Education: Facts and figures relating to occupational therapy in Europe
In these pages Chapter 3 of the booklet Occupational Therapy Education in Europe: An exploration is presented.
3.1 Facts and figures of occupational therapy practise and education in Europe (EU and EAA)
In this chapter data given by the COTEC delegates (appendix 12) are presenting the
geographical distributions of all occupational therapy educational institutions of the EU
and EEA, the total number of practising occupational therapists per country, the number
of practising occupational therapists per 100.000 inhabitants, the number of
occupational therapists qualifying annually per country and the factor of increase of
Occupational therapists in 1999.
COTEC delegates annually up-date their national associations data, which are compiled in
the document Occupational Therapy, Summary of the profession in the European
Countries (COTEC, 2000). In order to complete this chapter this document was
considered along with data from the extra questionnaire, which was sent out in spring
1999 to all COTEC delegates. While every effort has been made to establish accuracy of
the information, it remains difficult to show the exact figures, as not all associations have
the comparable registration methods.
Occupational therapy is still rapidly developing. Since 1996 there has been an increase of
occupational therapists in Europe of 47.4 %. The total number of occupational therapists
in Europe at present is about 73.700.
As many countries have very few institutes/schools the above figure only shows the
number of institutes per country up to 60. This enables the reader to clearly distinguish
the small numbers. For Germany additional institutes (100) need to be added.
This figure shows the number of practising (full time and part time) occupational
therapists per country. To differentiate between 1000 and 1500, the numbers stop at
10.000. In reality we have to add for Germany and United Kingdom respective 12.000 and
10.482, that is about 2 times more than shown in the above figure.
It is clear that in Germany and UK the numbers of Occupational therapists are the
highest, when however the numbers are compared per 100.000 inhabitants a different
picture will appear.
This table shows that despite the fact that Germany and UK have the biggest amount of
practising occupational therapists, the Scandinavian countries with Denmark on top have
the highest number of practising occupational therapists per 100.000 inhabitants (74 per
While in most European countries occupational therapy started at the same time, after
the second world war, it is clear from the difference in numbers of practising
occupational therapists in 2000 that the profession developed in a different way in the
respective European countries. The reasons behind these differences and the rights of the
clients for this kind of service across Europe need more research.
In order to make a proper differentiation between 50 and 100 qualifying occupational
therapists, the numbers are going up to 2000. In reality in Germany 3800 occupational
therapists are qualifying yearly, while the lowest amount is in Italy (0), where still no
formal education in occupational therapy exists.
As occupational therapy is a young profession and therefor not yet many occupational
therapists retire, the amount of annually qualifying students causes an average increase
of 10-12% of the total amount of occupational therapists in Europe.
This table shows the relative increase of occupational therapists in percentages. In Spain,
Malta, and the Netherlands the increase of occupational therapists in relation to the
number of practising occupational therapists per 100.000 inhabitants is the highest, i.e.
20-22%. Indeed in the Netherlands the amount of jobs for occupational therapists are
growing rapidly due to new legislation, however in Spain this is not the case and are
occupational therapists un-employed. More research needs to be done in (un-)
employment of occupational therapists in the different countries in relation to the
number of qualifying occupational therapists.
3.2 Other facts about occupational therapy education and practise
Hereafter several elements of the occupational therapy education per country are shown
in table forms. The type of education, academic level, responsible ministry and course
duration (study load), the title of the occupational therapy diploma/degree awarded and
the number of years of previous secondary education, and the title of the profession in
the different countries are mentioned.
The table shows an enormous diversity of occupational therapy education systems, from university to non- university higher education systems and to upper secondary vocational education. For the future it will be important to strive for one level (higher education) of occupational education in Europe or at least to provide students with pathways and programmes sufficiently interrelated to permit ready movement between the systems.
