Return to Work for People with Long Term Disability through Occupational Therapy Services in Riyadh, Saudi Arabia: Mixed Methods

This research proposal aims to explore the effectiveness of occupational therapy on functional disability in Riyadh, Saudi Arabia. The study will employ a mixed method approach to investigate the existing services for people suffering from long-term incapacity to return to their work in Saudi Arabia.

Running head: RESEARCH PROPOSAL
Return to work for people with long term disability through occupational therapy services in
Riyadh, Saudi Arabia: mixed methods
Name of the Student
Name of the University
Author Note

1RESEARCH PROPOSAL
Introduction- Occupational therapy refers to the discipline of science that provides
assistance to people across their lifespan, with the intention of supporting them to accomplish
the things they want to. Occupational therapy (OT) practitioners are entitled with the role of
enabling people belonging to different ages to live a purposeful and meaningful life, by
facilitating them enhance their health, and prevent the deterioration of health status due to
any illness, injury, or disability (Schell et al. 2013). Occupational therapy consultants have
been found to hold a holistic perspective that places due focus on bringing about an
adaptation in the environment and therapy, in order to meet the requirements of the person.
Some of the most common OT based interventions encompass facilitating children affected
with certain disabilities to completely participate in social and school related activities
(American Occupational Therapy Association 2015). OT also provides help to adults for
injury rehabilitation, besides supporting older adults who commonly report experiences of
cognitive and major physical changes. The assignment focuses on a research proposal that
aims to explore the effectiveness of occupational therapy on functional disability.
Research question- The research question for the proposal is as follows:
What are the provided services for people with long-term disability to return to work in
Saudi Arabia?
Research aim and objectives- The objectives of the proposal are given below:
 Explore the existing services for people suffering from long-term incapacity to return
to their work in Saudi Arabia
 Investigate the apparent context of healthcare where the occupational therapists
function
 Discover the services that are provided to disabled patients residing
 Gain a deeper understanding of awareness of OT services

2RESEARCH PROPOSAL
 Obtain an insight into the experiences of occupational therapists and their role in
facilitating return to work.
 Search the government and private employment system for people suffering with
disabilities.
Literature review- Restoring the capability to work has been identified as a crucial
element in rehabilitating adult patients who are aged above 18 years of age. The major
objective of occupational therapy in the form of a rehabilitative program is related to enabling
the participants to undertake the activities of daily living, counting their skill to work.
Cancelliere et al. (2016) elaborated on the fact that work related disability acts as a chief
financial, public, and personal health burden. While the authors identified musculoskeletal
disorders as an important factor that leads to functional disability due to pain in the neck and
lower back, stroke, cardiovascular complications, and multiple sclerosis were also recognized
as factors that contributed to functional disability. Al-Jadid (2013) elaborated on the fact that
although disability is one of the most overbearing community and economic medical
problems in the KSA, there exists lack of adequate studies that draw a comparison with
developed countries, in relation to prevalence and incidence of disability and its socio-
demographic properties. An estimated 3.73% of the Saudi Arabian population was found to
suffer from functional disabilities, thus restricting their independence. Spinal cord injuries,
cerebral palsy, stroke, road traffic accidents, inflammation and infection were identified as
the major factors that lead to functional disability among people residing in the KSA.
Parallel to this study, another article reported on the scarcity of data on the incidence and
prevalence of disability and impairment, besides their socio-demographic characteristics of
the individuals. The findings reported that occurrence of physical disability (1.7%) was
greater than mental retardation (1.4%). Further information presented in the article states that
legislation and the policies have reinforced the identical rights of people with disabilities,

