Thinking Outside the Box: Using Activity Analysis to Support a Return to Work

Supporting someone to return to work after illness or injury requires more than understanding their diagnosis or measuring their current functional abilities. Vocational rehabilitation professionals also need to understand what a person’s job actually involves, where difficulties may arise and how the demands of work can be explored safely before a return takes place.

In her VRA webinar, Taking Creativity Outside the Box – Using Activity Analysis to Focus on Work as an Occupation from Acute to Community, Lorna Neave, Clinical Specialist Neurological Occupational Therapist and Clinical Director of Neave Neuro Occupational Therapy Ltd, demonstrated how practitioners can use activity analysis and creative work simulation to make rehabilitation more relevant to an individual’s employment goals.

Drawing on practical case studies across acute, rehabilitation and community settings, Lorna showed how familiar occupational therapy skills can help practitioners identify barriers, build confidence and develop realistic, individualised return-to-work plans.

The central message was clear: understanding the demands of work, then finding creative ways to explore and practise those demands, can help turn a broad return-to-work goal into a practical rehabilitation plan.

In this article

• What is activity analysis, and why does it matter in vocational rehabilitation?
• Understanding the demands of a job
• Turning everyday activities into work simulations
• What the case studies teach us
• Building a graded return-to-work plan
• Practical ways to apply this in vocational rehabilitation

Key takeaways

• Start conversations about work early, even when someone is still receiving treatment or rehabilitation.
• Understand the specific tasks, responsibilities and working conditions associated with the individual’s role.
• Compare job demands with the person’s current abilities to identify where there is a match and where further support or development is needed.
• Use creative, occupation-based activities to simulate work tasks in settings where the actual workplace is not immediately accessible.
• Involve the employer, with the individual’s consent, to improve understanding and support effective planning.
• Grade the return to work by considering not only hours and days, but also duties, physical demands, cognitive complexity and responsibility.
• Review progress regularly and adapt the plan as the person’s capacity and confidence develop.

What is activity analysis, and why does it matter in vocational rehabilitation?

Activity analysis involves breaking an occupation down into its component parts to understand what a person needs to do, what abilities are required and what might prevent successful participation.

In vocational rehabilitation, this means looking beyond a job title or a general description of someone’s responsibilities. Practitioners need to understand the tasks that make up the role and the physical, cognitive, psychological, social and environmental demands involved in completing them.

For example, a job may appear physically undemanding but require sustained concentration, rapid decision-making, switching between competing tasks or managing challenging interactions with customers. Equally, someone may have regained the mobility needed to return to work following an injury but still be unable to safely manage the lifting, carrying or awkward postures their role requires.

Activity analysis helps practitioners explore these demands systematically and compare them with the individual’s current functional abilities.

It also supports two complementary approaches:

• A bottom-up approach: examining the person’s underlying abilities and difficulties, then considering how these affect occupational performance.
• A top-down approach: starting with the meaningful activity or work goal and identifying what the person needs to be able to do to participate successfully.

Using both perspectives helps practitioners understand not only why someone is experiencing difficulties, but also how an activity might be adapted, graded or used therapeutically to develop the skills needed for work.

Lorna highlighted that these are skills occupational therapists already use in many areas of practice. Applying them specifically to employment can help make vocational rehabilitation feel more tangible and achievable.

The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis was also discussed as one approach to understanding how people process information and use cognitive strategies when carrying out everyday tasks. This can be particularly relevant when exploring difficulties involving attention, memory, planning and executive functioning.

The important consideration is that an assessment should help practitioners understand how difficulties affect real-world performance, rather than relying solely on a diagnosis or an isolated test result.

Understanding the demands of a job

Before designing a return-to-work intervention, practitioners need a detailed understanding of the role the individual wants to resume.

A job description can provide a useful starting point, but it may not capture everything required in practice. The demands of a role can vary according to the workplace, working pattern, equipment, team structure and the way tasks are organised.

Lorna recommended gathering information from a range of sources, including the individual, their employer, job descriptions, company information and other relevant material about the role.

A job demands analysis can then help organise this information and compare it with the person’s current abilities.

What should a job demands analysis consider?

Depending on the role, relevant areas may include:

Physical demands

• Sitting, standing and walking.
• Lifting, carrying, pushing and pulling.
• Bending, kneeling, squatting or working in awkward positions.
• Fine motor skills and hand-eye coordination.
• Moving between locations or working across multiple sites.

Cognitive demands

• Attention and concentration.
• Memory and information processing.
• Planning, prioritisation and organisation.
• Problem-solving and decision-making.
• Switching between tasks and managing interruptions.
• Recognising risk and responding appropriately.

Psychological and interpersonal demands

• Managing pressure and competing priorities.
• Communicating with colleagues, customers or service users.
• Maintaining working relationships.
• Responding to difficult or unexpected situations.
• Working independently or under supervision.

