participants reported the benefits gained from the use of formal measures, including objectivity, partial/complete use to guide own assessment, and the ability to both identify and exclude issues for the person, some participants stated that the ability to measure or demonstrate change based on numerical scores may not always be possible. Further, the person's functional performance may have changed during their rehabilitation; however, it may not be possible to reflect this within a measure. One participant said:

I very rarely now will administer a screening tool in its entirety in this population, for a number of reasons. One, is that I'm never going to repeat it, I just don't, and two, I often find that with the timeframe that we have to work with them […] I find it much easier and actually much higher value to use a therapeutic assessment approach. So, I will pick things based on symptoms that are reported. I'll pick almost like the therapeutic activities that I'll pull from an assessment battery. (OT12, AUS)

A key consideration was the subjective nature of published measures and the reliance of patient report—with participants suggesting some patients can have difficulty rating their performance or experience on a particular scale. It was also evidenced that a person could either excel or struggle under testing conditions, but this may not correlate with having the same challenges in their functional contexts. One participant noted: ‘[…] there's a lot of subjectivity, because, of course, of the difference in perception of pain and all of that [scoring on published measures] (OT3, NZ)’.

Participants identified a willingness to use published measures if there is a benefit. One participant stated: ‘I mean, I'd be interested if there was something that was actually really beneficial. But I'm kind of not really interested in doing assessments for the sake of assessments, yeah, if I knew it was beneficial, then sure, I'd be willing to do it (OT5, NZ). However, cautionary use was also reported, as evidenced by one participant: We don't routinely do a lot of formal cognitive assessments with the goal of not reinforcing deficits that we hope naturally will improve with time (OT15, AUS)’.

• 2.3Goal setting is broad

Participants articulated that although return to work was the most common goal, goal setting completely depends on the person and what is meaningful to them. Participants frequently emphasised the focus on functioning, reporting that the people they work with often prioritise goals for intervention that enable them to get back to their pre‐injury level of functioning. To assist with their return to functioning, therapists reported the use of prioritisation strategies to determine the order in which goals were attended to during rehabilitation. One participant stated: ‘OT [occupational therapy] would touch on everything. If everything is problematic, we generally try to pick the “lowest hanging fruit” and work on that as our first target and goal intervention (OT15, AUS)’.

Participants acknowledged that although goals can change along the recovery trajectory and vary from person to person, understanding their symptoms, functional difficulties, and activity preferences was key to the rehabilitation process.

• 2.4Tailored intervention approaches are needed

The majority of participants reported the provision of education as fundamental to their intervention processes. There was a reported connection between education and anxiety, whereby participants felt that once clients had received education about PPCS and related information, their anxiety lessened, providing encouragement and reassurance:

So, the intervention, I guess, a lot of it is about educating people, about how to pace themselves to be able to do what they need to do, and lowering their expectations. I guess educating them about the way you grade activities […]a lot of the work I did was providing education to reduce anxiety, because [laugh] once you got their anxiety down, you could move on, so […] once their anxiety was reduced, they then often had the confidence or the ability to take on some of their roles. (OT1, AUS)

The use of fatigue/energy management, pacing, and grading strategies was also common. Participants referenced the importance of ‘errorless learning’, ensuring that their graded approach to return to functional participation was considered, setting the client up for success: ‘Yeah, […] activity grading is obviously a huge part of what we do […] It's breaking the activity down into the components of it and then building it up (OT11, NZ)’.

Finding the ‘right recipe’ (OT4, AUS) that works for each person was noted, as participants acknowledged that their interventions needed to be individually tailored using a problem‐solving approach and making necessary adjustments as needed. One participant stated:

For the intervention, is very much like a problem solving approach, task analysis and problem solving […] it is very much coming back to like what's the issue to them, like understanding that, what in particular in the processes required for that and the environments required for that when it's not working well […] It's very much more about picking and choosing and applying certain things, depending on what might be helpful for that person […]. (OT2, AUS)

Participants reported the use of self‐reflection and self‐regulatory approaches as important aspects of their intervention, empowering adults with PPCS to develop their metacognitive capacities to support behaviour change. These skills were seen to be essential within the therapeutic process to ensure clients are active participants in their recovery, with the necessary skills to support their own self‐management during rehabilitation and sustainability upon discharge—a possible point of difference from other disciplines. One participant stated:

Yeah, and integrating the education amongst everyday conversation with them around why they may be experiencing certain things, and that self‐reflect, helping them self‐reflect and pointing out their strengths, pointing out their fatigue levels, and how that how the influencing factors have, and their planning may have affected their fatigue or sleep. Just helping them identify what's going on with them. (OT6, NZ)

• 3Current role of occupational therapy and future practice opportunities

The third theme highlights participants' perspectives about the current role of the profession and its potential for future practice and consists of two subthemes: perceived impact and role of occupational therapy in adult PPCS rehabilitation, and there are future practice opportunities for the profession.

