Annals of International Occupational Therapy

History 

Occupational Therapy in Iran: Past, Present, and Future

Mehdi Rassafiani, PhD; Robab Sahaf, PhD; Farzaneh Yazdani, PhD

Abstract

Although occupational therapy recently reached the centenary year of its establishment in the United States, it is a relatively new profession across the world. Iran has experienced 45 years of a fluctuating history in occupational therapy within a political context of revolutionary upheaval and war. In line with practice elsewhere, occupational therapists in Iran have emphasized occupational therapy paradigms and the importance of a client-centered approach since the profession began. However, unique conditions in Iran have influenced the evolution of occupational therapy. This article reviews the history of occupational therapy in Iran and discusses the major events that affected its development. We describe the historical context of the development of occupational therapy in Iran; the current context and recent achievements, including evidence-based practice; and the future need for increased capacity, validation of tools for clinical practice, and expansion of research areas. This article provides a narrative review of the development of occupational therapy in an Eastern country. Consideration of the growth of occupational therapy in Iran from an analytical point of view would be worthwhile. [Annals of International Occupational Therapy. 2018;1(1):49–56.]

Abstract

Although occupational therapy recently reached the centenary year of its establishment in the United States, it is a relatively new profession across the world. Iran has experienced 45 years of a fluctuating history in occupational therapy within a political context of revolutionary upheaval and war. In line with practice elsewhere, occupational therapists in Iran have emphasized occupational therapy paradigms and the importance of a client-centered approach since the profession began. However, unique conditions in Iran have influenced the evolution of occupational therapy. This article reviews the history of occupational therapy in Iran and discusses the major events that affected its development. We describe the historical context of the development of occupational therapy in Iran; the current context and recent achievements, including evidence-based practice; and the future need for increased capacity, validation of tools for clinical practice, and expansion of research areas. This article provides a narrative review of the development of occupational therapy in an Eastern country. Consideration of the growth of occupational therapy in Iran from an analytical point of view would be worthwhile. [Annals of International Occupational Therapy. 2018;1(1):49–56.]

Although occupational therapy has 45 years of history in Iran, there is little information on its introduction and development. Occupational therapy is a profession that is influenced by context and culture. This article provides background information on Iran and discusses the past, present, and future of occupational therapy in Iran.

Iran: History and Context of Occupational Therapy

Iran was historically known as Persia, and it was home to one of the world's oldest civilizations, the Elamite kingdoms, in 4000 B.C. (Greenblatt, 2003). It is situated in the Middle East (west of Asia) between the Caspian Sea in the north and the Persian Gulf in the south, with a total area of 1,648,195 km2 (Curtis, Hooglund, & Library of Congress. Federal Research Division, 2008). Currently, Iran has more than 80 million inhabitants across 31 states (or provinces), with various ethnicities and languages. Each state is responsible for the delivery of subnational governance and has a capital city. The largest ethnicity is Persian (61%), followed by Azeri (16%), Kurd (10%), Lur (6%), Baloch (2%), Arab (2%), Turkmen (2%), and others (1%). The national language is Persian (Farsi), but different ethnicities speak their own languages. The capital and largest city is Tehran, which has a population of 12 million (Richter, 2005).

Because of its geopolitical position, Iranian culture has been influenced by European, Russian, Indian, and Arab cultures and has a rich cultural heritage that is famous for beautiful poetry, luxurious rugs, and lush gardens. In fact, the English word “paradise” comes from a Persian word, pardis, meaning “enclosed garden” (Curtis et al., 2008). Iran has 22 United Nations Educational, Scientific, and Cultural Organization (UNESCO) World Heritage Center sites, the third largest number found in Western Asia and the 11th largest number in the world (United Nations Educational, Scientific, and Cultural Organization, 2017). Most Iranians are Muslim; however, there are other religious groups as well, such as Zoroastrians, Christians, and Jews (Richter, 2005). The history of Iran, its geographical situation, and the variety of ethnicities and religions that are represented have influenced the culture of this country.

