Introduction
Paralympic sports provide individuals with disabilities the opportunity to compete at an elite level, offering physical, psychological, and social benefits while fostering inclusion and challenging societal perceptions of disability (Fagher et al., 2023 Puce et al., 2023; Forber-Pratt, 2015; Jefferies, Gallagher, and Dunne, 2012). However, participation in Paralympic sports presents distinctive challenges, including increased injury risks, fatigue, and psychological stressors such as anxiety and depression (Fagher, Dahlström and Lexell, 2022; Luiggi et al., 2025), all of which can impact athletic performance and overall wellbeing (Swartz et al., 2019). Addressing these challenges requires a multidisciplinary approach (Sanders, Spindler and Stanley, 2022), yet the specific role of OT in supporting Paralympic athletes remains underexplored.
Historically, the Paralympic movement has evolved significantly since its origins in 1948, when Dr. Ludwig Guttmann organised a sports competition for World War II veterans with spinal injuries in Stoke Mandeville, England (International Paralympic Committee, 2018b). This initiative marked a shift in the perceptions of disability, emphasising ability rather than limitation. The first official Paralympic Games, held in Rome in 1960, further reinforced this shift by providing a global platform to showcase the achievements of athletes with disabilities (International Paralympic Committee, 2018b; International Paralympic Committee, 2020). Over time, the Paralympic movement has expanded in scope and recognition, highlighting both the potential of adaptive sports and distinct demands placed on Paralympic athletes in training (Rodríguez Macías, Giménez Fuentes-Guerra, and Abad Robles, 2022). Adaptive sports encompass a broad range of physical activities modified to meet the needs of individuals with impairments, from grassroots participation to elite competition. Within this spectrum, the Paralympics represent the pinnacle of competitive achievement, bringing together the world’s top adaptive athletes to perform at the highest level on a global stage.
OT, with its focus on enabling meaningful participation in daily activities, has the potential to play a crucial role in supporting Paralympic athletes. OT and its interventions can address performance optimisation, rehabilitation, injury management, and holistic wellbeing (de Lima and Alves, 2020; Soares et al., 2022; American Occupational Therapy Association, 2020). However, despite the relevance of OT in this field, research specifically examining its role in Paralympic sports remains limited (Bullen and Clarke, 2020).
Existing literature frequently explores general rehabilitation and adaptive strategies for individuals with disabilities but seldom examines the broader lives of Paralympic athletes, including the ways OT can support them beyond sport performance (Fagher, Kunorozva, et al., 2022). Much of the research remains fragmented, focusing on either physical rehabilitation or mental health support in isolation, rather than considering how these domains intersect in the lived experiences of Paralympic athletes (Bullen and Clarke, 2020; Lima and Alves, 2020). This gap underscores the need for a comprehensive review that captures the full scope of OT’s potential contributions to Paralympic athletes’ sporting careers and overall quality of life.
Given the lack of consolidated research in this area, a scoping review is warranted to systematically identify and map the available literature. By synthesising findings from peer-reviewed studies, grey literature, and practice-based reports, this review will provide a clearer understanding of how OT contributes to the performance, rehabilitation, and overall wellbeing of Paralympic athletes. This will help inform future research, clinical practice, and policy development, ensuring that Paralympic athletes receive the specialised support they need to thrive in their respective sports.
A scoping review is well-suited to address this gap, as it allows for a broad exploration of diverse sources and study designs, mapping the range and nature of evidence on a given topic. Unlike systematic reviews, which focus on specific, narrowly defined questions, scoping reviews aim to provide an overview of available knowledge and identify areas for further investigation (Arksey and O’Malley, 2005; Peters et al., 2015). This methodology is relevant for emerging fields, where existing evidence is scattered across disciplines. A scoping review will provide a comprehensive overview of the current evidence, guiding future practice and research to better support Paralympic athletes in achieving their full potential.
Preliminary searches conducted in databases and search engines such as MEDLINE, PubMed, Scopus, and the Cochrane Database of Systematic Reviews revealed there are currently no studies explicitly focused on examining the distinct role of OT in Paralympic sports. While existing literature discusses broader topics such as rehabilitation and adaptive strategies, there is a lack of synthesised evidence on how OT specifically contributes to Paralympic athletes' performance, recovery, and wellbeing (Szabo and Kennedy, 2021). To address this gap, this scoping review will systematically gather and analyse relevant literature from peer-reviewed sources, grey literature, and practice-based reports, ensuring a comprehensive mapping of OT’s role in this field.
The aim is to examine existing literature on the role of OT in supporting individuals with disabilities who participate in Paralympic sports.
Objectives
To map evidence on ways in which OT supports Paralympic athletes across various populations, contexts and domains, including but not limited to performance optimisation, rehabilitation, injury management, and overall wellbeing of athletes.