In most European countries occupational therapy education is higher education (except in Germany), however only in half of the countries the diploma is officially (by law) recognised as Bachelor's degree. For the future credit systems as well as the articulation of programmes should be strengthened. The latter seems to be very important allowing fair assessment of a degree regardless of its origin from a university or a non- university institute. One of the major obstacles to recognition today is that nationally as well as internationally non-university degrees sometimes have difficulties in being recognised or getting credits if recognition is sought in
relation to a university degree.
Ten countries use the word 'ergotherapeut', six countries use the word occupational therapist, while three countries are using different terminology. Unity of terminology with respect for national and cultural differences is one of the future challenges.
The data described above give quantitative information about schools in Europe and
qualifying students annually. When the total number of qualifying occupational therapy
students (8095) is divided by the total number of schools (274), it shows an average
number of 30 students per institute qualifying annually. That suggests that in general
the institutes for occupational therapy education are relatively small. Often there is also
a limited number of occupational therapy lecturers. This has been one of the reasons
given, for occupational therapy institutes to co-operate within ENOTHE in order to share
educational resources and to increase educational quality.
Secondly the above information shows differences in the level of education, duration of
the programmes or study load and duration of fieldwork. In order to improve mutual
recognition the curriculum guidelines for occupational therapy have been developed
(ENOTHE2000,a). Occupational therapy educational institutes will be encouraged to
describe their programmes following these guidelines, so that qualifying occupational
students have fair access to master degree courses in occupational therapy.
Finally the tables show a variety in educational systems and terminology, of which it is
hoped that there will come more uniformity because of the Bologna declaration
(appendix 7) and more uniformity in occupational education terminology could be one of
the challenges for future activities within ENOTHE.
3.4 Occupational therapy in the Eastern and Central European region
In accordance with the Charter of ENOTHE one of the specific objectives is to focus on
providing assistance to occupational therapy institutes. This objective is formulated as
follows: "To provide assistance to institutes, who wish to start occupational therapy
education programmes and to advise on potential resources".
Since the Socrates/ Erasmus programme in 1998 is open to the so-called Associate
Countries, ENOTHE decided to organise an extraordinary meeting in Prague in 1999
(appendix 8) in order to share ideas about developing occupational therapy education
and practice in the Eastern and Central European region. A summary of the records of
this meeting together with the outcomes of the questionnaires filled in by the
representatives of this meeting give an impression of occupational therapy practice,
projects and education in this region.
In Belarus there are three major institutes. With money provided by UNESCO the German
Church of Westphalia set up a workshop for 120 mentally handicapped people. This
workshop has a needlework workshop and a printing- workshop.
There is a Parents' Association of parents of mentally handicapped children, which runs
support groups and publishes leaflets about its work. These leaflets are printed in the
printing workshop. This Association runs a day school for 30 children employing
therapists, teachers and doctors. Therapy is provided by Swedish occupational therapists
sponsored by the Star of Hope. The third institution is NOVIC which runs a children's
home and an adults' home. Support for this comes from England, Ireland and Germany.
There has been very little input from occupational therapists. However under the
auspices of a Tempus project a German occupational therapist has taught teachers and
parents how to use various pieces of equipment and also how to use sensory stimulation
with the children. Since the ENOTHE meeting contacts with two faculties in Minsk have
been started in order to develop occupational therapy education formally.
Occupational therapists work in the War Victims Project and in community based
rehabilitation. In 1997 physiotherapists had 6 months of practical occupational therapy,
occupational therapy theory and some fieldwork education in Canada. A second group
started in 1998. Legally occupational therapists do not exist and there is no association.
Much work needs to be done with heads of institutes and in the promotion of
This section was presented by a physiotherapist who was about to qualify as an
occupational therapist. In Croatia occupational therapy was first mentioned in 1915 in
psychiatry. After World War II occupational therapy was used with people with war
injuries. At present there is a Health School in Zagreb. Occupational therapy was set up
there in 1986 and there are two teachers. Recently a new curriculum has been approved
which has now been submitted to the National Council.
