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Occupational Therapy Across Borders: What Austria and the US Can Learn from Each Other
After graduating as an Austrian occupational therapist in 2025, I moved to the United States (US) to learn from local therapists. I quickly discovered that occupational therapy is practised differently across borders, yet remains fundamentally the same. On my bilingual (German/English) occupational therapy blog - Ergotherapie über Grenzen hinweg / Occupational Therapy Across Borders - I share insights on global evidence, systemic and clinical differences and daily clinical implementation. My motivation is to connect the occupational therapy world so that we can all learn from one another.
In today's article, I compare occupational therapy in Austria vs. the US, from education to work in neurorehabilitation and paediatrics.
Figure 1) Bridging Hands-On Intervention and Evidence-Based Practice
Occupational Therapy Education and Practice in Austria vs. the US
According to Ergotherapie Austria (n.d.), the national professional association, completing an Austrian bachelor's degree in occupational therapy takes three years. By comparison, becoming an occupational therapist in the US typically requires six to seven years of higher education: a bachelor's degree, which takes four to five years, followed by a two-year full-time master's degree (American Occupational Therapy Association, n.d.; DeAngelis et al., 2023).
Exploring the reasons behind these differences would require a comparison of occupational therapy curricula in both countries, which would go beyond the scope of this clinical article and could be addressed in a future publication.
In the US, occupational therapy graduates must pass a standardised examination administered by the National Board for Certification in Occupational Therapy (NBCOT) after completing an accredited master's or doctoral degree (National Board for Certification in Occupational Therapy, n.d.). In addition, occupational therapists must meet the licensing requirements of the state in which they intend to practice (Lyon, 2025).
In contrast, graduates in Austria must be registered in the Austrian Health Professions Register before they can work as occupational therapists (Ergotherapie Austria, n.d.).
Another difference is that, unlike in the US, Austria does not have a separate occupational therapy assistant (OTA) profession, meaning therapy is practised exclusively by qualified occupational therapists.
According to records from Gesundheit Österreich GmbH, Abteilung Gesundheitsberufe und Langzeitpflege (2026), for Austria and the University of St. Augustine for Health Sciences (2024) for the US, occupational therapists in both countries generally work in hospitals, nursing homes, rehabilitation centres, home environments and schools. However, the professional landscape could not be more different in the two countries.
Real-life experience: During my occupational therapy studies in Austria, we already learned about the American Occupational Therapy Association (AOTA) and I also used its research when writing my bachelor's thesis. However, when I attended an AOTA conference in the US, I found that many participants had never heard of occupational therapy in Austria. I hope we can change that together.
Now that we know how different occupational therapy education is in Austria and the US, let's see if the work of occupational therapists in the two countries is also different across practice settings.
Figure 2) Occupational Therapy Associations in the US and Austria
Occupational Therapy in Neurorehabilitation for People with Spinal Cord Injuries – Austria vs. the US
During my neurology internship at the AUVA Rehabilitation Center Häring in Tyrol, Austria (2025) and my clinical observation at the renowned Burke Rehabilitation Hospital in the US (2026), I had the privilege of working as an occupational therapist and observing colleagues supporting individuals with spinal cord injuries (SCI).
Real-life experience: At Burke Rehabilitation Hospital, it was remarkable to see how multifaceted the comorbidities were in this patient population. Patients presenting with stroke often had histories of multiple prior cerebrovascular accidents, diabetes mellitus, osteoarthritis, meniscus tears, obesity and other chronic conditions. These factors significantly complicated clinical pathways and extended the rehabilitation process. This observation made me wonder: Does this high burden of comorbidities also apply to patients with SCI and how does it affect their rehabilitation?
Research suggests that patients with SCI also present with multiple comorbidities, which can significantly impact their rehabilitation. This is reflected in current research, such as the international scoping review by Snell et al. (2025) and the Italian study by Lena et al. (2024). Lena et al. (2024) found that 44.3% of the 1,080 patients with SCI examined had multiple comorbidities during their hospitalisation. Snell et al. (2025) confirmed these findings, noting that the majority of the studies analysed indicated significantly poorer outcomes for individuals with comorbidities, particularly regarding motor and cognitive assessment scores.