• 3.1 Perceived impact and role of occupational therapy in adult PPCS rehabilitation

Participants described the role of occupational therapy in adult PPCS rehabilitation as broad yet important, offering clients a unique and specific service that can positively impact a person's life:

I feel like it's a missing piece for them. Either, yeah, I feel like we fill in the gap […] there's a whole lot of stuff that's still not, that the person's having trouble with, and it's having a massive impact in their life and their mental health […] I think it's got a really important role to play in practical, helpful advice and education, reassurance, and step by step, a way of helping people back to their pre‐injury function, despite their symptoms. (OT8, AUS)

Many participants reported that the occupational therapy role is useful in supporting people in their return to their daily activities. Further, reported methods used in practice facilitated this process, contributing to the unique contribution of the profession. Participants considered their role to be important, particularly in assisting with the translation of post‐concussion strategies into daily life:

Oh, I think it's [role of occupational therapy] huge. I think that without it the ability to integrate strategies successfully into your everyday life and to understand their benefit is really hard, really difficult, and people will often stop doing it because they just don't get it because you're also in that stage where they don't have the ability to think this through themselves, either. (OT11, NZ)

• 3.2There are future practice opportunities for the profession

Although participants identified the skills they offer this population—referred to by one participant as their ‘bread and butter’ (OT11, NZ)—and broader team environment, they perceived that they could provide additional offerings in their future practice, including for vision and autonomic nervous system dysfunction. One participant stated: ‘And the other part more recently was vision or visual issues. That's an emerging area of practice I think, for OTs in Australia. In America it's far more, I don't know, entrenched, I suppose, but not here (OT1, AUS)’.

Other opportunities included the use of other assessments, such as ‘upper limb assessment tools like the Nine‐Hole Peg Test, or the Dynamometer’ (OT14, AUS). Additional upskilling in clinical practice areas to enable further exploration during future practice experiences, including sleep, cognition, and sensory modulation, was also noted:

[…] exploring sleep better. I think that will become a like, more bigger part of our process, as it's more understood that it's like sort of one of those factors that needs to be addressed before other things, like it's not a symptom, not always a symptom of like fatigue, but could be actually changes to the sleep as a result of a direct result from the concussion. (OT13, AUS)

• 4Occupational therapy practice resources currently used and needed in the future

This theme explored the role of evidence‐based practice from the participants' perspectives and included current practice resources utilised and those they wished were available to assist in their future practice to support their work in this field. This theme consisted of three sub‐themes: the role of clinical experience, examples, and therapists' work environments as practice resources; use of published resources, professional development opportunities, and human supports to inform practice; and lack of evidence, education, and support networks to guide occupational therapy practice in adult PPCS rehabilitation.

• 4.1The role of clinical experience, examples, and therapists' work environments as practice resources

Some participants reported the contribution of their own clinical experience, including examples, through the acquisition of knowledge and experience over their years of practice, as some of the methods used to evidence‐inform their work. One participant reflected:

As a clinician […] I wasn't there trying to look at evidence‐based practice, and there was not really a lot of, I didn't have the opportunity to go and do any sort of extra training […] I was applying what I've done for the last 30 or 40 years. There you go, clinical experience rather than evidence‐based practice, and that did seem to work […] I did base it on my extensive clinical experience. (OT1, AUS)

Others discussed the knowledge and expertise offered in the workplace as pivotal to informing their practice, leaning into the experience of senior team members to guide their practice. One participant reported: ‘I've taken the practice and advice as my training […] we have team meetings, you have peers […] But it's a place for us to talk about cases and ask questions to the more experienced providers (OT3, NZ)’.

• 4.2Use of published resources, professional development opportunities, and human supports to inform practice

Participants reported the use of published literature, resources, and guidelines to support their practice, including online and face‐to‐face courses, webinars, conferences, supervision, and network meetings. A participant reflected: ‘So, we do use the like, the Ontario guidelines, the Living Concussion Guidelines. That would be the key thing that we refer to (OT13, AUS)’.