Little is known about occupational therapy in the country. Since 1986, 383 students have
commenced the programme, 186 graduated but only 45 have found appropriate posts in
Croatia. These therapists are paid a very low wage. There is an association of
Occupational Therapists but it only has 20 members. The constitution is written. There
appears to be a lack of logic in the system. Despite the lack of knowledge and
employment of occupational therapists 60 are enrolled in the programme this year.
3.4.4 Czech Republic
The history of occupational therapy in the Czech Republic is as follows. Early in the 20th
century the first occupational therapy department was set up in Barnice. After World
War II, the first occupational therapy programmes were run by occupational therapists
from the U.S.A. The process then stopped until the late 1950s.
Beginning of the 60s occupational therapy restarted with the establishment of the study
of rehabilitation assistant.
1970 - the occupational therapy profession started.
1978 - the Czech Rehabilitation Society was established.
1995 - the Czech Association of Occupational Therapy was established.
1998 - the Czech Association started the procedures to become WFOT associate member.
The working field for occupational therapists is still limited. Much occupational therapy
is carried out by physiotherapists. There are very few occupational therapists in large
hospitals. Where there are they work in the area of ADL, independence, compensatory
aids, quality of life and advice to patients. Occupational therapy in psychiatry consists of
work in hospitals, day centres, sheltered workshops with arts and crafts and aiming to
give structure to the day. There is also occupational therapy in rehabilitation centres (20
centres) which includes work with amputees, CVA, spinal cord lesions and physically
handicapped children. There is also occupational therapy with children which takes place
in special institutes.
There are three different routes of study - 4 diploma programmes at Ostrava, Teplice,
Most and Plzen. There is one graduate programme at Charles University in Prague and a
further education diploma programme run by the Ministry of Health in Brno. The
occupational therapy programme in Prague has co-operated with the Hogeschool van
Amsterdam, Glasgow Caledonian University and Lund University in a TEMPUS project.
Estonia is divided into two regions for health care. Some basic programmes have been
established at Tartu University, but a full occupational therapy programme is not yet
developed. The occupational therapy programme is planned to be based at Tartu
University. Developments in occupational therapy have taken place over the past ten
years: 1992 was the Foundation of the Council of Disabled Persons (Government
organisation). This resulted in two tiers of organisation of health. The first is run by local
government organisation in each county including: special institutes for learning
disabilities, special institutes for visually handicapped, departments of rehabilitation in
hospitals, out patient rehabilitation and specialist rehabilitation centres in mental health.
The second is non-governmental and private organisations including centres for technical
aids, production of technical aids, rehabilitation centres in private hospitals, associations
for disabled people, sanatoriums.
There are no professional occupational therapists in post as yet. The first seven
occupational therapists have been studying in Oulu in Finland (1996-1999) (most of these
students have a previous professional education e.g. medicine, social work, engineering,
teaching). These students work in nursing homes, psychiatry, mental handicap and
centres for physical disability.
Latvia gained its independence in 1991. Occupational therapy is a new profession but
there have been elements of it in speech therapy, physiotherapy etc. Occupational
therapy is needed for social reasons, because the biggest number of disabled people are
those who are of working age. Quality of life for disabled people is now important as
well. The profession is recognised and termed Ergotherapy. A professional association
was established in 1996 and is now an associate member of WFOT.
A group of Latvian physiotherapists studied occupational therapy in Sweden and in 1995
10 Latvian physiotherapist graduated as occupational therapists and 9 started work in
1996. A four-year programme was established in 1996 with an intake of 22 students.
There are now 58 students in the programme in years one to three. To be admitted
applicants must be 18 and have completed secondary education. They must also have
knowledge of what occupational therapy is. The programme is in accordance with the
minimum standards. All students must learn English. On qualification they will gain a
bachelors degree. The educational programme will soon seek WFOT recognition.
In 1991 a national health care concept was set up as a result of the law of Social
Integration of the Disabled. In 1998 the education of occupational therapists at Kaunas
University commenced. This is not an occupational therapy qualification, but a four-year
bachelor's degree with a choice of six specialities one of which is occupational therapy.
