Abstract
Why the research priorities matter
The identification of the top 10 research priorities for occupational therapy (Watson, 2021) provided a shared agenda for building the evidence that people with lived experience, practitioners, researchers and wider stakeholders agreed was most needed. The priorities clarified where research could strengthen practice, influence policy, and support the profession to demonstrate its contribution across health and social care.
Since their publication, occupational therapists have continued to work in increasingly complex systems, with growing expectations for personalised, prevention‑focused and value‑for‑money services. This editorial reflects on insights from the BJOT editorial series, considers progress and highlights where further work is needed to strengthen the evidence base for occupational therapy (Bennett and Mottram, 2023; Duncan, 2023; Harding and Markham, 2023; Kinsella and King, 2023; Letts et al., 2024; Martin and Ward 2024, McCormack and Pentland, 2022; Mcfeely, 2022; Micklewright and Farquhar 2022; Sutton and Roddam, 2025; Weatherly et al., 2024).
Cross‑cutting themes: complexity, collaboration and value
Across all 10 priorities, three themes consistently emerge.
Embracing complexity
Occupational therapy is embedded in dynamic, contextual and relational processes. Many editorials highlight that research approaches need to reflect this complexity, using methods that explore how and why interventions work in real‑world contexts. Approaches such as theory‑driven design, longitudinal follow‑up, occupation‑centred frameworks and research conducted in naturalistic settings are identified as particularly valuable. This essentially means designing research that reflects everyday practice rather than reducing interventions to isolated components.
Working collaboratively
Several priorities notably priority three, eight and nine, emphasise the importance of collaboration with families and carers, with people with lived experience, and with other professionals. The editorials on carer involvement and multiprofessional working demonstrate how outcomes depend on relationships and shared contexts. The message is clear: research should reflect the ways occupational therapy is delivered, drawing on multiprofessional teams and co‑production throughout design and delivery.
Demonstrating value
A strong thread across priorities is the need for clearer evidence of occupational therapy’s impact, outcomes and cost‑effectiveness. Priorities related to everyday impact, hospital admissions, primary care and economic evaluation all highlight gaps in the current evidence base. This is especially apparent for priority 10, where a lack of accessible health economics skills and limited economic evaluations have constrained the profession’s ability to demonstrate value at scale. Strengthening this evidence, in collaboration with health economists, will be essential for influencing commissioning and policy.
Progress across the 10 priorities: what has been addressed and what remains to be done
Bringing the editorial series together offers a helpful view of where progress has been made and where further work is required.
Areas where progress is visible
Conceptual clarity has strengthened, particularly in relation to person‑centred practice (priority two), integration of mental and physical health (priority six), and occupation‑centred approaches to self‑management (priority seven).
Recognition of the importance of lived experience and co‑production has become more prominent, with priorities such as reducing hospital admissions (priority eight) illustrating meaningful partnership in editorial authorship.
Methodological foundations have developed, with greater emphasis on logic models, theory‑driven designs and research that reflects the complexity of practice.
Priority-focused initiatives, including aligning Royal College of Occupational Therapists (RCOT) research grant applications with the priorities, have helped embed them into research activity.
Areas where progress is emerging but limited
Long‑term outcomes remain underexplored (priority four), despite clear articulation of the need for longitudinal research and the use of logic models.
Evidence relating to primary care is growing but needs further development (priority five).
Carer support continues to be an area with limited empirical evidence (priority three), despite being highly valued in practice.
Areas where significant gaps remain
Cost‑effectiveness and economic evaluation (priority 10) is consistently identified as the least addressed priority, with a need for greater capability in health economics and more high‑quality economic evaluations. Working collaboratively with health economics colleagues can build confidence, extend methodological rigour and ensure evaluations are meaningful for practice.
Demonstrating occupational therapy’s contribution to reducing hospital admissions (priority eight) remains challenging, with limited robust outcome data.
Multiprofessional research infrastructure (priority nine) is still developing, and research teams do not yet consistently reflect the collaborative nature of practice.
High‑quality longitudinal studies are scarce across several priorities.
Taken together, this suggests meaningful progress in strengthening conceptual foundations and collaborative approaches, with substantial opportunities to build a stronger empirical and economic evidence base.
Implications for the profession: strengthening capacity, confidence and leadership
Responding to the priorities requires continued investment in research capacity and capability across the profession (Royal College of Occupational Therapists, 2025). Practitioners need accessible training, institutional support and protected time to participate in research. Early career researchers benefit from mentorship, clear pathways and opportunities to lead collaborative projects. There is also a wider need to build confidence in using research methods that capture complexity, as well as developing skills in areas such as health economics, analysis of large datasets and realist or theory‑driven approaches. Working with specialists in these areas will help ensure methodological quality.
Collaboration is essential. Working with health economists, implementation scientists, data specialists and social care researchers can help generate evidence that is rigorous and relevant to system‑level decision‑making. Access to linked datasets and integrated care records creates new possibilities for understanding impact at scale. National organisations, including RCOT and research networks such as the Council for Allied Health Professions Research (CAHPR), have a key role in supporting this development by providing guidance, strengthening research communities, and championing inclusive and methodologically robust research.
A call to action
The top 10 research priorities continue to offer the profession a shared direction for strengthening its evidence base. They highlight not only what needs to be researched but why it matters for the people and communities occupational therapists serve. Progress is evident, but sustained focus and collective effort are required to address the areas where evidence remains limited.
Building a research culture that is rigorous, inclusive and grounded in occupation will enable the profession to articulate its contribution with greater clarity and confidence. By investing in skills, partnerships and leadership and by continuing to work alongside people with lived experience occupational therapists can ensure that future research reflects what matters most in everyday life. Therefore, we should continue to align research activity with these priorities and with RCOT’s Research and innovation strategy (2025) so that the profession is well positioned to advance the quality, visibility and impact of occupational therapy evidence.
Footnotes
Author contributions
Both authors contributed equally to writing, reviewing and editing the editorial and approved the final version for submission.
Funding
The authors declared no financial support for the research, authorship and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Patient and public involvement data
During the development, progress and reporting of the submitted research, Patient and Public Involvement in the research was not included at any stage of the research.