Iranian culture is different from Western culture in some ways (Curtis et al., 2008). For example, extended families are characteristic of Iranian culture, unlike the nuclear families commonly found in Western contexts. When family members become impaired or disabled, the parents and children are expected to help them by performing basic and instrumental daily activities for their loved ones until they fully recover. There is always a family member available to provide home care and transportation and to accompany the person to medical and rehabilitation services. This type of support can sometimes hinder the person with a disability from becoming independent in daily activities. The word that people use in this situation is sacrify, and this concept has deep roots in Iranian culture and motivates actions toward family members and friends. In this situation, occupational therapists must encourage family members to reduce unnecessary support and help the individual to carry out daily activities independently as much as possible. In other words, it is important to challenge this cultural value to achieve the goals of occupational therapy.

By and large, education in occupational therapy in Iran is similar to its roots in the United States. There are three degrees in occupational therapy—bachelor's, master's, and doctoral degrees. To complete a bachelor's degree, students must pass basic, fundamental, professional, and clinical courses within 4 years, based on a curriculum developed according to the minimum standards for education established by the World Federation of Occupational Therapists (WFOT). A master's degree takes an additional 2 years, with 1 year dedicated to professional courses and 1 year to conducting research under supervision. A doctoral degree is completed in about 4 years, with 2 years of professional courses and 2 years of supervised extensive research and completion of a dissertation.

Milestones in Occupational Therapy

As in the early history of the profession in the United States, the evolution of occupational therapy in Iran has experienced challenges (Bryden & McColl, 2003; Punwar, 2000). As World War I increased the need for mental health rehabilitation and alignment with a medical model in occupational therapy (Punwar, 2000), revolution and war provided the stimulus for the expansion of occupational therapy in Iran. The main breakthrough was approval of a bill that addressed the comprehensive protection of rights of people with disabilities by the Islamic Parliament of Iran in 2004 (Islamic Parliament Research Center of Iran, 2004). According to this law, all government and private sectors are obliged to ensure that people with disabilities comprise 3% of their workforce. The National Welfare Organization is responsible for delivering appropriate support to families of those with disabilities, and this organization provides funding for their education. Also, all new public buildings must accommodate the needs of people with disabilities.

Early Establishment of Education in Occupational Therapy

During the 1960s, in Iran, people with disabilities (the majority in capital cities) received rehabilitation services through nongovernmental organizations (NGOs). There was no national organization to provide rehabilitation services for people with disabilities across the country, and 25 NGOs were founded by public resources. These NGOs provided shelter and very basic rehabilitation services by physiotherapists. They were governed by a small government organization called the Rehabilitation Council. In collaboration with the World Health Organization, the Iranian government established staffing as a high priority to establish and expand rehabilitation programs. In 1971, the government recognized occupational therapy along with other professions, such as speech therapy and orthotic and prosthetic specialists (Rassafiani, Zeinali, Sahaf, & Malekpour, 2013). The first class of occupational therapy assistants was established at Shafa Rehabilitation Hospital in Tehran and included five students because of space limitations (Rassafiani et al., 2013). This group of assistants was later awarded a fellowship to complete their advanced training up to the bachelor's degree level. After 2 years, education at the assistant level was stopped and a bachelor's degree in occupational therapy was established at Shafa Rehabilitation Hospital (Rassafiani et al., 2013).

Soon the School of Social Welfare and Rehabilitation Sciences (currently known as the Faculty of Rehabilitation Sciences) was established, enabling the profession of occupational therapy to grow more quickly. In 1987, a second bachelor's degree program at Shaheed Beheshti Medical University was founded by Eghlidi in the capital city, Tehran (Rassafiani et al., 2013). Finally, Rassafiani established the third bachelor's degree program at the University of Social Welfare and Rehabilitation Sciences in 1991 (Rassafiani et al., 2013). Since then, nine more universities across the country and outside of Tehran have established occupational therapy programs at the bachelor's degree level, and this increase in programs has played an important role in expanding human resources. More than 260 students are currently accepted each year at these universities. However, preparing this number of occupational therapy students is not sufficient to meet the needs of the entire population now or in the future, and it will be necessary either to increase the number of students in each occupational therapy program or to start occupational therapy programs at other universities across the country.

The first master's degree program in occupational therapy was established in 1991 at Iran University of Medical Sciences. Currently, there are master's degree programs at four universities in Tehran, including Iran University of Medical Sciences, Tehran University of Medical Sciences, Shaheed Beheshti Medical University, and the University of Social Welfare and Rehabilitation Sciences. In 2008, the first group of doctoral students was accepted at Iranian universities, including Iran University of Medical Sciences and the University of Social Welfare and Rehabilitation Sciences, thus promoting leadership in research and expanding services to address the needs of people with disabilities. All of these programs are located at public universities (founded by government), and students are not charged any tuition fees.