Although such methods were deemed by some participants as useful in facilitating knowledge acquisition and supporting clinical practice, others reported the existence of contradictory advice across some resources as unhelpful in their practice. Factors such as participants having the skills to interpret published literature, limited time available, inherent constraints with working in private practice as a solo therapist, and busy caseloads were all reported to impact participants' capacity to enact evidence‐informed practice. One participant stated: ‘It's just too hard to go find this information. I kind of, you know, try to educate myself with what comes across, but I don't have time to go digging. I'd like some really concise info (OT8, AUS)’. Another participant highlighted current information is generic and lacks adequate detail:

I think the gap is like, what do you actually do? […] there's not enough examples of those more specifics. It'll say, you know, something that you know, resume activities of daily living, or, you know, come up with person‐centred intervention. So, it doesn't say exactly what you do or what assessment it is, or even, you know […] It's not structured in that way […] that's probably the biggest thing, it is not specific. (OT9, AUS)

• 4.3Lack of evidence, education, and support networks to guide occupational therapy practice in adult PPCS rehabilitation

The majority of participants reported a lack of published and accessible evidence that is specific to occupational therapy practice in adult PPCS rehabilitation: ‘So, I just feel like a lot of the evidence, that is, like a lot of the, you know, training and practice, and what have you is, is not focused on occupational therapy. And so therefore, I guess maybe it's a missed opportunity’ (OT5, NZ). One highlighted need was to have more offerings for participants, such as general informational supports and guidance about assessment and intervention strategies. One participant said: ‘I think, as well, in that education vein, there is very limited education available to clinicians across allied health disciplines, but definitely OT, there's certainly not much around tailored to the OT in concussion management other than US resources or online training […] And a lot of the stuff that exists in Australia is very much sports‐related. There is a gap in, you know, where people are going to be able to develop skills and knowledge’ (OT15, AUS).

Support networks were also deemed an important adjunct to some participants' practice, which highlighted a need for more group‐based supports to assist future practice: ‘Could there be a special interest group, you know, specifically for concussion? As I said, I've not. I've, you know, my sort of more local search hasn't uncovered many of us, you know. We need to get out there and be talking about what we're doing at conferences. And, you know, getting the word out […]’ (OT4, AUS).

Additional participant quotes are available in Table S1.

4. DISCUSSION

This study sought to explore and describe the role of occupational therapy, including assessments and interventions used, in adult PPCS rehabilitation, from the perspectives of practising occupational therapists in Australia and New Zealand. Four main themes were identified: (1) early timing and varied reasons for occupational therapy referral; (2) use of targeted assessments and interventions in current occupational therapy practice; (3) current role of occupational therapy and future practice opportunities; and (4) occupational therapy practices resources that are currently used and needed in the future. Participants reported key considerations regarding referrals to occupational therapy, assessments and interventions linked to their role, and professional practice opportunities and needs both now and into the future. Given the limited literature available that describes the role of occupational therapy in adult PPCS rehabilitation internationally, most of which is from the USA and Denmark (Licciardi et al., 2025), the current in‐depth qualitative study provides rich insights regarding the role of occupational therapists in adult PPCS rehabilitation in Australia and New Zealand.

4.1. Referral to occupational therapy: reasons for and importance of early referral

Participants discussed that although some adults do achieve full resolution of their symptoms and return to their desired life roles and activities, there is a proportion of people who experience limited symptom recovery, which in and of itself is across a spectrum of severity. Overall, participants' data reflected a role for occupational therapy at impairment, activity, and participation levels for adults with PPCS, across the continuum of their recovery. Such findings align with previous research, which highlights synergy with core components of the universally recognised World Health Organization's International Classification of Functioning, Disability and Health (WHO ICF) model—which may aid in further evidencing the role and professional identity of occupational therapy within adult PPCS rehabilitation (Licciardi et al., 2025; World Health Organization, 2001). Further, the benefits of occupational therapy input during initial assessment have demonstrated enhanced identification of functional impairments (Harris et al., 2019), thus evidencing the potential value‐add of referral to and the role of occupational therapy in adult PPCS rehabilitation.

