Occupational Therapy Services for Community-Dwelling Patients With Stroke in Thailand: Explanatory Sequential Mixed Methods Study

BACKGROUND: Stroke is a major cause of long-term disability, and upper extremity (UE) impairment frequently limits independence in activities of daily living (ADLs) and community participation. In Thailand, although acute stroke care has improved, continuity of rehabilitation in community settings remains uneven. Currently, there is limited empirical evidence identifying occupational therapy (OT) services and the barriers affecting service delivery in practice. OBJECTIVE: This study aimed to examine current OT practices among community-dwelling patients with stroke in Thailand, identify barriers affecting service delivery, and explore therapists' perspectives on the future development of community-based rehabilitation. METHODS: An explanatory sequential mixed methods design was used. Phase I (survey phase) involved an online survey of 59 occupational therapists to describe service patterns and perceived barriers, while phase II (interview phase) comprised semistructured interviews with 7 experienced occupational therapists to obtain deeper insight into practice contexts and challenges. Quantitative data were analyzed descriptively, and qualitative data were analyzed using thematic analysis. RESULTS: OT services were primarily individualized and focused on functional activities, particularly basic ADLs (49/59, 83.05%), cognitive (44/59, 74.58%), and sensorimotor training (40/59, 67.80%). Service frequency was generally limited, and nonstandardized assessments were commonly used alongside policy-required measures, such as the Barthel Index. Major barriers were identified at organization/leadership, client, and therapist levels, including resource shortages (50/59, 84.75%), inaccessible to service (45/59, 76.27%), lack of public awareness about OT (45/59, 76.27%), and lack of time (42/59, 71.19%). Occupational therapists described adapting practice through client-centered and culturally responsive approaches, with active caregiver involvement. A proposed home-based stroke rehabilitation box set emerged as a potential strategy to support continuity of rehabilitation. CONCLUSIONS: Community-based OT in Thailand operates within structural constraints, while maintaining occupation-centered practice. Strengthening services may require system-level support and practical strategies to enhance continuity of care.