Contextual Factors Affecting Occupational Therapy

During the last five decades, the expansion of occupational therapy in Iran has been greatly influenced by several factors, including the Iranian revolution, the 8-year war between Iran and Iraq, the establishment of the Iranian Occupational Therapy Association (IROTA), the recognition of IROTA as a full member by WFOT, the development of postgraduate training, and the introduction of independent work by occupational therapists in the private sector.

The Iranian revolution. During the Iranian revolution (1979), education in occupational therapy was discontinued for almost 4 years. Universities were closed for almost 2 academic years. When the universities reopened, education in occupational therapy was delayed for 2 more years because many of the experienced teaching staff fled the country. With the curtailment of education, many students did not return to the universities and some occupational therapy students changed their majors. During this time, occupational therapy was in its early stages of development. Fortunately, the remaining occupational therapy teaching staff gradually re-established the occupational therapy programs with considerable effort.

The war between Iran and Iraq (1981–1989). This war was distinguished as the longest war between two countries in the 20th century, and it caused approximately 1 million casualties and disabilities (Curtis et al., 2008). The war had both negative and positive effects on the occupational therapy profession. On one hand, because of economic decline during the war, the development of occupational therapy programs at universities across the country was curtailed. On the other hand, as the number of people with disabilities increased, the demand for occupational therapy became greater after the war. This demand for skilled practitioners fueled the rapid expansion of 12 occupational therapy programs for two decades after the war.

Establishment of the Iranian Occupational Therapy Association. Pioneer members of IROTA resolved that there was a need for a professional body to meet the needs of occupational therapists and promote the goals of the association at national and international levels, despite the effects of war. Thus, IROTA was formally established in 1994 (Rassafiani et al., 2013).

The goals of IROTA are to enhance education and training in occupational therapy, advance practice, maintain standards, increase the number of facilities for practitioners, and develop international collaborations (Rassafiani et al., 2013). Since it was established, IROTA has been successful in achieving these goals, holding annual national conferences, and facilitating ongoing training and workshops for occupational therapists across the country. In addition, the association has worked closely with the Iranian Ministry of Health to cover the cost of occupational therapy services, has approved a set of ethical guidelines for occupational therapists, and has developed standards of practice and services (Iranian Occupational Therapy Association, 2017).

Given the increase in the number of occupational therapists in various states, the need for state associations was identified. Seven states have independent associations that promote the interests of the states and address the needs of occupational therapists in those areas. These state associations have been very active in holding workshops, conferences, and training sessions; raising social awareness about occupational therapy; and supporting research.

Membership in the World Federation of Occupational Therapists. The Iranian Occupational Therapy Association applied to became a WFOT member in 1996. It took several years to become an associate member in 2004, and full membership was awarded in 2006 (World Federation of Occupational Therapists, 2017a). Achieving this standard in entry-level education and joining the world professional body was an important accomplishment for occupational therapists in Iran. Since then, most education programs in Iran have been approved or reapproved by WFOT (World Federation of Occupational Therapists, 2017b).

Development of postgraduate education in occupational therapy. Occupational therapy programs in Iran are approved and evaluated regularly (every 5 years) through the Iranian Occupational Therapy Evaluation Board of the Ministry of Health. In addition, occupational therapy programs are required to hire trained, well-educated occupational therapists; therefore, postgraduate training supports this development across the country. The establishment of master's degree and doctoral programs was the cornerstone of developing occupational therapy in Iran and enriching training and practice. Occupational therapy training in Iran is based on various models developed by Western countries, including the United States, Canada, and Australia. However, Western viewpoints may not be appropriate for Middle Eastern countries. Therefore, for decades, research studies have focused on standardizing assessments for use by occupational therapists in Iran and writing textbooks in Persian. To accomplish these cultural and linguistic modifications, it has been necessary to train highly capable researchers at the postgraduate level who can publish their findings in both local and internationally recognized rehabilitation journals.

Independent work in the private sector. In the past, occupational therapists in the private sector were required to work under the supervision of a physician. Occupational therapists could provide treatment only with the approval of a physician. In addition, occupational therapists shared a portion of their income with the supervising physician. Through the long-term efforts of IROTA, in 2003, the Ministry of Health allowed physical therapists to work independently in the private sector (Rassafiani et al., 2013). This policy facilitated work in the nongovernment sector. This change to independent practice also created demand for assessment and intervention tools for use by occupational therapists. As a result, tools and equipment for occupational therapists have increased dramatically in both quantity and quality.

