Chronic respiratory diseases are chronic diseases of the airways and structures of the lung [1]. In 2017, an estimated 545 million people globally were impacted by chronic respiratory diseases; in Canada, approximately 1 in 10 adults are affected [2,3]. Chronic respiratory diseases impose a high burden of morbidity and mortality worldwide [2]. In recent years, chronic respiratory diseases represented the third-leading cause of death globally [2] and chronic obstructive pulmonary disease (COPD) represented the sixth greatest contributor to global disability-adjusted life years (DALYs) [4]. As such, people with chronic respiratory diseases present with multifaceted physical, psychological, and social impairments, compromising their ability to perform activities of daily living (ADLs) and threatening their participation in meaningful life roles [5].

Pulmonary rehabilitation (PR) is a core component of the management of respiratory diseases, and there is strong evidence to support its effectiveness in people with COPD [6], interstitial lung disease (ILD) [7], lung cancer [8], pulmonary arterial hypertension [9], and COVID-19 [10], as well as those who are pre–lung transplantation or post–lung transplantation [11,12], among others [6]. PR has been shown to relieve dyspnea and fatigue, improve overall exercise capacity, reduce hospital readmissions, enhance the sense of control that an individual has over their condition, and improve health-related quality of life [13,14]. A PR program generally involves a thorough individual assessment, followed by a comprehensive, multidisciplinary, person-centered intervention that may include education, exercise, and self-management strategies targeting healthy behavior change [6,15]. These interventions aim to restore an individual’s exercise capacity and improve their ability to complete ADLs [16].

Occupational therapists are rehabilitation professionals who work to help individuals engage in ADLs and other meaningful “occupations” that affect their health, well-being, and participation in life roles [16,17]. Given the concordance in the aims of PR and the occupational therapy (OT) scope of practice, occupational therapists appear to be well suited as key players in PR programs [18]. The benefits of adding OT to PR programs have been sparsely reported in small studies of patients with COPD [19-21] but have never been synthesized or reported in national and international guidelines [6,22]. The lack of knowledge about OT roles and benefits may be hampering its inclusion in PR programs and preventing people with chronic respiratory diseases from getting the best evidence-based care. Indeed, the most recent Canadian survey found that less than 40% of PR programs in Canada report having occupational therapists on their team [22].

In preparation for this review protocol, an initial search of the literature was conducted in EMBASE, MEDLINE, CINAHL, the Cochrane Database of Systematic Reviews, and the JBI Evidence Synthesis; no current or underway scoping reviews or systematic reviews on OT in PR were identified. However, the terms “occupational therapy,” “cardiopulmonary rehabilitation programs,” “respiratory rehabilitation programs,” and “pulmonary rehabilitation programs” yielded a wide breadth of literature. These preliminary search findings support the need for a scoping review to map the available research; explore the extent, range, and nature of the research activity; and identify gaps in the available evidence [23].

The main objective of this scoping review is to explore the role of OT in PR programs. The secondary objectives are the following: (1) systematically map the recommendations of current guidelines for the inclusion and roles of OT in PR programs, if any, (2) estimate the prevalence of OT as part of PR programs, and (3) summarize the reported effects of OT as part of PR.

The project was initiated in January 2021. After formalizing the study methods, and prior to title and abstract screening, the protocol was registered with the Open Science Framework (OSF) from the Center for Open Science in February 2021. Data collection commenced in March 2021 and is ongoing at the time of submission. Data collection is expected to be completed by June 2021. Data analysis and drafting of the manuscript will occur throughout 2021, with expected publication in 2022.

To the author’s knowledge, this is the first scoping review to explore the role of OT in PR programs. By exploring a breadth of literature, including quantitative, qualitative, and mixed methods study designs, as well as clinical practice guidelines, systematic reviews, and PR program surveys, this study will provide a comprehensive description of the role of OT in PR programs. In addition, this study will systematically map the recommendations of current guidelines for the inclusion and roles of OT in PR programs, if any; estimate the prevalence of OT as part of PR programs; and summarize the reported effects of OT as part of PR. In doing so, this study will complement several guidelines that emphasize the importance of multidisciplinary care in PR [32-34] and may provide more specification and clarification for the role of OT in these multidisciplinary programs.

The results of this study will be of interest to all health care professionals and policy makers involved in the delivery of PR programs across many health care settings. The findings of this scoping review will allow these stakeholders to better understand the scope, roles, and responsibilities of OT within PR care pathways. This role clarification will inform program development and clinical decision making and will serve to optimize the delivery of multidisciplinary care for patients in PR programs, ultimately improving patient and health care services outcomes.

This proposed scoping review has many strengths. Preregistering the protocol prior to title and abstract screening reduces risk of bias and ensures research transparency [35]. Furthermore, using the JBI methodological framework and PRISMA guidelines for reporting results optimizes the rigor of this scoping review. Additionally, a comprehensive search strategy was developed in consultation with an experienced librarian, and the broad scope of the inclusion criteria was chosen to provide the most breadth and depth of information relating to the role of OT in PR programs. Finally, targeted gray literature searching will capture the most relevant information from OT association websites.

This scoping review is limited by language criteria, which restricts our ability to examine the role of OT in PR programs delivered in languages other than English, French, or Portuguese. There is a possibility that important roles of OT in PR programs exist in literature inaccessible to our group due to language barriers. Furthermore, though intentionally targeted, the search of gray literature will be minimal due to time constraints. Additionally, the literature search will be limited to four databases. It is likely that the majority of the relevant literature on the topic is included in these databases, but the possibility remains that additional literature of interest may be missed. Finally, and inherent to all scoping review methodology, this review will not include a critical appraisal of the evidence, which limits the ability of this review to make recommendations based on the literature or identify gaps on the basis of low-quality evidence.

In conclusion, this study will enhance our understanding of the role, extent, and effect of OT in PR programs, which has the potential for OT role enrichment or expansion, ameliorated interdisciplinary patient care and, most importantly, improved patient outcomes.