Healthcare systems are increasingly accountable for delivering care that is effective, safe, and cost-efficient 1. However, despite substantial advances in research, a persistent gap remains between the generation of evidence and its uptake in clinical practice. The underutilization of research findings by healthcare professionals is a prevalent challenge across the healthcare sector 2. Understanding the barriers and facilitators that influence the adoption of evidence-based interventions is therefore critical to ensuring that innovations are implemented as intended and achieve their desired impact.

Implementation science focuses on optimizing the integration of evidence-based innovations into routine practice and examines how implementation strategies can support this process 3. A range of implementation theories, models and frameworks have been developed for this purpose, including the Knowledge to Action Model 4. These tools can systematically identify potential barriers and facilitators, thereby inform the selection and tailor of implementation strategies, guiding necessary adaptations, and clarification of outcomes. Applying an implementation model such as the 5-Step Approach of Peters 5, has shown to be successful in addressing barriers and facilitating changes in practice 6. This approach typically involves several stages: identification (analyzing knowledge gaps and selecting the novel intervention), context analysis (understanding barriers and facilitators), developing an action plan (linking and tailoring action to identified barriers and facilitators, selecting quality indicators, and initiating implementation), evaluation (assessing progress and adjusting as needed) and striving for sustainability planning (embedding in routine care) 5.

Implementing evidence-based interventions in occupational therapy (OT) is essential to support people with multiple sclerosis (PwMS) in managing symptoms such as fatigue, muscle weakness, impaired coordination, and cognitive problems. OT is a client-centered profession that promotes health and wellbeing through engagement in everyday activities. Its core aim is to enable participation in meaningful activities by enhancing individuals’ ability to manage symptoms and perform daily activities, often through targeted activity or environmental modifications 7.

Recent evidence synthesized in a Cochrane review, confirm that OT interventions can improve daily functioning and aspects of quality of life of people with MS, while also emphasizing the need for improved implementation to ensure these benefits are realized in routine care 8.

Occupational therapy practice is complex, involving diverse service users and interventions. To support the adoption of evidence-based practices within this complexity, several theoretical frameworks and models have been developed to help identify barriers and facilitators and to guide the selection of appropriate implementation strategies 91011. These frameworks provide structured approaches to designing implementation plans tailored to the specific context of OT practice.

Commonly used change interventions include educational strategies, audit and feedback, reminders, task substitution, multiprofessional collaboration, quality management initiatives, financial incentives, patient-mediated interventions, and combinations of these approaches 10. The modified Mazza framework 11 categorizes implementation actions into five groups: professional-level, patient/consumer-level, financial (for both providers and patients), organizational (for both providers and patients), and structural changes.

By systematically identifying barriers and facilitators to implementation, OT can progress toward more consistent, effective and evidence-based service delivery. Strengthening implementation efforts ultimately has the potential to improve the quality, efficiency, and outcomes of OT services, thereby enhancing the wellbeing and independence of PwMS. This mapping review synthesizes current evidence on the implementation of OT interventions for PwMS.

The objective of this study is to identify barriers, facilitators and implementation strategies relevant to occupational therapists when integrating evidence-based occupational therapy interventions for adults with multiple sclerosis in physical rehabilitation settings.

The search identified 337 unique articles (see Figure 1). Of these, 22 underwent full-text review, and 15 studies were included. (See Supplement 2)

The included studies were feasibility studies (n=5), qualitative studies (n=4), a mixed method study (n=1), a descriptive study (n=1), a systematic review (n=1), an RCT (n=1) and a secondary analysis of RCT (n=1), and a quasi-experimental study (n=1). Across these studies, a range of facilitators and barriers were identified (See Table 1) as well as implementation actions (See Supplement 2).

This mapping review highlights the inherently multi-level nature of implementing evidence-based occupational therapy (OT) interventions for people with multiple sclerosis (PwMS). Using Grol’s framework, the findings indicate that implementation is shaped by interacting determinants rather than isolated factors, underscoring the need for comprehensive, theory-informed implementation planning.

Successful implementation of evidence-based OT for MS requires multifaceted, context-sensitive strategies. Our review demonstrates that successful implementation of OT interventions for PwMS relies on strategies operating across multiple levels of Mazza’s taxonomy 11. At the professional level, structured guidance, accessible resources, and collaborative therapeutic relationships support consistent and high-quality intervention delivery. Consumer-focused strategies underscore the importance of empowering PwMS through tailored approaches that enhance self-management, motivation, and engagement 2930. Organizational strategies, though less frequently reported, highlight the value of clear role delineation and active leadership in creating an environment conducive to implementation. The absence of identified economic–political determinants likely reflects a gap in the literature, indicating an important direction for future research.