3RESEARCH PROPOSAL
nonetheless unsuccessful implementation of these rulings has resulted in a gap between the
envisioned purposes and the real provision of facilities. Besides, the health services present in
Saudi Arabia are primarily controlled by the Ministry of Health. An estimated 415 hospitals
were present in Saudi Arabia in 2011, with approximate 58,696 beds (Al-Jadid 2014).
According to Attar (2014) musculoskeletal complaints were identified as an essential
occupational problem in Saudi Arabia. Upon conducting a comparative cross-sectional study
on registered nurses, the findings suggested that 85% nursing staff reported musculoskeletal
problems that most commonly affected their lower back (65.7%), shoulders (29%) and the
feet and ankles (41.5%). Thus, the research results elaborated on the fact that lengthy
working hours and underweight were features that mostly contributed to functional
disabilities among Saudi Arabian nurses.
Robert and Zamzami (2014) conducted a study where they indicated that the occurrence
and prevalence of stroke in Saudi Arabia were less, in comparison to western countries,
which in turn was accredited to the domination of the young age individuals in the region.
The researchers identified stroke as the chief reason that contributes to functional disability
among the individuals. Another study was successful in providing a brief overview in relation
to the existing policies present in Saudi Arabia that guaranteed students suffering from
disabilities the right to procure public education (Alquraini 2013). Abdur Rahman et al.
(2013) presented a communicating multimedia environment that could be effectively put to
implementation, with the aim of complementing the role therapists in rehabilitation for
disabled children in Saudi Arabia. They used Microsoft Kinect 3D dependent depth sensing
camera, in association with online Second Life virtual world for recording rehabilitation
exercises that a disabled child could perform, even without the assistance of any therapist, for
conducting daily activities.

4RESEARCH PROPOSAL
According to data obtained from a demographic survey conducted in 2016, of the
20,064,970 Saudi Arabian citizens who enrolled in the survey, 667,280 of them testified
disabilities that accounted for a prevalence rate of 3326/100,000 population (3.3%). Person
aged more than 60 years (11,014) and men (3818) reported increased prevalence rates of
functional disabilities, when compared to women (2813). Highest rates of such disabilities
were reported in the Tabuk region (4.3%) (Bindawas and Vennu 2018). Another piece of
scholarly literature that aimed to evaluate the disability future in KSE stated that the
Disability Discrimination Act 1995 (DDA) creates provisions for delivering a plethora of
rights to the disabled individuals, namely access to facilities, goods, premise, and services.
Furthermore, the statements also illustrated that the requirements of individuals suffering
from physical impairments are virtually ignored during developmental plan implementation.
If the data on disability is adequately collected and recognised, it will be easier for the
government to plan projects that are fitting for helping the disabled individuals to return to
their normal lives (Elsheikh and Alqurashi 2013).
Reports from a data analysis however suggested that the KSE described higher prevalence
of subjects who suffered from disability (severe and extreme), in contrast to other high
income countries. While the rate of extreme disability was found to be 6.44, that of severe
disability was 21.6 in Saudi Arabia. Furthermore, women were found to suffer more from
different forms of disability, in comparison to their male counterparts. The data also indicated
that 143,000 individuals in the KSE, aged above 15 years of age reportedly go out of labour,
which in turn was accredited to their disability (Cdc.gov 2014).
Methodology- The research is intended to be conducted in Riyadh, the capital of Saudi
Arabia. The primary reason for selection of this place for the research can be attributed to the
fact that little research has been conducted in the nation to draw relevant information
regarding functional disability among people residing there. Furthermore, results presented in

5RESEARCH PROPOSAL
an article also provided evidence for the fact that healthcare professionals employed in the
country demonstrate poor acquaintance with occupational therapy (49.35%, SD=7.36). The
results also suggested that maximum percentage of awareness on OT within four healthcare
professionals group was found in the sequence of physicians (51.97%), physical therapists
(50.81%, n=24), followed by nurses (48.32, n= 165). Furthermore, social workers
demonstrated lowermost percentage of awareness and understanding on importance of OT
(47.17%, n= 30) (Meny and Hayat 2017). The proposed research will be based on a multi-
method research in that it will employ a mixed method approach by implementing both
qualitative and quantitative research design in the process. This research methodology is
generally employed for conducting investigation that comprises of collection, analysis, and
integration of results from experiments, surveys (quantitative) and focus groups or interviews
(qualitative) (Creswell and Creswell 2017).
This approach will help in gaining a better understanding of the problem. The possibility
of triangulation is the major advantage of the research method, for the examination of the
similar phenomenon (Mertens 2014). Triangulation will permit the researchers to recognise
facets of a phenomenon more precisely by approaching it from dissimilar vantage ideas using
diverse methods and practises (Carter et al. 2014). Successful triangulation will also need a
careful examination of the kind of evidence provided by each technique, including its assets
and weaknesses.
Focus group and telephonic interview will form the qualitative aspects of the research. On
the other hand, electronic surveys will encompass the quantitative domains of the research.
The focus groups refer to small, demographically assorted group of folks and whose
responses are studied particularly in through open or guided discussions about a
phenomenon. The focus group will be conducted among 12 occupational therapists, which
has been recommended as the traditional size for data collection (Cleary, Horsfall and Hayter