Environmental and organisational demands

• Noise, lighting, temperature and available space.
• Equipment, technology and workplace layout.
• Working hours, shift patterns and travel requirements.
• The pace of work and the level of responsibility.
• Training requirements and the consequences of errors.

It is also important to understand how frequently particular demands occur. A task that happens occasionally may have a very different impact from one that occupies most of the working day.

The purpose is not simply to create a comprehensive list of everything a job involves. It is to identify which demands are essential, which currently present difficulties and what could be done to address any mismatch.

Identifying the match and mismatch

Comparing job demands with current capacity helps practitioners move from a general assessment of difficulties towards specific, actionable goals.

For example, someone recovering from a fractured femur may be able to walk independently, stand for reasonable periods and use their hands effectively. However, they may not yet be able to lift and carry the equipment required for their job.

In this situation, the aim is not necessarily to delay all work until every aspect of recovery is complete. Instead, the practitioner can explore whether the individual could initially undertake suitable duties while heavier tasks are temporarily reduced or supported.

The same principle applies to cognitive rehabilitation. Someone may be able to complete individual tasks but struggle when required to manage multiple activities, respond to interruptions or make decisions quickly.

Understanding these differences allows the rehabilitation plan to focus on the specific demands that need to be addressed.

It also supports clearer conversations with employers and multidisciplinary colleagues, because recommendations can be linked to identifiable job requirements rather than general statements about a person’s abilities.

Turning everyday activities into work simulations

One of the most practical messages from Lorna’s webinar was that work-related rehabilitation does not always require access to the actual workplace.

Where someone is still in hospital, attending a rehabilitation unit or recovering at home, practitioners can use creative activities to simulate aspects of their role. These activities can then be graded according to the individual’s abilities and progress.

The key is to ensure that the activity reflects a meaningful element of the person’s work, rather than simply being an unrelated exercise.

Start with the real task

The first step is to understand what the person actually does at work.

This may involve reviewing their job description, obtaining information from their employer or asking the individual to explain a typical working day. Where appropriate, colleagues or supervisors may be able to clarify particular responsibilities or demands.

Once the task is understood, the practitioner can identify the skills it requires and consider how these might be explored in a different environment.

For example, someone whose job involves using multiple computer screens may be able to practise visual scanning and information management using printed materials or a computer at home.

Someone who regularly handles customer enquiries may be able to practise communication and decision-making through role-play.

A practitioner supporting a person whose role involves planning visits and administering medication may be able to develop a simulated schedule to explore their organisation, prioritisation and attention to detail.

These activities can provide opportunities to observe performance, identify difficulties and develop strategies before the person returns to their usual duties.

Grade the activity to match the person’s needs

A work simulation can begin with a relatively simple task and gradually increase in complexity.

Depending on the role and the individual’s presentation, this might involve:

• Introducing more information to process.
• Increasing the number of tasks to complete.
• Adding time limits.
• Introducing distractions or interruptions.
• Requiring the person to switch between tasks.
• Increasing the physical demands.
• Practising more complex decisions or unexpected situations.

The aim is to understand how the person performs as demands change, while ensuring the activity remains appropriate to their rehabilitation needs.

Practitioners should also consider what the simulation can and cannot tell them. Performance in a controlled environment provides useful information, but it does not automatically establish that someone can manage every aspect of their role in a live workplace.

Where possible and appropriate, findings should inform further assessment, workplace discussions and a carefully planned return.

What the case studies teach us

Lorna shared several examples demonstrating how work simulation and activity analysis can be adapted to different occupations and rehabilitation settings.

Case study: Returning to a betting shop management role after a traumatic brain injury

One example involved a 28-year-old man who sustained a traumatic brain injury after being hit by a car while cycling. He had significant difficulties with attention, memory and executive functioning, alongside cognitive fatigue, poor sleep and post-traumatic stress symptoms.

He was motivated to return to his full-time role as a deputy manager in a betting shop. However, fatigue and a lack of routine presented barriers, and he needed support to rebuild everyday skills and develop strategies for managing his difficulties.

Alongside work on routines, fatigue management and cognitive rehabilitation, Lorna obtained information about his role and its training requirements.

She then developed activities that reflected some of the tasks he would need to perform at work.

Initially, he used a newspaper to locate horse races and identify relevant information. As his performance developed, he progressed to working with several newspapers at once to simulate the demands of switching between multiple screens.

Further activities involved matching race information, identifying deliberate errors, working within time limits and entering information into a spreadsheet. Role-play was also used to practise customer interactions and scenarios involving cash handling.

These activities allowed Lorna to increase the complexity of the tasks gradually while observing how the individual managed the demands involved.