Altogether, our findings emphasize the need for multilevel, coordinated implementation efforts and point to opportunities for future work to address underexplored systemic determinants that may further strengthen the adoption and sustainability of OT interventions for this population.

Actions to adopt evidence-based interventions often occur late in the research process, after study results have been published. However, evidence shows that strong early-stage implementation planning substantially increased the likelihood of successful uptake and delivery of interventions 31. Over the past decade, several initiatives have sought to improve the reporting of interventions. For example, the use of the TIDieR (Template for Intervention Description and Replication) checklist is a valuable tool to inform both researchers and clinicians about intervention delivery 32. Although TIDieR represents an important advance, it may not completely convey the complexity of rehabilitation (including OT) interventions. In response, the Cochrane group recently developed the Guideline for Intervention Description in Rehabilitation (GUIDE-Rehab) 5, which aims to better reflect the multi-faceted nature of rehabilitation practice. These initiatives may support the evidence of adoption by occupational therapists working in MS rehabilitation. However, language barriers may hinder the use of these resources, most often written in English. Therefore, locally delivered educational initiatives led by professional organizations are needed to facilitate optimal implementation for example by developing and disseminating translated summaries or practical guides in the local language, and by offering workshops or webinars tailored to the national context. Regulatory bodies may also support this process, by establishing standards, rules, and guidelines that define how interventions should be implemented - although evidence supporting their role remains lacking.

This mapping review is characterized by several strengths, like its systematic and transparent search strategy, which was developed and executed across five major databases spanning biomedical, allied health, educational, and OT specific sources. By clearly documenting the databases and search parameters, the review aligns with recommendations from the PRISMA framework 33, thereby enhancing the reproducibility and credibility of the process. The breadth of databases also ensured that the review captured a wide range of perspectives relevant to OT and multiple sclerosis, reducing the risk of missing disciplinespecific literature.

Furthermore, the use of two wellestablished theoretical frameworks—Grol’s model of barriers and facilitators 14 and Mazza’s taxonomy of implementation strategies 11— guided the data extraction and synthesis. This dualframework approach enabled a structured, theorydriven interpretation of findings while ensuring that barriers, facilitators, and implementation strategies were mapped in a consistent and comprehensive manner. The integration of both frameworks contributed to the conceptual clarity of the review and facilitated comparison between studies operating at different levels of implementation (innovation, professional, patient, organizational, and consumer-focused strategies).

The involvement of a multidisciplinary clinical academic research team in conducting this study, including occupational therapists, a nurse, a physiotherapist, a methodologist, and rehabilitation specialists, as well as a person with lived experience of multiple sclerosis, represents another significant strength. This diversity enriched the interpretative process and ensured that the findings were examined through multiple lenses. The iterative teambased review of search strategies, inclusion decisions, extractions, and interpretations enhanced the internal validity and practical relevance of the conclusions 34. Including a person with MS further grounded the work in enduser experience, ensuring that the synthesis reflected both clinical and realworld perspectives 35.

Despite its strength, this review also has some limitations. As is typical for mapping reviews, it did not include a formal critical appraisal of methodological quality. While mapping reviews are designed to provide an overview rather than evaluate study rigor, the absence of a quality assessment limits the ability to draw conclusions about the strength or reliability of the identified evidence. This means that while the review identifies which barriers, facilitators, and strategies are reported in the literature, it cannot determine how strongly these findings are supported by highquality empirical research.

Another limitation is that data selection was conducted by a single reviewer. Although this approach is not uncommon in mapping reviews, it introduces the possibility of bias in data-extraction and reduces reliability. Dual independent data-extraction could have increased methodological robustness.

Finally, the limited depth and variability of the evidence base itself. The included studies were heterogeneous in design—ranging from feasibility studies to qualitative research and small-scale trials—but often lacked detailed reporting on contextual factors or long-term sustainability.

Implementation of evidence-based occupational therapy for MS requires context-sensitive strategies across multiple levels, supported by practical tools like manuals, coaching, patient empowerment and sufficient organizational resources. However, limited attention to structural and financial barriers may compromise sustainability. Strengthening implementation through early planning, clear intervention descriptions, and collaboration among clinicians, researchers, and policymakers is essential to improve uptake and ultimately enhance patient outcomes and quality of life.

To facilitate the implementation of new evidence:

· Tailor mapped barriers, facilitators and implementation strategies to the specific setting.

· Develop and implement an action plan based on the mapped determinants.

· Identify and evaluate relevant quality indicators.

Use this mapping review as a supportive tool for implementing new evidence into OT for MS.

The authors used ChatGPT OpenAI to improve the language of the paper.

The authors have no conflicts of interest to declare for this study.

Supplementary Material