6RESEARCH PROPOSAL
2014). They will be allowed to present their opinions and ideas on the specific questions
related to the research objectives, thus facilitating gaining a deeper awareness of the ideas of
a larger population. The major advantage of conducting focus group is that it will help
explore complex behaviour of occupational therapists and will add human dimension to
objective data (Ritchie et al. 2013). Telephone interview will be conducted among people
living in Riyadh, with long-term disability. This data collection method will facilitate
communication with the respondents via telephone, in agreement with a pre-set questionnaire
that will address the problems and concerns they face while accessing occupational therapy
services (Irvine, Drew and Sainsbury 2013). This will be conducted among at least 30
patients for generating a reliable result.
The quantitative aspect of the research will encompass electronic survey that will be
disseminated across a minimum of 40 members of the Saudi Arabian society. Respondents
will get the opportunity to put in their personal opinion as answers to online questions (Stern,
Bilgen and Dillman 2014). This will also take lesser time to complete. Use of few open ended
questions will encourage them to provide meaningful answers to their concerns related to OT
services. One of the most imperative ethical considerations in this research would be related
to presence of human subjects. To address this concern, prior approval will be taken from the
Institutional Review Board (IRB). Principles of informed consent and voluntary participation
will also be followed where all participants will be sent sealed envelopes that will explain
them the actual purpose and benefits of the research (Ritchie et al. 2013). They will be
provided the opportunity to leave the research at any point of time (refer to appendix).
Preliminary data- The first step of focus group data analysis would comprise of
transcribing the interviews verbatim that will pick up incomplete sentences, and aid further
analysis. They will be subjected to constant comparison where the data will be chunked into
smaller segments, followed by axial coding and selective coding. Thematic content analysis

7RESEARCH PROPOSAL
will be used for drawing relevant findings from the telephone interviews (Vaismoradi,
Turunen and Bondas 2013). The interview texts will be coded and reviewed for broader
themes, relevant to the research question. The electronic survey results will be analysed with
the use of the SPSS version 21.0 tool.
Limitations- Although the mixed methods study would help in providing a
comprehensive understanding of the investigation problem related to OT services in Riyadh,
the research design can be quite complex and would take longer time for implementation.
Furthermore, following a sequential exploratory design might create difficulties in building
conclusions from the qualitative analysis, to the succeeding data collection steps.
Conclusion- The primary importance of the study is that it will help in exploring the
current OT services that help functionally disabled people to return to their work. This will
act as a novel research that will contribute to the inadequate body of evidence on disability
and occupational therapy services that are present across Saudi Arabia. The mixed method
research will be adopted due to the fact that little is known about the research topic, and it is
utmost essential to learn about the important variables that govern the return to work of the
functionally disabled individuals. In other words, the mixed method research needs to
uninterruptedly explore the research question from diverse angles, and elucidate unexpected
results and/or probable contradictions.