The Current State of Occupational Therapy

Since the establishment of occupational therapy in Iran, more than 3,000 occupational therapists have received graduate and postgraduate degrees. However, the number of practicing occupational therapists is currently somewhat less because some work in administrative positions, some have left the occupation, and some have emigrated to other countries. It is estimated that only 2.9 occupational therapists remain for every 100,000 people, which is very low compared with other developed countries and in relation to the increasing demand for occupational therapy services in Iran (World Federation of Occupational Therapists, 2017a). To become eligible to practice, an individual must complete 4 years of education, with a final examination at the end of university education. To establish an independent private practice, an occupational therapist must have either at least 5 years of work experience in capital cities or 3 years of experience in smaller cities.

Occupational therapists have various career opportunities (i.e., areas of practice) in the government, nongovernment, and private sectors. The government sector includes hospitals and clinics affiliated with the Ministry of Health, the National Organization for Exceptional Education, and the National Welfare Organization. These three government institutions provide rehabilitation and education for people with acute, subacute, and chronic disabilities. Most of these services are covered by national health insurance and complementary private health insurance companies. The National Welfare Organization is responsible for providing long-term services for people with disabilities. This organization provides rehabilitation services and assistive devices free of charge for those who cannot afford them. Occupational therapists also have opportunities to open private offices, establish rehabilitation clinics with various other professions, or work for NGOs that provide services for people with disabilities.

Occupational therapy is available for children with physical disabilities, such as cerebral palsy, and cognitive disorders, such as autism and attention deficit hyperactivity disorder. Occupational therapy services also are available for people with hand injuries and orthopedic disorders, adults with neurological disabilities, and persons with mental disorders. In recent years, occupational therapy services also have been provided for people with cancer and heart disease as well as children who require early intervention (Jaramillo, Gamborg, Rassafiani, Mlambo, & Sriphetcharawut, 2016). Some occupational therapists work in emerging areas, such as assessment and training to develop occupational therapy services for those who have work injuries. In addition, occupational therapy services soon will be available to enhance well-being (e.g., increasing the ability to participate in physical activities) among students beginning in early childhood.

Occupational therapists in Iran must register with the state Iranian Medical Council. The Iranian Medical Council provides ongoing assessment, ethical oversight, and ongoing training, and is responsible for approving health care professionals for practice in the private sector. Occupational therapists are given permission to practice for a 5-year period. After that time, they must provide evidence of attending training worth 25 points per year to maintain eligibility. These yearly points can be achieved through attending occupational therapy conferences or workshops or by completing short-term training. The conferences and training sessions are approved by the Iranian Ministry of Health, but provided by universities and IROTA.

Occupational therapists are committed to updating their skills and knowledge while they are practicing. In addition to attending workshops, conferences, and special training sessions, occupational therapists have access to several national peer-reviewed rehabilitation journals approved by the Iranian Ministry of Health, available in both Persian and English, that are partly dedicated to occupational therapy. Important national journals that publish research on occupational therapy include the Iranian Rehabilitation Journal, Journal of Rehabilitation, Scientific Journal of Rehabilitation Medicine, Journal of Rehabilitation Sciences and Research, Journal of Paramedical Sciences & Rehabilitation, Salmand: Iranian Journal of Aging, Journal of Research in Rehabilitation Sciences, and Journal of Modern Rehabilitation. Each journal must meet the standards for scientific journal publication set by the Iranian Ministry of Health to be approved as a scientific journal (Scientific Information Databases, 2017). Practitioners have free access to these journals across the country, allowing them to stay current with research in the field.

Research and Evidence-based Practice

Establishing the doctoral level of education has helped to train high-level researchers who can identify problems in various areas of occupational therapy education and services and initiate changes to advance these services. In addition, these highly trained graduates have influenced occupational therapy services through the development of new areas of practice, such as home-based training (Nobakht & Rassafiani, 2016) and treatment of children with cancer (Mohammadi, Mehraban, & Damavandi, 2017). Postgraduate education with experimental research design and systematic review methods also has advanced the level of evidence in research.