The timeliness of and desire for early referral were articulated by participants in the context of achieving better outcomes. This is an important consideration regarding models of care implemented in the delivery of PPCS rehabilitation services, including occupational therapy. With annual health system costs of concussion at more than AU$50 million and an increased number of TBI no‐fault insurance claims (including concussion) in New Zealand, implications for clinical health‐care services remain a focus as they aim to address this significant public health issue (Gordon & Kuhle, 2018; King et al., 2025; Lefevre‐Dognin et al., 2021; Thomas et al., 2020). It is important to consider the potential impacts of PPCS across both individual and systemic levels, including productivity and paid work outcomes. Given the evidence base that exists for occupational therapy assessment and intervention within the area of vocational rehabilitation, often identified as a significant rehabilitation need, early referral to occupational therapy could render enhanced recovery pathways in the treatment of this chronic health condition (Australian Institute of Health and Welfare, 2024; Barlow et al., 2025; Graff et al., 2019; Smith et al., 2025).

4.2. Current occupational therapy practice methods—including assessments and interventions

In the current study, participants stated that published measures used by occupational therapists in adult PPCS rehabilitation need to be intentional and have a clear purpose in supporting symptom‐based and/or functional outcomes. As current evidence points to a lack of validated outcome measures in the assessment and post‐treatment evaluation of PPCS, a call for further work in this area is necessary to enhance the efficacy of future assessment and intervention practice methods (Moser et al., 2025).

In their scoping review, Licciardi et al. (2025) reported that occupational therapy assessments and interventions mapped to 90% (27 of 30) WHO ICF One‐Level classifications (World Health Organization, 2001). The authors further highlighted that such findings demonstrated breadth of the occupational therapy role in adult PPCS rehabilitation. Upon consideration of these findings with the present study, it is further confirmation that occupational therapy assessments and interventions—as described in published literature and as reported by study participants—in adult PPCS rehabilitation are broad and variable across health‐care systems, practice settings, and treatment teams. Following, an individual's needs and goals are cornerstone to service delivery. Moreover, some assessments and interventions reported within the scoping review were also reported to be used by occupational therapists in the present study, demonstrating alignment between some practice methods. These included published measures, such as the Rivermead Post Concussion Questionnaire and Montreal Cognitive Assessment, and intervention strategies including education, energy conservation/pacing, and symptom monitoring/management—while supporting a graded‐return approach to daily roles and activities. Participants highlighted that occupational therapy may offer a potential point‐of‐difference from their health professional counterparts. They reported that although other health‐care disciplines may provide information to individuals to assist in their PPCS recovery, such information may lack specificity with respect to its application to the individual's particular context. As such, the present study builds on previous research that further substantiates the role of occupational therapy in the rehabilitation of adults with PPCS—progressing the understanding about occupational therapy's role in adult PPCS recovery.

The current study demonstrated heterogeneity within current occupational therapy practice methods, including the use of assessments and interventions. This can be problematic for adults seeking care for persisting symptoms, as there is the potential for variability of care between therapists and across rehabilitation settings. Given recent evidence highlights the important role occupational therapists have within multidisciplinary concussion teams, including their ability to identify impacted performance domains (Barlow et al., 2025; Harris et al., 2019), research efforts that support the development of discipline‐specific, evidence‐informed guidelines are necessary. Such work may advantageously translate into the future implementation of consistent practice methods and improve intervention efficacy (Carrier et al., 2010). Consensus‐based research that builds a core set of assessments and interventions used by occupational therapists, including Australian and New Zealand therapists who work in adult PPCS rehabilitation, could revolutionise the profession's future contribution in this field. Moreover, help to support the need to clearly substantiate the profession's identity within the multidisciplinary health‐care setting has been recommended (Strate & Ullucci, 2023)—with a focus on the ‘how to’ implementation of PPCS‐specific education and strategies, customised to the individual's needs and contexts, relevant to their desired activities, tasks, and roles.

Furthermore, it is important to consider the contribution of occupational therapy in the broader interdisciplinary context. The small body of published evidence that does exist in this area points to the benefits of interdisciplinary collaboration, inclusive of occupational therapy, in adult PPCS rehabilitation—to ensure team‐based problem‐solving and coordinated care planning is enacted (Jennings & Islam, 2023; Shelley‐Tremblay & Lawton, 2025). Depending on the composition of the treating team and the allied health disciplines represented in a PPCS rehabilitation service, the role of occupational therapy may provide additional assessments and interventions that complement and inform the work of other professions, such as physiotherapy and speech pathology (Licciardi et al., 2025). Participants in the present study identified adults with PPCS experience challenges related to cognitive impairments, fatigue management, self‐regulation, and vocational participation, for example. Occupational therapy, physiotherapy, and speech pathology are allied health disciplines that could all provide input on these issues from their varied professional standpoints. Thus, it is important to acknowledge that although shared practice areas do exist in PPCS rehabilitation, each discipline offers their own distinct yet complementary role in the clinical picture, with the need for both discipline‐specific and interdisciplinary approaches to achieve best‐practice (Rytter et al., 2021).