With the individual’s permission, she also liaised with his employer and arranged for him to undertake workplace assessments. Following observation and discussion, a graded return-to-work plan was developed, increasing his hours and working days in stages.

At the time of discharge, he had been working for two years.

The learning: Work simulation can help practitioners identify the specific difficulties affecting performance and develop relevant strategies. It can also provide a bridge between rehabilitation activities and a workplace assessment, helping the practitioner and individual make more informed decisions about the next stage of the return-to-work process.

Case study: Supporting a plumber following a fractured femur

Another example involved a plumber recovering from a fractured femur that had required surgery.

Although his mobility improved during rehabilitation, his job involved physical demands that needed to be considered carefully, including prolonged standing, walking between jobs, lifting equipment, carrying materials and working in awkward positions.

Lorna used activities that reflected these demands, including practising tasks associated with fixing taps, removing bath panels, carrying a tool belt and working on balance, mobility and bending.

The activities were graded to reflect increasing levels of physical challenge and complexity.

A comparison of job demands with current capacity helped identify where the individual was already able to meet the requirements of the role and where further development was needed. Carrying heavy equipment and transporting materials, for example, presented difficulties even when other aspects of the job were manageable.

A staged return-to-work plan was developed, gradually increasing working hours, the number and type of jobs undertaken, geographical range and lifting demands. The plan included regular reviews to monitor progress.

He returned to full-time work after six weeks.

The learning: Returning to work is not simply a question of whether someone can perform a task once. Practitioners need to consider the frequency, duration and intensity of the demands involved, and whether the person can manage them safely and consistently as their working responsibilities increase.

Case study: Exploring a return to hairdressing after a brain injury

Lorna also described working with a 30-year-old man who had sustained a brain injury and experienced mild left-sided weakness, reduced hand-eye coordination and difficulties with visuospatial awareness.

He worked as a hairdresser, and concerns had been raised about whether his difficulties would prevent him from returning to the role.

Rather than relying solely on the assessment findings to determine his future work options, Lorna explored the practical demands of hairdressing.

Activities included practising standing and stooping, holding scissors, cutting paper shapes at different lengths and angles, and eventually practising on a wig.

This provided opportunities to explore the specific skills involved in the role in a practical setting.

Following rehabilitation, he was referred for community support and returned to hairdressing.

The learning: Assessment findings are important, but they need to be interpreted in the context of real-world occupational performance. Where appropriate, practical exploration can help establish what a person can do, which difficulties remain and whether strategies or adaptations may make a return possible.

This does not mean overlooking genuine risks or assuming that everyone can return to their previous role. It means making decisions through a careful, evidence-informed assessment of the individual, the task and the environment.

Building a graded return-to-work plan

Work simulation and activity analysis can help inform a return-to-work plan, but the plan itself needs to reflect the demands of the individual’s role and their progress through rehabilitation.

Lorna emphasised that graded returns should be specific to the person and their job, developed with input from the relevant parties and based on an assessment of job demands and current capacity.

Grade more than hours

Reducing working hours is often an important part of a phased return, but it is not the only variable that can be adjusted.

Depending on the circumstances, a plan might also gradually increase:

• The number of working days.
• The duration of individual tasks.
• The complexity of duties.
• The physical demands, including lifting and carrying.
• The number of competing tasks or interruptions.
• The level of responsibility.
• The range of locations or working environments.
• The pace of work and time pressures.

For someone recovering from a physical injury, this could mean starting with shorter shifts and lighter duties before progressively increasing lifting requirements and the number of jobs completed.

For someone recovering from a brain injury, it might involve beginning with familiar tasks in a quieter environment before introducing more complex responsibilities, interruptions or time pressures.

The appropriate approach will depend on the individual’s needs, the risks associated with the role and the evidence gathered through assessment.

Agree review points from the outset

A graded return should include clear expectations and regular opportunities to review progress.

The individual, employer and relevant rehabilitation professionals need to understand what is expected at each stage, what indicators will be used to assess progress and what should happen if difficulties arise.

Monitoring should take account of symptoms and functional performance, including fatigue, pain, cognitive difficulties and the individual’s ability to sustain their working pattern.

Regular communication with the employer can also help identify whether adjustments are working in practice and whether the demands of the role need to be modified further.

A plan should remain flexible enough to respond to new information. Progress may not be linear, and increasing demands too quickly can undermine confidence or lead to setbacks.

The goal is not to complete a phased return according to a fixed timetable regardless of circumstances. It is to support a safe and sustainable return that reflects the individual’s developing capacity.

Practical ways to apply this in vocational rehabilitation

Lorna’s examples demonstrate how activity analysis can help practitioners translate a broad employment goal into specific, meaningful interventions.