In addition to comorbidities, I observed a significant international difference in length of stay (LOS). According to AUVA Rehabilitation Center Häring in Tyrol, Austria, patients with SCI remain in inpatient care for approximately six months, depending on the severity of their injuries, reflecting the clinical standard of 150 to 200 days (Konrad, 2013). In contrast, my experience at Burke Rehabilitation Hospital showed that, in the US, the LOS is often limited to a few weeks or a maximum of one to two months. This inspired me to take a closer look at international variations in LOS and their impact on functional recovery.
Two studies from the US (Deutsch et al., 2025; Barnett et al., 2022) examined LOS in different age groups: Deutsch et al. (2025) focused on older adults, while Barnett et al. (2022) examined adolescents with SCI. The average LOS was 12 to 14 days for older adults and 37.7 days for adolescents with SCI. In contrast, a study from Italy showed that adults with SCI stayed for 98 to 143 days (Lena et al., 2024). In both systems, patients were discharged either home or to outpatient rehabilitation. Interestingly, Deutsch et al. (2025) found improvements in self-care, mobility and communication, while Lena et al. (2024) reported a very similar degree of progress despite the much longer stay.
At the same time, Lena et al. (2024) observed a positive correlation between a longer LOS and higher rates of discharge directly to the patient's home. This is partly attributed to the Italian healthcare system, which does not impose strict funding restrictions on the duration of inpatient rehabilitation.
Figure 3) International Interventions in Neurorehabilitation for Spinal Cord Injury
Occupational Therapy in Paediatrics – Austria vs. the US
One month after arriving in the US, I attended the AOTA Children & Youth Specialty Conference. As I currently live and work in the US with a child with special needs, the focus was particularly relevant to my daily experience.
Real-life experience: Throughout the conference, school-based occupational therapy (SBOT) was a central topic, clearly highlighting the structural differences between practice in Austria and the US. In Austria, occupational therapists working with children and adolescents are mainly employed in inpatient or outpatient settings, rehabilitation facilities, or private practices. Conversely, in the US, occupational therapy for kids and adolescents is much more commonly provided directly within schools.
These differences exist partly because, in the US, the Individuals with Disabilities Education Act (IDEA) provides a legal framework that ensures eligible children with disabilities have access to a free appropriate public education. It also governs the provision of early intervention, special education and related services (U.S. Department of Education, 2026).
Such services can include occupational therapy when it is required to support a child's educational needs. As a result, SBOT can be integrated into the educational system and support children's participation in their school environment.
According to Ulbrich-Ford & Morgenthaler (2023), SBOT has not yet been formally integrated into the Austrian education system. However, SBOT is an emerging field in Austria and a working group within the Austrian professional association has presented a position paper on this topic. This may create opportunities for closer collaboration between occupational therapists, educators and parents in the future.
Figure 4) Differences in International Paediatric Occupational Therapy Settings
Take-Home Messages
International comparisons demonstrate that there is no single 'correct' pathway; both short- and long-term rehabilitation models can have positive outcomes. Furthermore, both the legally established model of SBOT in the US and the more clinic-based models in Austria have their justification. We are also bound by the healthcare, educational, legal and political frameworks of our respective countries. However, we can actively shape our therapeutic attitudes and communication.
1. Holistic View of Comorbidities: We must perceive patients in their entirety. This requires understanding the interactions between pre-existing conditions and integrating these factors into occupational therapy to provide optimal support.
2. Care Transition: Especially with shorter stays, discharge planning is essential. We must ensure a smooth transition to outpatient care through targeted recommendations and the implementation of bridge-to-home exercise programmes.
3. Participation as a Shared Goal: Regardless of whether we work in a private practice or directly in a school, the overarching goal remains the child's participation in everyday life. Looking at international models such as IDEA can encourage us to focus even more strongly on supporting children in their natural learning environments.
International exchange does not end here. If you are interested in exploring further topics - including animal-assisted interventions in child and adolescent psychiatry, occupational therapy in dementia care and the international social media presence of occupational therapists - feel free to connect with me on LinkedIn or visit my blog. Let's keep learning from one another!