Lajevardi, Rassafiani, Shafaroodi, Hassani Mehraban, and Ahmadi (2011) reviewed national articles published by occupational therapists in Iranian scientific journals showing various levels of evidence used in research. Only 52 articles were published between 2004 and 2011. Of these, 49% employed experimental and randomized controlled trial designs. Most of these articles (45%) were in the area of pediatrics, and a minority were in the area of mental illness (7%) and the elderly (6%). During this period, only seven international articles were published by Iranian occupational therapists (Ghahari, Leigh Packer, & Passmore, 2010; Ghahari, Packer, & Passmore, 2009; Hassan-Zadeh, Lajevardi, Esfahani, & Kamali, 2009; Rassafiani, 2009; Rassafiani, Copley, Kuipers, & Sahaf, 2008; Rassafiani & Sahaf, 2010; Rassafiani, Ziviani, & Rodger, 2008). After this review and since 2011, the number of national and international scientific articles published by Iranian occupational therapists has increased dramatically because of the development of postgraduate education. According to the Iranian Scientometric Information Database (access http://isid.research.ac.ir), established by the Iranian Ministry of Health on the basis of Scopus data, Iranian university professors and teachers in occupational therapy published more than 270 articles, although the actual number of articles is less than 270 because some articles were written by multiple authors. Further, the areas of research have been expanded. For example, one area of research and practice is the training of parents and caregivers of children with cerebral palsy at home and school. The literature in this area includes qualitative and quantitative studies of therapists' and caregivers' knowledge of care (Razavi Afzal, Rassafiani, Sarfraz, Malekpour, & Salehi, 2013; Rezaei, Malekpour, & Rassafiani, 2014); co-occupation of mothers and children with cerebral palsy (Dalvand et al., 2015; Dalvand, Rassafiani, Hosseini, Samadi, & Khankeh, 2015); effects on health and quality of life of mothers of children with cerebral palsy (Ahmadizadeh, Rassafiani, Khalili, & Mirmohammadkhani, 2015; Dehghan et al., 2015; Rassafiani, Kahjoogh, Hosseini, & Sahaf, 2012); and individual and group training of caregivers (Dalvand, Rassafiani, & Hosseini, 2015; Ghorbanpoor et al., 2014; Jalili, Rassafiani, Dalvand, Haghgoo, & Farzi, 2013; Johari, Rassafiani, Dalvand, Ahmadi Kahjoogh, & Daemi, 2016). Other research has been conducted in the area of occupational science, such as the concept of occupation and occupational balance (Khayatzadeh Mahani, Hassani Mehraban, Kamali, & Parvizy, 2015; Yazdani, Harb, Rassafiani, Nobakht, & Yazdani, 2017; Yazdani, Roberts, Yazdani, & Rassafiani, 2016); the use of occupational therapy in practice by Iranian therapists (Khazaeli, Rassafiani, & Sourtiji, 2012); and adaptation of Western models and frameworks to the Iranian context (Derakhshanrad et al., 2016; Gharebaghy, Rassafiani, & Cameron, 2015; Ghorbani et al., 2017; Kahjoogh et al., 2017). Although a greater number of quality studies have been performed in recent decades, many gaps need to be addressed.

The Future: Expanding the Perspective of Occupational Therapy

Occupational therapy in Iran has developed in recent decades. However, some issues still need to be addressed. These include: (a) the shortage of occupational therapists in most small cities and rural areas; and (b) the need for up-to-date knowledge among occupational therapists concerning rapid advances in technology.

To address these issues, occupational therapists must establish new programs to train more occupational therapists. More well-trained researchers also are needed to promote new technology and evidence-based therapeutic interventions. Current practice models and assessment tools acquired from Western countries must be adapted to Iranian culture and context. As mentioned earlier, Iranians live in extended families. Within these families, members respect and support each other during various circumstances and health challenges. These supports and relationships help clients to adapt and may increase quality of life. However, no studies have addressed the positive and negative influences of this group-oriented culture on the choice of occupation and the well-being of people with disabilities. Moreover, to promote the depth and breadth of our research, experienced researchers who conduct studies specific to Iranian culture and contexts are needed.

In addition, the professional body, IROTA, must further develop the quality and scope of occupational therapy. Expansion of state associations in all states is the first priority to help organize occupational therapists to pursue their professional needs according to specific practice areas. Currently, IROTA has a scientific committee to evaluate and plan policies to develop education and ongoing training in occupational therapy. However, this body should be extended to small committees that focus on specific areas, such as advancing technology and investigating new methods of education and new interventions. The establishment of working groups to develop guidelines, publications, and policies for each specific area is necessary if IROTA is to improve occupational therapy in Iran.