4.3. Evidence‐informed practice challenges and future practice opportunities

Licciardi et al. (2025) identified limited evidence available to guide occupational therapy practice in adult PPCS rehabilitation. A limited evidence base for occupational therapists to use in guiding their practice in this field may be problematic. Further, authors reported published literature to date was primarily from the USA, with little evidence to support the work of occupational therapists from southern regions, such as Australia and New Zealand. Roelke et al. (2022) reported similar, with limited generalisability of findings to other countries beyond the USA. Such findings are supported by participant feedback in the present study, indicating a variability of practice resources available—some of which were said to be offering contradictory advice and/or considered contextually irrelevant, due to resources being produced by countries other than Australia/New Zealand. For example, some participants reported the use of international guidelines (e.g., Ontario Neurotrauma Foundation Living with Concussion Guidelines) in their practice and reported challenges in their alignment with the needs of the Australian/New Zealand context. Thus, furthering the evidence base specifically for Australian and New Zealand occupational therapy context is critical to ensure therapists have access to contextually relevant information and training to guide future practice.

Although the recent Australian and Aotearoa New Zealand ANZ Concussion Guidelines offer contextually relevant information to guide concussion management, including those with PPCS, they are designed with the wider health professional group in mind (Barlow et al., 2025). Similarly, in New Zealand, the recently updated NZ Accident Compensation Corporation Sport Concussion Guidelines provides information to support sports‐related concussion management in community settings (Accident Compensation Corporation, 2025). Although both guidelines provide useful information that aligns with the findings of the present study, such as recommendations about graded return to activities, there is paucity regarding the provision of comprehensive discipline‐specific guidelines—including assessments and interventions that could guide the practice of occupational therapists in their treatment of adults with PPCS. Such guidelines could aid in furthering an understanding about the profession's identity across the health sector and community settings, supporting a role for occupational therapists, while substantiating their potential contribution to the recovery pathway for this population.

Recent research has also suggested that occupational therapists' perceived level of confidence in providing concussion management was variable, thus highlighting the need for clear guidance—such as practice guidelines, resources, education, and training—to bolster the future work of occupational therapy in this practice area (Finn, 2019). Such findings align with sentiments shared by study participants, who highlighted a need for additional resources to guide their clinical practice and support their confidence during practice. Some participants saw occupational therapy practice opportunities in the areas of vision, sensory management, and autonomic nervous system dysfunction—areas considered important components of occupational therapy practice during adult TBI rehabilitation, including concussion (McGuire, 2022). Participants acknowledged that further training and knowledge acquisition were needed to fulfil the perceived potential in these practice areas. Additional resources, training opportunities, and enhanced confidence to treat adults with PPCS remain consistent with current literature, suggesting a need for further research to address these areas to ensure therapists' practice has the necessary supports in place to guide them (Reiser et al., 2020; Smith et al., 2025).

4.4. Practice‐based evidence and tacit knowledge in occupational therapy practice

Participants reported using tacit knowledge to guide their practice, which they had developed over years of practice and via information and guidance from their respective work settings. This finding aligns with the sentiments presented in the literature about ‘practice‐based evidence’, as opposed to ‘evidence‐based practice’ (Hoffmann et al., 2024). Further, this finding aligns with previous research that identified internal and external factors deemed to influence occupational therapists' clinical reasoning during their practice (Carrier et al., 2010). The present study provides further evidence of the importance of practice‐based evidence and the use of tacit knowledge to guide professional reasoning in occupational therapy practice in the field of adult PPCS rehabilitation. This finding is poignant in understanding the ‘current state’ of practice and may be helpful when developing future practice resources.