References
American Occupational Therapy Association. (n.d.). Program admissions and formats. https://www.aota.org/career/become-an-ot-ota/start-your-career-journey/program-admissions-and-formats
Barnett, H. M., Patel, H. R., Fuentes, M. M., & Bunnell, A. E. (2022). Trends and disparities in inpatient rehabilitation of adolescents: The effect of demographics, injury characteristics, and facility type. Topics in Spinal Cord Injury Rehabilitation, 28(1), 13–20. https://doi.org/10.46292/sci21-00033
DeAngelis, T., Marazita, I., Mahoney, W., Johnson, A., Alexander, C. Z., Keehn, A. N., Kemp, E., Levandowski, S., McLaughlin-Gray, J., Piernik-Yoder, B., Qualls, K., Richardson, K., Wilson-Alston, A., Yue, J., & Harvison, N. (2023). A descriptive review of occupational therapy education. The American Journal of Occupational Therapy, 77(Suppl. 3), Article 7713410100. https://doi.org/10.5014/ajot.2023.77S3006
Deutsch, A., Burns, J., Potelle, J., & Kessler, A. (2025). Trends in the characteristics and outcomes of older patients with non-traumatic spinal cord injury treated in inpatient rehabilitation facilities: 2013–2018. The Journal of Spinal Cord Medicine, 48(5), 802–812. https://doi.org/10.1080/10790268.2024.2335414
Ergotherapie Austria. (n.d.). Ausbildung und Berufsberechtigung. https://www.ergotherapie.at/ausbildung-und-berufsberechtigung
Gesundheit Österreich GmbH, Abteilung Gesundheitsberufe und Langzeitpflege. (2026, March 3). Ergotherapeutin/Ergotherapeut: Aufgaben und Arbeitsbereiche. https://www.gesundheit.gv.at/gesundheitsleistungen/berufe/gesundheitsberufe-a-z/medizinisch-therapeutisch-diagnostische-gesundheitsberufe/ergotherapeut.html#aufgaben-und-arbeitsbereiche
Konrad, T. (2013, March 7). Dauer und Phasen der Rehabilitation bei Querschnittlähmung: Dauer der Rehabilitation. DER-QUERSCHNITT.DE. https://www.der-querschnitt.de/dauer-und-phasen-der-rehabilitation-2248
Lena, E., Timelli, L., Di Fonzo, S., Tonini, A., Pisani, V., Garcovich, C., Covella, E., Tamburella, F., & Scivoletto, G. (2024). Unveiling the mosaic: Comparing demographics and outcomes in traumatic vs. non-traumatic spinal cord injuries. European Journal of Physical and Rehabilitation Medicine, 60(6), 980–988. https://doi.org/10.23736/S1973-9087.24.08554-X
Lyon, S. (2025, October 6). How to become an occupational therapist (2026). OT Potential. https://otpotential.com/blog/become-an-occupational-therapist
National Board for Certification in Occupational Therapy. (n.d.). Who we are & what we do. https://www.nbcot.org/about
Snell, D. L., Wynands, P., Dunn, J., Nunnerley, J., & Theadom, A. (2025). Screening and outcomes of co-occurring traumatic brain injury among people with spinal cord injury: A scoping review. Journal of Rehabilitation Medicine, 57, 1–14. https://doi.org/10.2340/jrm.v57.41897
Ulbrich-Ford, S., & Morgenthaler, T. (2023). Positionspapier zur schul- und kindergartenbasierten Ergotherapie: Ergotherapie Austria – Bundesverband der Ergotherapeutinnen und Ergotherapeuten Österreich. Pädiatrie & Pädologie, 58(Suppl. 1), 41–43. https://doi.org/10.1007/s00608-023-01070-8
University of St. Augustine for Health Sciences. (2024, April 29). Eight places an occupational therapist can work. https://www.usa.edu/blog/places-an-occupational-therapist-can-work/
U.S. Department of Education. (2026, June 11). Individuals with disabilities education act (IDEA): Guidance, resources, and technical assistance related to IDEA. https://www.ed.gov/laws-and-policy/individuals-disabilities/individuals-disabilities-education-act-idea
Declaration of AI Use and Author Attribution
Author
Anna Francesca Seniov - BSc Occupational Therapist (Austria), Creator of Occupational Therapy Across Borders.
Visuals
All graphics and photographs were created and provided by the author.
AI Disclosure
This article was written by the author in English and incorporates adapted content from the author's previously published bilingual blog articles. Generative AI tools were used to support the translation and linguistic adaptation of the original German-language blog content into English. The author reviewed and revised the adapted material and takes responsibility for the final article, including its professional perspectives, interpretation of the literature and factual accuracy.
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