Conclusion

The pioneers of occupational therapy in Iran have worked extensively to provide training and expansion of occupational therapy services for various groups of people with disabilities in diverse settings. These efforts must be continued. Key areas to address include the promotion of further qualitative and quantitative research supporting occupational sciences, expansion of occupational therapy into emerging areas such as people with diabetes, development of research and modernization of services in current areas of practice, and integration of technology within education and services. All Iranian occupational therapists can play a role in research, training, and raising awareness as they support each other to develop occupational therapy across the country.

References

  • Ahmadizadeh, Z., Rassafiani, M., Khalili, M. A. & Mirmohammadkhani, M. (2015). Factors associated with quality of life in mothers of children with cerebral palsy in Iran. Hong Kong Journal of Occupational Therapy, 25, 15–22. doi:10.1016/j.hkjot.2015.02.002 [CrossRef]
  • Bryden, P. & McColl, M. A. (2003). The concept of occupation, 1900–1974. In McColl, M. A., Law, M., Stewart, D., Doubt, L., Pollock, N. & Krupa, T. (Eds.), Theoretical basis of occupational therapy (Vol. 2, pp. 27–39). Thorofare, NJ: SLACK Incorporated.
  • Curtis, G. E. & Hooglund, E. J.Library of Congress. Federal Research Division. (2008). Iran: A country study [PDF version]. Retrieved from https://www.loc.gov/item/2008011784
  • Dalvand, H., Hosseini, S. A., Rassafiani, M., Samadi, S. A., Khankeh, H. R. & Kelly, G. (2015). Co-occupations: The caregiving challenges of mothers of children with cerebral palsy. British Journal of Occupational Therapy, 78(7), 450–459. doi:10.1177/0308022614562793 [CrossRef]
  • Dalvand, H., Rassafiani, M. & Hosseini, S. A. (2015). Especial care: The missing link of handling in the children with cerebral palsy: A letter to the editor. Journal of Research in Rehabilitation Sciences, 10(8), 1004–1008.
  • Dalvand, H., Rassafiani, M., Hosseini, S. A., Samadi, S. A. & Khankeh, H. R. (2015). Concept analysis of occupational therapy handling in children with cerebral palsy: A hybrid model. Rehabilitation, 16(2), 110–119.
  • Dehghan, L., Dalvandi, A., Rassafiani, M., Hosseini, S. A., Dalvand, H. & Baptiste, S. (2015). Social participation experiences of mothers of children with cerebral palsy in an Iranian context. Australian Occupational Therapy Journal, 62(6), 410–419. doi:10.1111/1440-1630.12215 [CrossRef]
  • Derakhshanrad, S. A., Piven, E., Hosseini, S. A., Shahboulaghi, F. M., Nazeran, H. & Rassafiani, M. (2016). Exploring the nature of the intention, meaning and perception process of the neuro-occupation model to understand adaptation to change. Occupational Therapy International, 23(1), 29–38. doi:10.1002/oti.1402 [CrossRef]
  • Ghahari, S., Leigh Packer, T. & Passmore, A. E. (2010). Effectiveness of an online fatigue self-management programme for people with chronic neurological conditions: A randomized controlled trial. Clinical Rehabilitation, 24(8), 727–744. doi:10.1177/0269215509360648 [CrossRef]
  • Ghahari, S., Packer, T. L. & Passmore, A. E. (2009). Development, standardisation and pilot testing of an online fatigue self-management program. Disability and Rehabilitation, 31(21), 1762–1772. doi:10.1080/09638280902751956 [CrossRef]
  • Gharebaghy, S., Rassafiani, M. & Cameron, D. (2015). Effect of cognitive intervention on children with ADHD. Physical & Occupational Therapy in Pediatrics, 35(1), 13–23. doi:10.3109/01942638.2014.957428 [CrossRef]
  • Ghorbani, N., Rassafiani, M., Izadi-Najafabadi, S., Yazdani, F., Akbarfahimi, N., Havaei, N. & Gharebaghy, S. (2017). Effectiveness of cognitive orientation to (daily) occupational performance (CO-OP) on children with cerebral palsy: A mixed design. Research in Developmental Disabilities, 71, 24–34. doi:10.1016/j.ridd.2017.09.007 [CrossRef]
