Transforming Occupational Therapy for the 21st Century PAIRE: Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity.
Catherine R Hoyt, Maribeth Clifton, Cristina Reyes Smith and 2 others
PMID 37837307WHAT IT FOUND
Current occupational therapy models rarely address how provider bias and systemic barriers limit patient participation.
The authors propose a new framework requiring therapists to actively reflect on their own privilege and adapt care to the patient's cultural context, rather than just treating the impairment.
Key findings
01Existing occupational therapy models do not adequately center the provider's role in determining health outcomes or addressing systemic inequities.
02The proposed PAIRE model identifies three core drivers of occupational equity: the provider/team, the person/people, and the occupation-in-context, all influenced by access, justice, and societal context.
03Experts consulted for this model noted that current frameworks favor North American approaches and often lack explicit connections to clinical interventions for justice and inclusion.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study is a theoretical model development, not an efficacy trial. There is no evidence yet that using the PAIRE model improves patient outcomes. The expert panel was small (n=8) and demographically homogeneous (mostly White, able-bodied, Christian, and heterosexual), which may limit the perspective on equity issues. The model was developed within a US context using Northern terminology, which may not translate directly to other cultural or healthcare systems. The scoping review indicated a lack of empirical research connecting these concepts to practice, meaning the proposed model is currently based on expert opinion and literature gaps rather than tested interventions.
Declared interests
The authors report no competing interests to declare. The study was approved by the Institutional Review Board at Washington University School of Medicine.
The easy way to misread this
Do not treat the PAIRE model as an evidence-based intervention that has been proven to improve patient outcomes. It is a proposed framework for reflection and practice design, developed from expert opinion and a literature review, with no data yet on its effectiveness in clinical settings.