8RESEARCH PROPOSAL
References
Abdur Rahman, M., Qamar, A.M., Ahmed, M.A., Ataur Rahman, M. and Basalamah, S.,
2013, April. Multimedia interactive therapy environment for children having physical
disabilities. In Proceedings of the 3rd ACM conference on International conference on
multimedia retrieval (pp. 313-314). ACM.
Al-Jadid, M.S., 2013. Disability in Saudi Arabia. Saudi medical journal, 34(5), pp.453-460.
Al-Jadid, M.S., 2014. Disability trends in Saudi Arabia: Prevalence and causes. American
journal of physical medicine & rehabilitation, 93(1), pp.S47-S49.
Alquraini, T., 2013. Legislative rules for students with disabilities in the United States and
Saudi Arabia: A Comparative Study. International Interdisciplinary Journal of
Education, 1(1037), pp.1-14.
American Occupational Therapy Association, 2015. Standards of practice for occupational
therapy. American Journal of Occupational Therapy, 69(6913410057).
Attar, S.M., 2014. Frequency and risk factors of musculoskeletal pain in nurses at a tertiary
centre in Jeddah, Saudi Arabia: a cross sectional study. BMC research notes, 7(1), p.61.
Bindawas, S.M. and Vennu, V., 2018. The National and Regional Prevalence Rates of
Disability, Type, of Disability and Severity in Saudi Arabia—Analysis of 2016 Demographic
Survey Data. International journal of environmental research and public health, 15(3),
p.419.
Cancelliere, C., Donovan, J., Stochkendahl, M.J., Biscardi, M., Ammendolia, C., Myburgh,
C. and Cassidy, J.D., 2016. Factors affecting return to work after injury or illness: best
evidence synthesis of systematic reviews. Chiropractic & manual therapies, 24(1), p.32.

9RESEARCH PROPOSAL
Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J. and Neville, A.J., 2014, September.
The use of triangulation in qualitative research. In Oncology nursing forum (Vol. 41, No. 5).
Cdc.gov., 2014. Saudi National Disability Registry. Available from
https://www.cdc.gov/nchs/data/washington_group/meeting14/wg14_session6_1_-
aljumah_almubarak.pdf [Accessed on 04 October 2018].
Cleary, M., Horsfall, J. and Hayter, M., 2014. Data collection and sampling in qualitative
research: does size matter?. Journal of advanced nursing, 70(3), pp.473-475.
Creswell, J.W. and Creswell, J.D., 2017. Research design: Qualitative, quantitative, and
mixed methods approaches. Sage publications.
Elsheikh, A.S. and Alqurashi, A.M., 2013. Disabled future in the Kingdom of Saudi
Arabia. Journal of Humanities and Social Science, 16, pp.68-71.
Irvine, A., Drew, P. and Sainsbury, R., 2013. ‘Am I not answering your questions
properly?’Clarification, adequacy and responsiveness in semi-structured telephone and face-
to-face interviews. Qualitative Research, 13(1), pp.87-106.
Meny, A. and Hayat, A., 2017. Knowledge About Occupational Therapy in Makkah, Saudi
Arabia. Where Do Health Care Professionals Stand? International Annals of
Medicine. 1(11). pp. 1-6.
Mertens, D.M., 2014. Research and evaluation in education and psychology: Integrating
diversity with quantitative, qualitative, and mixed methods. Sage publications.
Ritchie, J., Lewis, J., Nicholls, C.M. and Ormston, R. eds., 2013. Qualitative research
practice: A guide for social science students and researchers. Sage.
Robert, A.A. and Zamzami, M.M., 2014. Stroke in Saudi Arabia: a review of the recent
literature. The Pan African Medical Journal, 17.

10RESEARCH PROPOSAL
Schell, B.A., Gillen, G., Scaffa, M. and Cohn, E.S., 2013. Willard and Spackman's
occupational therapy. Lippincott Williams & Wilkins.
Stern, M.J., Bilgen, I. and Dillman, D.A., 2014. The state of survey methodology:
Challenges, dilemmas, and new frontiers in the era of the tailored design. Field
Methods, 26(3), pp.284-301.
Vaismoradi, M., Turunen, H. and Bondas, T., 2013. Content analysis and thematic analysis:
Implications for conducting a qualitative descriptive study. Nursing & health sciences, 15(3),
pp.398-405.

11RESEARCH PROPOSAL
Appendix
Timeline of the research proposal