To describe the extent, range, and nature of available evidence on OT’s role in Paralympic sports
To identify gaps in research on OT’s role in Paralympic sports.
Methods
The specific application of OT in Paralympic sports remains a relatively new and underexplored area. While Bullen and Clarke (2020) highlight occupational therapists’ broader experiences in supporting participation in sport, their work points to the growing relevance of this area within OT practice. This methodology is ideal for mapping broad and fragmented evidence in emerging areas, enabling the inclusion of diverse sources such as peer-reviewed studies, grey literature, and practice-based reports to ensure a comprehensive exploration (Arksey and O’Malley, 2005; JBI Manual, 2024).
The proposed scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews, recognised for its systematic and comprehensive approach to mapping evidence (Aromataris et al., 2024). This methodology is particularly well-suited for exploring emerging and multidisciplinary topics, as it allows for the inclusion of diverse sources of evidence and the identification of research gaps (Aromataris et al., 2024).
The JBI framework (Aromataris et al., 2024) involves a series of structured steps to ensure a rigorous review process:
Define the Review Objectives and Questions: Clearly articulate the purpose of the review and develop research questions using the Population, Concept, and Context (PCC) framework.
Develop a Comprehensive Search Strategy: Conduct an initial exploratory search, followed by a systematic search across multiple databases, grey literature, and other relevant sources to ensure a thorough capture of evidence.
Select Relevant Sources of Evidence: Screen and include sources that meet predefined eligibility criteria based on the review objectives.
Extract Data Systematically: Collect data from included studies using a standardised tool to capture key information on study characteristics and findings.
Analyse and Synthesise the Evidence: Identify patterns, themes, and gaps within the data to provide a comprehensive overview of the evidence landscape.
Report Findings Transparently: Present the results in alignment with the PRISMA-ScR guidelines, ensuring clarity and reproducibility (Page et al., 2021).
This methodology will ensure a systematic and transparent approach to exploring the role of OT in Paralympic sports, providing valuable insights for research and practice.
Review Question
This scoping review seeks to explore the role of OT in supporting individuals with disabilities who participate in Paralympic sports. The review is guided by the Population-Concept-Context (PCC) framework to ensure a systematic and comprehensive approach to identifying and mapping existing literature.
| PCC Element | Description |
|---|---|
| Population | Individuals with physical, sensory, or intellectual disabilities competing in, or in training in preparation of competing in, Paralympic sports at the elite international level. |
| Concept | The role and contributions of OT. This includes interventions related to performance enhancement, injury prevention, rehabilitation, assistive technology, mental health support, and holistic wellbeing in the context of Paralympic sports. |
| Context | Paralympic and adaptive sports settings, including rehabilitation centres, community programmes, sports clinics, elite training environments, and competitions at local, national, and international levels. |
Table I: Population–Concept–Context (PCC) Framework
The central review question is:
What is the role of occupational therapy in supporting individuals with disabilities in Paralympic sports?
Population
The review will focus on individuals with physical, sensory, or intellectual disabilities who are actively participating in or training for Paralympic sports at any level of competition. This includes athletes competing in professional or amateur Paralympic sporting events.
Concept
The core concept explored in this review is the role of OT in Paralympic sports. The following key areas are adapted from established domains of OT practice and applied to the context of high-performance sport, reflecting both clinical and performance-oriented contributions (American Occupational Therapy Association, 2020). They include interventions and strategies that address athlete performance, injury management, and overall wellbeing:
Performance optimisation – Techniques used to enhance functional skills, endurance, and efficiency in sport-specific tasks.
Rehabilitation and injury prevention – OT strategies that facilitate recovery and minimise the risk of injury.
Adaptive equipment and assistive technology – The selection, customisation, and use of devices to support mobility, accessibility, and sport participation.
Mental health and wellbeing support – OT interventions addressing stress management, coping strategies, and psychological resilience in high-performance sports.
Training and competition preparation – OT’s role in helping athletes develop routines, manage fatigue, and enhance participation in training and competitive events.
Context
This review will include studies that examine the role of OT, which is the profession dedicated to enabling participation in meaningful activities, and the OT services provided to Paralympic athletes, which are the structured, organised offerings delivered by occupational therapists in various settings. It will also consider OT interventions, which are the specific, targeted actions or strategies implemented within those services to support athletes’ performance, wellbeing, and daily functioning. Relevant contexts include, but are not limited to:
Training facilities – High-performance centres, gyms, or practice venues where athletes prepare for competition.
Competition venues – Locations where Paralympic events take place, including on-site OT support during tournaments.
Rehabilitation centres – Medical and therapeutic facilities where OT services are integrated into athlete recovery plans.
