Renewing occupation-centered practice: research, education, and advocacy in occupational therapy

Occupational therapy (OT) has repeatedly adapted to social, economic, and institutional change. This Perspective examines structural pressures that can narrow occupation-centered practice, including impairment-focused service logics, theory–practice gaps, professional identity fragmentation, and potential risks associated with platform-mediated delivery. It proposes an integrative clinical stance linking biomedical knowledge about mechanisms and performance constraints with occupation-centered knowledge about meaning, agency, context, and participation. A meal-preparation example illustrates how these forms of reasoning can inform a single formulation without making impairment remediation the endpoint of care. Preliminary neurophysiological findings are considered as one source of evidence about possible processes involved in occupational engagement; they do not establish therapeutic mechanisms or clinical effectiveness. A practical renewal agenda is organized around research, education, and health-systems advocacy, with recommendations for model integration, case-based learning, supervision, participation-focused evaluation, and advocacy across medical and non-medical settings. The aim is constructive adaptation that connects health care to the occupations through which people sustain meaningful lives.