  • Ghorbanpoor, Z., Hosseini, S. A., Vameghi, R., Rassafiani, M., Dalvand, H. & Rezasoltani, P. (2014). The effect of “handling training” for caregivers at home and home adaptation on gross motor function of 15–72 months old cerebral palsy children. Journal of Modern Rehabilitation, 8(1), 35–42.
  • Greenblatt, M. (2003). Iran: Enchantment of the world. New York, NY: Children's Press.
  • Hassan-Zadeh, R., Lajevardi, L., Esfahani, A. R. & Kamali, M. (2009). Improvement of hand sensibility after selective temporary anaesthesia in combination with sensory re-education. NeuroRehabilitation, 24(4), 383–386. doi:10.3233/NRE-2009-0493 [CrossRef]
  • Iranian Occupational Therapy Association. (2017). Occupational therapy. Retrieved from http://www.irota.ir/fa/index.php/ot/about-ot/ot-field
  • Islamic Parliament Research Center of Iran. (2004). Comprehensive protection of the rights of people with disabilities. Retrieved from http://rc.majlis.ir/fa/law/show/94044
  • Jalili, N., Rassafiani, M., Dalvand, H., Haghgoo, H. A. & Farzi, M. (2013). The effectiveness of handling training on stress and quality of life among mothers of children with cerebral palsy aged 4–12 years old. Journal of Research in Rehabilitation Sciences, 9(1), 48–58.
  • Jaramillo, L. A., Gamborg, G., Rassafiani, M., Mlambo, T. & Sriphetcharawut, S. (2016). OT around the world. OT Practice Magazine, 21(1), 8–12.
  • Johari, S., Rassafiani, M., Dalvand, H., Ahmadi Kahjoogh, M. & Daemi, M. (2016). Effects of maternal handling training at home, on development of fine motor skills in children with cerebral palsy: A randomized clinical trial. Journal of Occupational Therapy, Schools, & Early Intervention, 9(4), 321–331. doi:10.1080/19411243.2016.1220342 [CrossRef]
  • Kahjoogh, M. A., Kessler, D., Rassafiani, M., Hosseini, S. A., Khankeh, H. & Akbarfahimi, N. (2017). Occupational performance coaching for mothers of children with cerebral palsy: A case report. International Journal of Therapy and Rehabilitation, 24(5), 218–222. doi:10.12968/ijtr.2017.24.5.218 [CrossRef]
  • Khayatzadeh Mahani, M., Hassani Mehraban, A., Kamali, M. & Parvizy, S. (2015). Facilitators of implementing occupation based practice among Iranian occupational therapists: A qualitative study. Medical Journal of the Islamic Republic of Iran, 29, 307.
  • Khazaeli, K., Rassafiani, M. & Sourtiji, H. (2012). A study on employing occupation during intervention by occupational therapists in Isfahan and Tehran Iran. Research in Rehabilitation Sciences, 8(1), 132–144.
  • Lajevardi, L., Rassafiani, M., Shafaroodi, N., Hassani Mehraban, A. & Ahmadi, M. (2011). Quality of methodological design and level of research articles published by occupational therapists in Iranian scientific journals. World Federation of Occupational Therapists Bulletin, 64(1), 39–42. doi:10.1179/otb.2011.64.1.009 [CrossRef]
  • Mohammadi, A., Mehraban, A. H. & Damavandi, S. A. (2017). Effect of play-based occupational therapy on symptoms of hospitalized children with cancer: A single-subject study. Asia-Pacific Journal of Oncology Nursing, 4(2), 168–172. doi:10.4103/apjon.apjon_13_17 [CrossRef]
  • Nobakht, Z. & Rassafiani, M. (2016). Review of caring training for caregivers of children with cerebral palsy. Scientific Journal of Rehabilitation Medicine, 5(3), 175–183.
  • Punwar, A. J. (2000). The development of occupational therapy. In Punwar, A. J. & Peloquin, S. M. (Eds.), Occupational therapy: Principles and practice (Vol. 3, pp. 21–37). London, England: Lippincott Williams & Wilkins.
  • Rassafiani, M. (2009). Is length of experience an appropriate criterion to identify level of expertise?Scandinavian Journal of Occupational Therapy, 16(4), 247–256. doi:10.3109/11038120902795441 [CrossRef]