Community-based programmes – Initiatives that support Paralympic athletes outside of formal training or clinical settings.
Telehealth or remote service delivery – Digital or virtual platforms through which OT services are provided to athletes with disabilities.
By addressing these key elements, this scoping review will systematically map existing evidence on the role of OT in Paralympic sports, identifying gaps in research and informing future studies.
Inclusion Criteria
The following table outlines the inclusion criteria applied in this scoping review, along with the corresponding rationale for each. These criteria were developed to ensure a focused and methodologically sound approach to identifying literature that specifically addresses the role of OT in the context of Paralympic sport.
| Criteria | Rationale |
|---|---|
| Participants | This scoping review will include individuals with physical, sensory, or intellectual disabilities who actively participate in Paralympic sports, as defined by the International Paralympic Committee (IPC, 2016). Eligible participants must be engaged in training or competition at any level within an IPC-classified Paralympic sport. Eligible impairment types include impaired muscle power, impaired passive range of movement, limb deficiency, leg length difference, short stature, hypertonia, ataxia, athetosis, vision impairment, and intellectual impairment. Both Summer (e.g., Para athletics, Boccia, Para swimming) and Winter (e.g., Para alpine skiing, Para ice hockey) sports recognised by the IPC will be included. Studies focusing on individuals with disabilities who do not participate in Paralympic sports, non-disabled athletes, or general adaptive sports outside IPC classification will be excluded (IPC, 2018a). By ensuring that only studies directly involving Paralympic athletes or those training to reach that level are included, this review maintains a clear focus on the role of OT in this specific population. |
| Concept | This includes OT interventions and strategies aimed at enhancing athletic performance through improved functional movement, endurance, and sport-specific skills. The review will also consider OT’s role in injury prevention and rehabilitation, focusing on recovery, conditioning, and reducing injury risks. Mental health and wellbeing support, including interventions for psychological resilience, stress management, and coping strategies, will be included. Additionally, the review will examine OT’s involvement in adaptive strategies and assistive technology, including the selection, customisation, and use of devices to optimise mobility, accessibility, and sport participation. The broader impact of OT on athletes’ quality of life, particularly in balancing training, daily activities, and personal wellbeing, will also be explored. Studies that do not specifically focus on OT, OT interventions, or that address general rehabilitation without explicitly detailing OT involvement will be excluded. |
| Context | This review will aim to adopt a global perspective, examining the role of OT in Paralympic sports across different geographic, cultural, and gender-specific contexts. Studies from any country will be considered. Eligible settings include high-performance centres, training facilities, competitive environments (e.g., Paralympic events), rehabilitation centres, community-based programmes, and telehealth or remote service delivery. Studies that do not examine OT in the context of sports performance or rehabilitation for Paralympic athletes will be excluded. |
| Types of Sources | A broad range of study designs will be included, covering quantitative (experimental, quasi-experimental, observational) and qualitative research exploring athlete experiences and OT effectiveness, as well as systematic reviews on OT in Paralympic sports. Both peer-reviewed and grey literature will be considered. Only studies published in English will be included, with no restriction on publication date. Studies unrelated to OT’s role in Paralympic sports or focusing solely on coaching, training, or medical interventions without OT involvement will be excluded. |
Table II: Inclusion Criteria and Rationale
Search Strategy
The search strategy will employ a comprehensive three-step approach, as recommended by the Joanna Briggs Institute (JBI) (Aromataris and Munn, 2024), to systematically identify both peer-reviewed and grey literature studies on OT's role in Paralympic sports for individuals with disabilities First, an initial limited search will be conducted in EBSCOhost (CINAHL, APA PsycArticles, APA PsycInfo, MEDLINE) and PubMed to identify seed articles highly relevant to the topic. Keywords, indexed terms, and subject headings from these articles will then be used to refine the search strategy. Second, a systematic and comprehensive search will be performed in additional databases, including Scopus, Web of Science, ScienceDirect, and SPORTDiscus, to broaden the evidence base. Third, supplementary searches will include theses and dissertations grey literature from sources such as Google Scholar, WorldCat and OATD.org. To ensure thoroughness, the reference lists of all included sources will be screened for additional studies.
Any tools or methodologies used to identify keywords or index terms, such as controlled vocabularies or MeSH terms, will be documented, along with any filters (English only) and boolean operators.