4.5. Policy and funding considerations

Diagnosis and subsequent funding of this often‐considered elusive phenomenon is a contentious area (Parliament of Australia, 2023). Despite the utilisation of diagnostic tests, such as neurocognitive and ophthalmological/vertigo‐based assessments, to facilitate concussion assessment and diagnosis, conclusive PPCS assessment and determination of an adult's potential for a prolonged recovery is yet to exist (Smith et al., 2025). Outcome‐based measures are necessary to justify funding for a population that currently lacks definitive neuroimaging, fluid biomarkers, or other diagnostic measures. Additionally, such measures may help to evidence the role and identity of occupational therapy within the multidisciplinary adult PPCS rehabilitation context. A potential clinical conundrum with the concussion population is the current reliance on client/self‐report, which may inherently propose memory recall biases during the use of patient‐rated outcome measures—a particular dilemma for a population that typically experiences cognitive difficulties. In the present study, some participants reported the reliance on empirical or ‘practice‐based’ evidence to guide their clinical practice. This may be troublesome when working with compensable clients when determining and justifying their treatment requirements and subsequent outcomes. Additionally, there needs to be a ‘cut‐off point’ when it comes to the funding period provided by the compensable funding body. This and aforementioned dilemmas suggest the need for advancements in the field, including focussed research that aims to ensure the recovery needs of Australian and New Zealand adults with PPCS are provided in an evidence‐based manner (Smith et al., 2025).

5. LIMITATIONS

Researchers in this study only investigated the perspectives of occupational therapists, which could bring an inherent bias to the study findings. As such, future research is warranted to explore the perspectives of other health professionals—as well as people with lived experience of PPCS—to provide additional perspectives about the role of occupational therapy in adult PPCS rehabilitation. Further, it would be advantageous for future research to explore the perspectives of occupational therapists who identify with other gender types (via purposive sampling), to obtain a broader representation of therapists practising in the field. Although some qualitative studies engage multiple coders for data analysis, researchers of the present study adopted a single‐coder approach with collaborative discussion with the wider research team. Although this may be viewed by some as a limitation, such an approach is supported by published literature, in an effort to reflexively develop final themes (see Section 2.5) (Braun & Clarke, 2021a). Lastly, the use of convenience sampling resulted in a higher proportion of Australian participants (73%). However, this distribution reflects the broader workforce context. Recent figures indicate registered occupational therapists in New Zealand (n = 3640; Occupational Therapy Board of New Zealand, 2025) represent approximately 11% of those in Australia (n = 34,143; Occupational Therapy Board of Australia, 2025). Despite this, 27% of the study sample was from New Zealand. This indicates that New Zealand occupational therapists were proportionally overrepresented relative to their proportion of the combined workforce across both countries. However, future research may consider the use of purposive sampling approaches to increase the yield of participants from New Zealand.

6. CONCLUSION

The experience of PPCS in adulthood is a complex yet growing phenomenon that requires effective multi‐disciplinary treatments to aid recovery. Occupational therapy is one health profession that can undertake goal‐oriented practice approaches, including the use of targeted assessments and interventions, to help to identify and address functional performance challenges, while considering an individual's PPCS profile and sub‐symptom thresholds. To clearly substantiate impactful outcomes of the profession and its core offerings that differentiate it from other health professions, a well‐defined role within the adult PPCS rehabilitation realm is necessary. This includes a ‘call to action’ for future research to aid in further clarification of the assessments and interventions used by occupational therapists in adult PPCS rehabilitation. Such research may aid in the profession's advocacy meanwhile enhance transparency of its role and identity across health services and the communities they serve, with the potential to achieve better treatment outcomes.

AUTHOR CONTRIBUTIONS

All authors contributed to study conceptualisation, with LL leading development of the research aims and methods. All authors were involved in the development of the interview schedule. LL undertook all data collection, cleaning and analyses, with input from AL, JO and LC to finalise the results for reporting. LL completed the initial drafting of the manuscript, with contributions from AL, JO and LC in the co‐authorship of the final manuscript.

CONFLICT OF INTEREST STATEMENT

The authors report there are no competing interests to declare.

ETHICAL STATEMENT

Ethical approval was obtained by the Monash University Human Research Ethics Committee (ID: 44739).

DECLARATION OF USE OF ARTIFICIAL INTELLIGENCE

Artificial intelligence was not used in the preparation of this manuscript.

Supporting information

Table S1 Themes and subthemes identified, with additional verbatim quotations.

Licciardi, L. , Lalor, A. , Olver, J. , & Callaway, L. (2026). The role of occupational therapy in the rehabilitation of adults with persistent post‐concussion symptoms in Australia and New Zealand: A qualitative study. Australian Occupational Therapy Journal, 73(5), e70126. 10.1111/1440-1630.70126

DATA AVAILABILITY STATEMENT

Research data are not shared.