Occupational therapists’ preferences for criteria and challenges in implementing instrumental activities of daily living training in convalescent rehabilitation wards: A study using best–worst scaling

Introduction: Instrumental activities of daily living (IADL) training faces clinical barriers that vary by context, sometimes limiting its implementation. Therefore, the criteria and challenges remain unclear, leaving decisions to individual therapists and hospitals. This study aimed to clarify preferred criteria for introducing IADL training and perceived importance of related challenges in convalescent rehabilitation wards in Japan. Method: A nationwide survey was conducted among heads of occupational therapy departments in 1000 rehabilitation wards. Using best–worst scaling, six introduction criteria and 11 challenges were evaluated. Relative importance (RI) scores were calculated using counting analysis; higher RI values indicated stronger preferences. Results: Of 339 responses, key introduction criteria were ‘patient and family preferences’ (RI: 1.00) and ‘anticipated post-discharge IADL performance’ (RI: 0.92); ‘sufficient physical and mental functions’ (RI: 0.36) and ‘independence in basic ADL’ (RI: 0.33) were less prioritised. Major challenges were ‘insufficient time and opportunities for real-life practice’ (RI: 1.00) and ‘discrepancies between patient and family expectations’ (RI: 0.69); ‘heavy workload and high task demands’ (RI: 0.25) and ‘challenges related to infection control measures’ (RI: 0.15) ranked lower. Conclusion: Client-centred considerations and anticipated post-discharge performance outweigh physical or mental prerequisites for IADL training. Addressing practice and expectation gaps may facilitate implementation.