The following indexed search descriptors was developed alongside a subject librarian and will be used across all databases in the following format:
| ("occupational therapy" or "occupational therapies" or "occupational therapist" or "occupational therapists" or "occupational therapist intervention" or "ot”) AND (“para sports" or "para-sport" or "para-athletes" or "para-athletes" or "paralympics" or "sports for persons with disabilities" or "para-athletic" or "adaptive sport" or "wheelchair sports" or "paralympian") | Expanders - Apply equivalent subjects Narrow by language – English |
Interface - EBSCOhost Research Databases Search Screen - Advanced Search Database - MEDLINE Ultimate |
31 |
|---|
Table III: Search strategy; Search conducted on Medline, February/2025
Study/Source of Evidence Selection
After the search, identified citations will be compiled and uploaded into Rayyan, a web-based citation management system, where duplicates will be removed (Ouzzani et al., 2016). The author and another reviewer (second reviewer) will independently screen titles and abstracts against the screening tool.
| Screening Criteria Tool | Yes | No | Unclear |
|---|---|---|---|
| 1. Does the title/abstract indicate that the population includes individuals with disabilities participating in Paralympic or adaptive sports? | |||
| 2. Is OT mentioned or implied as a focus? | |||
| 3. Is the article set in a context relevant to Paralympic or adaptive sports (e.g., training, rehabilitation, community programmes, elite competition)? | |||
| 4. Is the source a primary research study (peer-reviewed, case study or grey literature) that addresses the review objectives? |
Table IV: Screening criteria tool
To ensure inter-rater reliability, a pilot screening of 10% of the citations will be conducted by both reviewers. The aim is to achieve at least 80% agreement between reviewers. If this threshold is not met, the reviewers will discuss discrepancies and repeat the pilot process until the desired agreement level is achieved. If disagreements persist then the research supervisor will be consulted as a third reviewer.
Full-text articles of potentially relevant sources will be retrieved and assessed by the author. Reasons for exclusion will be documented. A PRISMA flow diagram will visually represent the study selection process, detailing the number of records identified, screened, included, and excluded at each stage (Page et al., 2021).
Data Extraction
Data will be extracted from the included papers using a modified JBI Data Extraction Tool (Aromataris et al., 2024)
| Field | Description |
|---|---|
| Citation | |
| Year | |
| Country | |
| Participants | |
| Disability Type (IPC) | |
| Paralympic Sport Type | |
| Study Design | |
| OT Role & Interventions | |
| Setting/Context |
Table V: Data Extraction Tool
Prior to full extraction, the tool will be piloted on a sample of studies (5) to ensure clarity and comprehensiveness by the author. Research supervisor feedback will guide refinements, including the addition of fields for relevant information on paralympic sports and OT interventions. The extracted data will encompass details about participants, context, study methods, and key findings, with any modifications documented to ensure transparency and reliability in the review process.
Data Analysis and Presentation
Data will be synthesised into themes that address the study objectives and presented in a narrative summary and tables and figures where appropriate highlighting OT role, outcomes, and key findings.
Conclusion
This scoping review protocol will systematically map the current evidence on the role of OT in Paralympic sports, identifying the breadth and nature of existing literature across domains such as performance optimisation, rehabilitation, and psychosocial support. By highlighting gaps and patterns in the evidence base, the review will contribute to guiding future research, informing practice, and supporting the development of OT-specific approaches within elite sport. For the profession, this work underscores the expanding scope of OT and its relevance in emerging, interdisciplinary practice areas focused on inclusion and occupational engagement at the highest levels of athletic performance.
Acknowledgements
The author would like to acknowledge the following individuals for their contributions to this scoping review:
Research Supervisor, for providing irreplaceable guidance and feedback on the process and the manuscript.
This scoping review was conducted as part of the degree requirements for the MSc Occupational Therapy at the University of Essex.
Declarations
The authors of this scoping review emphasise the importance of equity, diversity, and inclusion in research, particularly within occupational therapy for individuals with disabilities involved in paralympic sports. We acknowledge diverse voices throughout the research process and encourage further participation from underrepresented groups. Our aim is to highlight and amplify experiences from varied backgrounds, ensuring their perspectives are reflected in our findings.
Lead author, a professional powerlifter representing the Cayman Islands under the International Powerlifting Federation (IPF), brings valuable insight to this review, reinforcing the need for inclusive practices in OT, especially in paralympic sports. This review aims to contribute to existing literature while advocating for future research that prioritises diversity and inclusion in the field.
Author Contributions
Lead Author: Contributed to the conceptualisation of the review topic and the formulation of research question. Searched and collected the data and performed the data extraction and analysis. Wrote the manuscript, integrating findings and insights from all authors.
Second Author: Contributed to the literature search strategy, identifying relevant databases and sources. Participated in the drafting and editing of specific sections of the manuscript, focusing on the context and implications of the findings. Supported the review process by verifying references and ensuring compliance with publication standards.
Conflicts of Interest
There is no conflict of interest in this project.
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Copyright Statement
© Arianna Simonetta McCoy & Hei Ting Wong. This article is licensed under a Creative Commons Attribution 4.0 International Licence (CC BY).