Date Presented 04/02/2022

Bias in health care contributes to health disparities of people with disabilities (PWD). OT and physical therapy assistants are key stakeholders in rehabilitation; however, little research examines these clinicians’ bias toward PWD. This study examined OT and physical therapy assistants’ explicit and implicit disability bias, and the results show that the majority are implicitly biased toward PWD despite the majority being explicitly not biased. Implications and recommendations on approaches to address concern are discussed.

Primary Author and Speaker: Laura Vanpuymbrouck

Contributing Authors: Carli Friedman, Heather Feldner

PURPOSE: Healthcare provider bias has contributed to health disparities faced by people with disabilities (PWD) by influencing patient encounters and impacting overall quality of care through biased interactions (Iezonni et al., 2021). Occupational and physical therapy assistants (OTA/PTA) are key stakeholders in rehabilitation practice. However, few studies have examined OTA/PTA attitudes towards PWD. Therefore, the aim of this study was to examine OTA/PTA explicit (conscious) and implicit (unconscious) disability attitudes, the relationship between these attitudes, and how OTA/PTA attitudes compare to all other professions.

DESIGN AND METHOD: We analyzed secondary Disability Attitudes Implicit Association Test (DA-IAT) data from 12,226 people, 50% of which were OTA/PTA using descriptive statistics (explicit attitudes) and Greenwald et al.’s (2003) updated IAT scoring protocol (implicit attitudes). We then used Son Hing et al.’s (2008) two-dimensional model of prejudice to determine the relationship between OTA/PTA’s explicit and implicit attitudes. Finally, we used a linear regression to compare OTA/PTA’s attitudes with those of other professions.

RESULTS: The majority of participants were Women (78.1%) and White (75.8%). The mean age of participants was 28.2 years old (SD = 11.0). Only a small proportion of participants (13.2%) identified as people with disabilities. Almost two-thirds of participants (61.7%) had a family member or friends with disabilities. The majority of participants (45.6%) identified as liberal, with fewer identifying as neutral (30.2%) or conservative (24.2%). Findings revealed the majority of OTA/PTA (68.7%) reported no explicit preference for PWD, however, the overwhelming majority of OTA/PTA (80.1%) implicitly preferred nondisabled people. The relationship between attitudes found the majority of OTA/PTA were aversive ableists, with low explicit and high implicit (60.1%) bias. Additionally, OTA/PTA held lower explicit biases, but higher implicit biases, when compared to other professionals.

CONCLUSION: It is critical to reflect upon these findings to recognize the power and impact of implicit (unconscious) bias. Implications of this study suggest the need for comprehensive evaluation of OTA/PTA curriculum approaches to address disability prejudice through a deeper understanding of how OTA/PTA disability bias can contribute to inequitable healthcare and health outcomes for PWD.

IMPACT: Educators of OTAs/PTAs can use the findings of this study to challenge individualized notions of disability within curricula and introduce disability as diversity, embrace the intersectional nature of disability as a part of person’s identity, and bring people with disabilities into academic settings as faculty or guest lecturers. In doing so, this might begin to address the negative bias practitioners have of PWD.


Greenwald, A., Nosek, B., & Banaji, M. (2003). Understanding and using the implicit association test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85(2), 197-216.

Iezzoni, L. I., Rao, S. R., Ressalam, J., Bolcic-Jankovic, D., Agaronnik, N. D., Donelan, K., ... & Campbell, E. G. (2021). Physicians’ Perceptions Of People With Disability And Their Health Care: Study reports the results of a survey of physicians’ perceptions of people with disability. Health Affairs, 40(2), 297-306.

Son Hing, L., Chung-Yan, G., Hamilton, L., & Zanna, M. (2008). A two-dimensional model that employs explicit and implicit attitudes to characterize prejudice. Journal of Personality and Social Psychology, 94(6), 971-987.