This speciality takes one-year (40 weeks) Swedish occupational therapists teach this part
of the degree. There are 3 occupational therapists in Lithuania at present. Next autumn
there will be 10. A major problem is the recruitment of teachers. Although there is no
occupational therapy association there is an Association of Rehabilitation workers and
occupational therapists will be members of this.
The Christian Association in Warsaw runs the School of Occupational Therapy and
Occupational Psychotherapy. Occupational therapy in Poland is under the supervision of
nurses and is very poorly paid. The Government does not appear interested although the
school does have legal status. The programme is based on those of other European states
and lasts for 3 years. It now gets a grant from the state. This programme has 350
graduates. The education is divided into four branches; consorting or arresting therapy
(for the very ill), resting therapy, activity therapy and psychotherapy. The school has a
link with the Karolinska occupational therapy institute in Stockholm. There is no
occupational therapy association in Poland.
The first school of occupational therapy was set up in 1947 with the help of occupational
therapists from the USA. The first department had commenced in 1945. In 1984 a
National Rehabilitation centre was established and many organisations for disabled
people were set up. In 1987 there were links established with the Charles University in
Prague. There are now 40 occupational therapists in departments in hospitals, social
institutes and physical and mental rehabilitation units. Mostly people who work in this
field are not occupational therapists but are social workers or special teachers.
At present there is a three-year programme in physiotherapy with an optional one and a
half-year top up in occupational therapy. The education is not recognised by WFOT.
There is no professional association in Slovakia.
Occupational therapy is based in Ljubljana University of Professional Education and is
under the auspices of the Ministry of Education and Sport. The development of
occupational therapy in Slovenia is as follows:
1964 occupational therapy education began - a 2 year programme with intake every
second year, 20 students. Occupational therapists worked in psychiatric hospitals
and rehabilitation units.
1982 a 2 year programme with intake every second year, 30 students. Occupational
therapists work in the above plus special institutes and paediatrics
1985 as above plus occupational therapists also work in health resorts
1992 2 1 / 2 year programme with intake every year, 30 students
1996 3 year-programme, 40 students. Occupational therapists also work in community
care and private practice.
1997 co-operation with York and Amsterdam started.
There are 387 qualified occupational therapists. An association of occupational therapists
and physiotherapists was formed in 1970. Occupational therapy became an independent
association in 1989. The profession was accepted in the law in 1969. The association
started in 1998 the procedures to become associate WFOT member.
There have been rehabilitation centres in spas for many years. In 1974 rehabilitation
became a clinical speciality and physiotherapy was recognised. Occupational therapy did
not develop as a speciality on its own. Its tasks were carried out by doctors,
physiotherapists, speech therapists etc. As yet there are still no occupational therapists.
There is a tradition of the use of arts and crafts in psychiatry, which is carried out at a
low level by physiotherapists. The importance of occupational therapy was discovered by
a rehabilitation specialist on a visit to Amsterdam (NL).
Education is for physiotherapy at present, although those doing a four-year
physiotherapy programme can add one more year to gain a Masters degree in
occupational therapy. There is now a willingness to set up occupational therapy
programmes but a legal framework for the profession is needed.
The representatives from Yugoslavia were defectologists. They explained the range of
rehabilitation and involvement of defectologists in Yugoslavia. They presented figures
showing the numbers of people with disabilities and categories of disability in the
country describing the health care system there in great detail. There are no
occupational therapists at present.
The above stated data were mainly collected by the representatives of the Prague
meeting and recorded in the report of this meeting (ENOTHE1999).
This must be seen as a first attempt to describe some developments in occupational
therapy in the Eastern and Central European region. It is clear that in most countries the
profession of occupational therapist did not formally exist till recently, but there were
rehabilitation workers or other kind of therapists involved in the care for the disabled.
In the last few years different contacts between faculties of Eastern and Western
European universities have been established to develop the education in occupational
Hereafter a summary of quantitative data will be given. Due to low professionalism and
less registration in this area the data must be seen as provisional. Further research in this
area is needed.