  • Rassafiani, M., Copley, J., Kuipers, K. & Sahaf, R. (2008). Are explanatory randomized controlled trials feasible in rehabilitation?International Journal of Therapy and Rehabilitation, 15(11), 478–479. doi:10.12968/ijtr.2008.15.11.31542 [CrossRef]
  • Rassafiani, M., Kahjoogh, M. A., Hosseini, A. & Sahaf, R. (2012). Time use in mothers of children with cerebral palsy: A comparison study. Hong Kong Journal of Occupational Therapy, 22(2), 70–74. doi:10.1016/j.hkjot.2012.11.001 [CrossRef]
  • Rassafiani, M. & Sahaf, R. (2010). Single case experimental design: An overview. International Journal of Therapy & Rehabilitation, 17(6), 285–289. doi:10.12968/ijtr.2010.17.6.48151 [CrossRef]
  • Rassafiani, M., Zeinali, R., Sahaf, R. & Malekpour, M. (2013). Occupational therapy in Iran: Historical review. Iranian Rehabilitation Journal, 11, 81–84.
  • Rassafiani, M., Ziviani, J. & Rodger, S. (2008). Perceived level of disability: Factors influencing therapists' judgment for clients with cerebral palsy. Hong Kong Journal of Occupational Therapy, 18(1), 12–19. doi:10.1016/S1569-1861(08)70008-1 [CrossRef]
  • Razavi Afzal, Z., Rassafiani, M., Sarfraz, Z., Malekpour, M. & Salehi, M. (2013). A survey on caregivers' knowledge about special caring for 1- to 5-year-old children with cerebral palsy and their compliance with these practices. Journal of Research in Rehabilitation Sciences, 9(4), 618–628.
  • Rezaei, M., Malekpour, M. & Rassafiani, M. (2014). Assessment of knowledge of Iranian occupational therapists of handling of children with cerebral palsy. Occupational Therapy International, 21(2), 63–70. doi:10.1002/oti.1362 [CrossRef]
  • Richter, J. (2005). Iran: The culture. Toronto, Ontario, Canada: Crabtree.
  • Scientific Information Databases. (2017). Rehabilitation Journal. Retrieved from http://en.journals.sid.ir/AdvanceJournal.aspx?str=rehabilitation
  • United Nations Educational, Scientific, and Cultural Organization. (2017). World Heritage list: Iran (Islamic Republic of). Retrieved from http://whc.unesco.org/en/statesparties/ir
  • World Federation of Occupational Therapists. (2017a). Country and organisation profiles. Retrieved from http://www.wfot.org/Membership/CountryandOrganisationProfiles.aspx
  • World Federation of Occupational Therapists. (2017b). Entry-level educational programmes WFOT approved. Retrieved from http://www.wfot.org/Education/EntrylevelEducationalProgrammesWFOTApproved.aspx
  • Yazdani, F., Harb, A., Rassafiani, M., Nobakht, L. & Yazdani, N. (2017). Occupational therapists' perception of the concept of occupational balance. Scandinavian Journal of Occupational Therapy. doi:10.1080/11038128.2017.1325934 [CrossRef]
  • Yazdani, F., Roberts, D., Yazdani, N. & Rassafiani, M. (2016). Occupational balance: A study of the sociocultural perspective of Iranian occupational therapists. Canadian Journal of Occupational Therapy, 83(1), 53–62. doi:10.1177/0008417415577973 [CrossRef]
Authors

Dr. Rassafiani is Associate Professor, Occupational Therapy Department, Faculty of Allied Health, Kuwait University, Sulaibikhat, Kuwait; Dr. Sahaf is Associate Professor, Iranian Research Center on Aging, the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; and Dr. Yazdani is Senior Lecturer, Occupational Therapy Program, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom. Dr. Rassafiani is also Associate Professor, Pediatric Neurorehabilitation Research Center, the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

The authors have no relevant financial relationships to disclose.

The authors thank Professor Emily Piven for her helpful feedback on the manuscript.

Address correspondence to Mehdi Rassafiani, PhD, Associate Professor, Occupational Therapy Department, Faculty of Allied Health, Kuwait University, P.O. Box 31470, Sulaibikhat 90805, Kuwait; email: mrassafiani@yahoo.com.

Received: June 02, 2017
Accepted: November 27, 2017

10.3928/24761222-20180212-04

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