The approach is relevant across rehabilitation settings, including acute hospital wards, inpatient rehabilitation, community services and private practice. The activities available may differ, but the underlying principles remain consistent.

1. Start the work conversation early

Where appropriate, ask about employment goals and current work responsibilities while the person is still receiving treatment or rehabilitation.

Early conversations can help identify potential barriers, establish what returning to work would involve and ensure that employment is considered as part of the wider rehabilitation journey.

Starting early does not mean rushing someone back to work. It means recognising work as a meaningful occupation and allowing time to plan for it.

2. Understand the individual’s actual role

Do not rely solely on a job title or a general description of duties.

Gather information from the individual and, with their consent, their employer. Review job descriptions and other available information, and clarify the physical, cognitive, psychological and environmental demands of the role.

Consider the demands that are essential to the job, how frequently they occur and what the consequences of difficulty might be.

3. Identify specific barriers and strengths

Compare the job demands with the person’s current abilities.

Identify where there is a match, where there is a mismatch and what could help address the difference. Consider not only difficulties but also the skills the individual retains and the tasks they can already manage.

This can help make the rehabilitation plan more focused and provide a clearer rationale for the interventions being recommended.

4. Design relevant work simulations

Where the actual workplace is not accessible, consider how key tasks could be recreated using the resources available.

This may involve everyday materials, role-play, computer-based activities or simulated work scenarios. Technology and simulation tools may also offer opportunities to reproduce particular demands, where appropriate.

The important question is whether the activity provides useful information about the skills required for work and helps the practitioner or individual make progress towards their goal.

5. Involve the employer

Employer involvement can help practitioners understand the role more accurately, identify possible adjustments and plan a return that works in practice.

With the individual’s informed consent, early communication can support a shared understanding of the person’s needs and the demands of their job.

Where appropriate, workplace observation can provide additional information that cannot be fully replicated in a clinical setting.

6. Use findings to inform decisions and recommendations

Document what has been assessed, what the individual has demonstrated, where difficulties remain and what support may be required.

Clear evidence helps practitioners explain their reasoning to clients, employers and multidisciplinary colleagues. It can also support decisions about further rehabilitation, workplace adjustments, graded duties or the need for additional assessment.

7. Keep the plan under review

As the individual progresses, revisit the relationship between their capacity and the demands of work.

Review whether the agreed activities and working pattern remain appropriate, whether adjustments are effective and whether new barriers have emerged.

The plan should evolve as the person’s needs and abilities change.

Looking beyond the clinical environment

A recurring theme throughout Lorna’s webinar was the importance of not allowing the clinical environment to define the limits of vocational rehabilitation.

A hospital ward or rehabilitation unit cannot reproduce every aspect of a workplace. However, practitioners can often identify meaningful elements of a job and create activities that explore the relevant demands.

This requires detailed understanding of the role, clinical reasoning and a willingness to adapt familiar rehabilitation skills to a work-focused purpose.

It also requires recognising the limitations of simulation. A successful simulated task is one part of the evidence available to inform a return-to-work decision, not a guarantee of performance in every workplace situation.

Where appropriate, activity analysis should therefore be combined with other relevant assessments, discussion with the individual and employer, workplace observation and ongoing review.

The approach supports a broader view of rehabilitation in which work is considered alongside other meaningful occupations, rather than being left until the end of the process.

Supporting meaningful and sustainable work

Vocational rehabilitation is most effective when it responds to the individual’s circumstances and the real demands of the work they want or need to do.

Lorna Neave’s webinar demonstrated how activity analysis can help practitioners bridge the gap between functional assessment and employment. By breaking work down into its component tasks, identifying matches and mismatches, and creating relevant opportunities for practice, professionals can develop interventions that are practical, purposeful and tailored to the individual.

The case studies also highlighted the value of early conversations, employer involvement, clear clinical reasoning and carefully graded returns to work.

For vocational rehabilitation professionals, the challenge is to look beyond the assessment setting and ask a practical question: How can we understand the work well enough to help this person move towards doing it safely and sustainably?

Sometimes the answer will involve workplace adjustments or changes to duties. Sometimes it will require further rehabilitation, additional support or a longer timeframe. In other situations, creative work simulation may help establish what is possible and what needs to happen next.

By combining a detailed understanding of job demands with an individualised, occupation-based approach, practitioners can make vocational rehabilitation more relevant to the person’s goals and more closely connected to the realities of working life.

About the speaker

The VRA thanks Lorna Neave, Clinical Specialist Neurological Occupational Therapist and Clinical Director of Neave Neuro Occupational Therapy Ltd, for sharing her experience and practical examples of using activity analysis to support return-to-work journeys.

Her presentation offered valuable insight into how practitioners can apply established clinical skills creatively across acute, rehabilitation and community settings to support people working towards a meaningful and sustainable return to employment.

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