Reimagining the domain of work in occupational therapy education: From vocational rehabilitation to work-related practice in South Africa

Occupational therapy’s engagement with work has historically been shaped by biomedical and vocational rehabilitation paradigms, emphasising functional restoration and return-to-work within formal employment systems. In South Africa, this orientation is increasingly misaligned with socio-economic realities characterised by persistent unemployment, labour precarity, and structural inequality. This commentary critically examines the limitations of a narrowly individualised, medicalised approach to work and argues for a reconceptualisation of work participation as a socially embedded, justice-oriented phenomenon. Drawing on literature related to social determinants of health, occupational justice, and decolonising practice, the paper foregrounds the need to shift from “vocational rehabilitation” toward a broader model of “work-related practice.” This expanded framework recognises diverse forms of livelihood, engages with both formal and informal economies, and situates occupational therapy within interconnected social, economic, and policy contexts. Three curriculum shifts are proposed to operationalise this reconceptualisation: 1) expanding target populations across the lifespan, 2) broadening intervention goals toward livelihood development and systems-level engagement, and 3) integrating role-emerging practice placements. Reframing the domain of work in occupational therapy education in this way enables the profession to move beyond restoring workers toward enabling equitable, sustainable participation in work, aligned with contemporary South African realities and commitments to occupational justice.