2. Instruments
Long-term care depends on measures that are valid in the local context. Simorgh et al. adapted the Adult Sensory Profile and reported acceptable internal consistency (α = 0.72 - 0.76) and test–retest reliability, with an intraclass correlation coefficient (ICC) of 0.765, in 166 healthy university students (3). Fathipour-Azar et al. developed a questionnaire comprising 13 activities of daily living for people with heart failure, in which each activity is rated on 8 parameters, including value, safety, independence, fatigue, and dyspnea, and reported high reliability (ICC > 0.9) (4). These are welcome first steps. However, the authors acknowledge important limitations, such as single-center samples, the absence of factor analysis (3), and the lack of an estimate of the minimal important change (4). Future psychometric work would benefit from reporting structural validity, responsiveness, and measurement error as defined in the Standards for the Selection of Health Measurement Instruments (COSMIN) taxonomy (5).
3. Context
Evidence from other settings does not always transfer directly. Khazaeli et al. adapted international autism guidelines using a national adaptation model. A 13-member panel rated 40 clinical scenarios on accessibility, cost, acceptability, and feasibility, and 8 recommendations were endorsed (6). Ahmadizadeh et al. interviewed 13 people with heart failure about an occupational performance coaching program and identified facilitators, including intrinsic motivation, self-management, therapist presence, and remote delivery, as well as barriers, including limited time, physical limitations, and economic and environmental constraints (7). Remote delivery emerged as both an opportunity and a limitation.
4. Interventions
The intervention studies share an emphasis on occupation and participation. The selected publications represent different stages and forms of research. Guideline adaptation and instrument development contribute to contextual relevance and measurement capacity, whereas the scoping review synthesizes existing evidence. In contrast, the registered trial protocol describes planned research and does not yet provide evidence of intervention effectiveness. These contributions should be interpreted according to their distinct purposes and evidential status.
In a pilot randomized trial of 31 adults with severe mental illness in Tehran, the Clubhouse group showed statistically significant within-group improvements in performance and satisfaction on the Canadian Occupational Performance Measure, whereas statistically significant within-group improvements were not reported for the comparison group. However, these findings alone do not establish a statistically significant between-group difference or confirm intervention efficacy. The small sample and short follow-up further limit the conclusions that can be drawn (8).
A scoping review of 21 studies examining video modeling for self-care in children with neurodevelopmental disorders reported favorable findings in 20 studies. However, the predominance of single-subject designs and the inclusion of only 3 randomized trials limit the strength of conclusions regarding comparative effectiveness, generalizability, and certainty of evidence. The frequency of favorable findings should therefore not be interpreted as definitive evidence of robust intervention efficacy (9). A registered protocol will test whether adding motivational strategies based on the Model of Human Occupation to bimanual activity training improves participation and upper extremity function in Parkinson’s disease (10). The results will be of interest.
5. Gaps and Priorities
Across the seven selected publications, several recurring limitations are apparent, including small samples or predominantly single-center recruitment, limited follow-up, and incomplete reporting of measurement properties or trial details. These observations should be interpreted in the context of this focused selection and should not be taken as a comprehensive assessment of Iranian occupational therapy research. However, within this limited evidence base, 3 priorities merit consideration: a) COSMIN-informed psychometric reporting, including structural validity and responsiveness (5); b) multicenter trials with longer follow-up and participation-level outcomes; and c) implementation studies, including telehealth delivery and cost, based on locally adapted guidelines (6, 7).
The studies summarized here show a promising shift toward culturally adapted, participation-focused occupational therapy for people with long-term conditions in Iran. Addressing these gaps would help translate these local findings into evidence that can guide chronic care practice and policy. I thank the authors for their contributions to the field.
