What are Common OT Recommendations After Assessment?

Research completed by student Occupational Therapists Ashley Carnegie and Natalia Puchala, Supervisor Julie Entwistle.
Blog completed by Ashley Carnegie, Occupational Therapist

As an Evidence Based Research Project through McMaster University, Solutions for Living set out to summarize and highlight common OT recommendations after initial assessment.  The goal was to publish these findings to help student OTs, or OTs looking to enter the sector, to understand the scope, depth and breadth of the recommendations we tend to make.  Here are the highlights of our research findings, the completed study will be submitted for publication to OT journals when finalized.

Occupational Therapists play a valued role in Ontario’s auto insurance sector. In this, Occupational Therapists are hired by lawyers for assessment and treatment, or by insurers to conduct Insurance Examinations. Assessments usually start the OT service delivery process and serve to determine and outline the impact the client’s motor vehicle collision, and resulting injuries has had on all aspects of their previous life (e.g. self-care, productivity, leisure).  These assessments end with recommendations for the treatment and care that are needed to help the client recover. Occupational therapy treatment recommendations are designed to support clients in maximizing their potential to return to pre-accident function in all areas of life.

Despite the 1000+ Ontario Occupational Therapists working in this role, available literature about this sector is limited and does not adequately capture the role of occupational therapy in this setting. Therefore, in this study, a retrospective chart review was conducted of 205 occupational therapy assessments conducted with clients who had a motor vehicle collision. The aim, as indicated earlier, was to summarize OT recommendations post-assessment to help others interested in learning more about this area of practice. Recognizably, Solutions for Living by Entwistle Power Occupational Therapy was the only company involved in this chart review, and different companies may, and are likely to, have different findings.  Further, clients seen for OT assessment are already pre-screened to be eligible candidates for service, and thus assessments with “no recommendations” are unlikely.

Through the 205 charts reviewed, the results demonstrated the following:

Common Injuries

















Intervention Recommendations



















These interventions are in-line with best practices and standard treatment for the most common injuries identified in this study.

Surprisingly, only 3% of OT assessments recommended use of the OTA in treatment delivery, highlighting that most OTs tend to initiate treatment directly.  It is felt that therapists may introduce OTA later in treatment once rapport with the client has been established, but the use of OTA early for some education and device delivery may prove more cost-effective and is something OT’s should consider.

Additional Results

Attendant care: 91% of clients needed attendant care. The average dollar amount recommended for attendant care was $3565, the median was $1733, and the range was between $0 and $10,544. A trend was identified between number of injuries and attendant care recommendations; The amount of attendant care recommended increased with the number of injuries.

Assistive Devices: 91% of clients needed assistive devices. The average dollar amount for devices was $757.46, the median was $397.94, and the range was between $0 and $5670.

Occupational therapy treatment: The average number of occupational therapy treatment sessions recommended was 6; with an average duration of 12 weeks. Injury or number of injuries was not predictive of OT sessions or duration recommended.  Notably, however, recommendations are often made to conservatively encourage insurer approval and only represent the first treatment block.  Multiple blocks of treatment are common.

This retrospective chart review outlined typical injuries, common intervention recommendations, and recommendations for attendant care and assistive devices following an occupational therapy assessment. Although there is some uniformity in recommendations, the lack of consistency indicates the customization taken by OT’s in assessing for client’s unique and specific needs.  This individualized approach is necessary and encouraged as being best-practice and client-centered.  Of further note, it was evidenced that OT’s play a very important part in system navigation and help to outline and connect the client to other necessary providers.   Doctors, lawyers, insurers and other professionals should recognize that OT’s are valuable front-line providers and can be the keystone to helping clients to get the help they need.

As demonstrated, Occupational Therapists play a vital role in Ontario’s auto insurance sector and their assessments are pivotal in helping clients to get care, devices, education and treatment, along with connection to other professionals. This study is the first to showcase the OT role in Ontario’s insurance sector, and more research is needed to look more closely at OT service delivery.

Stay tuned for the entire research study with its methods, findings and recommended next steps.  We will be sure to circulate the article on our blog once published


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