Neurology and Cognitive Occupational Therapy Practice Across the Middle East and North Africa: An Exploratory...

Occupational therapy (OT) has a defined role in neurological and cognitive rehabilitation, yet empirical data describing how this role is enacted across the Middle East and North Africa (MENA) are sparse, uneven across countries, and rarely drawn from multicountry samples. In a context of rapidly rising neurological disease burden across the region, the absence of workforce-level evidence directly constrains workforce planning, continuing-education design, and evidence-based practice (EBP) implementation. This exploratory cross-sectional online survey aimed to profile occupational therapists working in neurology and cognitive rehabilitation across 13 MENA countries (using the World Bank MENA + Turkey, or "MENAT", regional grouping). Licensed occupational therapists with at least 1 year of clinical practice were recruited between November 2023 and January 2024 through professional OT associations, networks and social media platforms. The content-validated questionnaire was administered using Google Forms. Analyses were descriptive with Wilson 95% confidence intervals; χ²/Fisher exact tests and Mann-Whitney U tests examined bivariate associations; multivariable logistic regression adjusted for key covariates; reporting followed STROBE and CHERRIES. A total of 118 occupational therapists (61.0% female; 56.8% aged 20-29 years; 78.0% bachelor-level preparation; 58.5% in governmental services) from 13 MENA countries were analysed, with Kuwait (37.3%), Saudi Arabia (19.5%) and Jordan (11.9%) providing most responses. Stroke was the dominant clinical focus (92.4%). Neurodevelopmental treatment (71.2%, 95% CI 62.4-78.6), biomechanical (65.3%) and motor-control/motor-learning (63.6%) were the most commonly reported frames of reference; the Functional Independence Measure (65.3%) and Montreal Cognitive Assessment (61.9%) were the most commonly reported standardised tools. Perceived EBP challenges were reported by 72.0% of respondents. Stratified analyses revealed that postgraduate-qualified respondents reported more organisational barriers than bachelor-level colleagues (73.1% vs. 45.7%, p = 0.025), private-sector respondents reported more distinct barriers overall (Cohen d = 0.54, p = 0.005), and respondents practising outside the Gulf Cooperation Council (GCC) subregion reported substantially higher rates of confidence-related and evidence-quality barriers (all p ≤ 0.008). Conference attendance was independently associated with use of motor-learning approaches (adjusted OR 3.72, 95% CI 1.44-9.58; p = 0.007). Findings identify an evidence-practice gap in the predominance of neurodevelopmental treatment and highlight structural, subregion-linked barriers to EBP across the MENA region. Strengthening organisational support, protecting time for evidence use, expanding postgraduate neuro-OT pathways, and coordinating regional workforce research and assessment-adaptation are priorities aligned with the WHO Rehabilitation 2030 workforce agenda.