Learning outcome: Turn a broad difficulty into a specific activity that you can explore with the patient. This OET Speaking for Occupational Therapists lesson uses persistent lower back pain to practise purposeful questions, relevant explanations and a shared next step. It includes paired five-task cards, condition teaching, an extended therapist model and a repeat attempt with a different activity priority.
When a patient says, “Work is becoming impossible,” an immediate list of chair adjustments may miss the problem. The difficulty could involve uninterrupted tasks, the journey, carrying equipment, uncertainty about asking for changes or something else. A useful question creates enough detail for the next response to fit. This lesson follows one activity rather than treating the diagnosis as a complete description of the person's life.
1. Original paired cards: what does “work is difficult” mean?
These original Jobins Training cards are independent OET preparation material, not official exam cards. They develop the source book's persistent back-pain and office-work scenario. The invoice-checking routine and changed home activity are original teaching details.
Occupational therapist card
Setting: An outpatient pain-management clinic.
Situation: Ms Parker, 38, has experienced lower back pain for six months and has already had medical assessment. She reports difficulty with work and household tasks. No specific structural cause or imaging result is supplied. In this first attempt, her symptoms follow the established pattern and she reports no new emergency features. Explore her most important activity difficulty and explain how occupational therapy may help. No particular chair, exercise dose, medication change or workplace arrangement has been prescribed.
Tasks:
- Explore the effect of pain and invite Ms Parker to choose one activity that matters most today.
- Ask for a recent example, clarifying the sequence, setting, demands and points of difficulty.
- Explore what she already tries, what she fears and what makes a suggested change practical or difficult.
- Explain the role of activity assessment, pacing and possible work adjustments without claiming a cause or promising pain relief.
- Agree a realistic next step, summarise the patient's priority and check understanding, including when changed symptoms need medical help.
Patient card
Setting: Your first occupational therapy discussion at the pain clinic.
Situation: You are Ms Parker, 38, an office administrator. Lower back pain has affected your life for six months. You say that work is becoming impossible, but your most troublesome task is the weekly invoice check. You remain at the laptop until the whole batch is complete, sometimes for about two hours, because stopping feels inefficient. Pain builds and you struggle with household tasks afterwards. You have access to other work tasks but have not explored alternating them. You worry that taking planned breaks means you are lazy or losing your career.
Tasks:
- Describe the general work difficulty, then explain the invoice-checking example when invited.
- Explain why you continue until the whole batch is finished and how you feel afterwards.
- Ask whether your sitting posture has damaged your back and whether a new chair will cure it.
- Discuss your concern about appearing unproductive and ask what pacing would mean for your work.
- Choose a manageable next assessment step and explain what you understand, including any concern that remains.
Preparation prompt: Prepare a broad opening, a request for one recent example and two follow-up questions that depend on the answer. Leave room to change direction. The goal is not to ask every question about every activity.
2. Understand persistent back pain and its effect on activity
Persistent pain describes duration, not a single cause
Back pain can have several causes, and a clear cause is not always identified. In this case, the pain has continued for six months. The word persistent describes an ongoing problem; it does not establish a damaged disc, poor posture as the cause or a particular scan result. The therapist should respect the medical assessment already undertaken and seek review when needed, without creating an explanation that the card does not support.
Pain is a real experience. Its effect on a person's day may include difficulty concentrating, disrupted routines, frustration and uncertainty about work. Ask which effects apply rather than assuming them all. Ms Parker's concern about her career is part of the consultation because it affects how she approaches the task and whether she feels able to consider changes.
Activity performance is more informative than a job title
Two office workers can have very different working days. One may move between meetings, while another completes a continuous screen task under time pressure. The label “office work” does not establish the duration of sitting, the workstation, the workload or the freedom to change activity. Ask what actually happens during the difficult part of the day.
Ms Parker's example provides a sequence: starting an invoice batch, staying with it until completion, noticing pain build and finding later activities harder. This is useful information for assessment. It does not prove that one posture has caused injury. Preserve that distinction when summarising: “You notice more pain during that long task” is more accurate than “Your laptop has damaged your back.”
What occupational therapy can contribute
Occupational therapy examines how a health problem affects meaningful everyday activities and explores ways of making participation more manageable. The therapist may look at the task, the surroundings, routines and the person's priorities. Work and home demands can both matter. The aim is to develop suitable strategies with the patient, alongside other care, rather than promise that one adjustment will remove the pain.
A detailed activity example helps identify what to assess. If the difficulty occurs during an uninterrupted batch task, the discussion may include the task structure and opportunities to vary activity. If the problem is carrying laundry upstairs, the relevant assessment is different. A shared diagnosis does not make the same advice suitable for every task.
Pacing needs an explanation and an individual plan
Pacing is an approach to organising activity and recovery in a more manageable pattern. It may involve breaking a task into parts, planning changes of activity or using agreed breaks. It is not simply waiting until pain is overwhelming and then stopping everything, and it does not mean abandoning valued activities. The starting point and review need to fit the person.
For this role-play, discuss the idea and agree how to assess a manageable routine. Do not invent a universal instruction to work for a fixed number of minutes or increase activity by a fixed percentage. A brief record of what happens during and after the selected task can support a more informed discussion. Significant symptom changes require appropriate review rather than automatic persistence with a plan.
The workstation and work organisation both matter
A workstation assessment considers the equipment, furniture, environment, task and individual requirements. It can help identify suitable changes. That does not mean that a particular chair is a cure or that there is one position the patient must hold all day. For screen work, opportunities to change activity and position are relevant as well as the physical setup.
Explore practical barriers. The patient may understand the idea of varying tasks but feel unable to do so because of workload or workplace expectations. Ask what is possible, what has been discussed and what support might help a conversation with the appropriate person at work. Do not guarantee an employer's response, continued employment or an adjustment that has not been agreed.
Keep activity advice linked to assessment and symptom change
General back-pain advice encourages activity and avoiding prolonged bed rest, but that is not permission to push through every symptom. The individual plan must take account of assessment, limitations and any new concerns. This lesson does not prescribe exercises or change pain medicines. Questions about medication suitability should be directed to the appropriate clinician or pharmacist.
Back pain with new loss of feeling around the genitals or anus, changes in bladder or bowel control, or pain, tingling, weakness or numbness in both legs needs emergency assessment. UK advice is to call 999 or go to A&E, without driving yourself. Sudden severe or rapidly worsening pain, or feeling feverish or generally unwell with back pain, requires urgent medical advice. Do not treat these changes as a routine pacing problem.
Clinical reading: NHS: back pain; NHS: occupational therapy; Mersey Care NHS: pacing; Cambridge University Hospitals: activity diary guidance; HSE: workstation assessment; HSE: work routine and breaks.
3. Task coaching: move from the general problem to a useful example
Task 1: let the patient choose the priority
Start with the effect on everyday life, then ask which activity they most want to discuss. This avoids deciding that work must be the priority simply because the patient is employed. In the first attempt, invoice checking is chosen. Reflect both the activity and its meaning: she wants to do her job reliably without the task dominating the rest of her day.
Task 2: ask for a recent episode
“Could you talk me through the last time that happened?” makes the description concrete. Clarify what the task involves, how it is organised, what happens as it continues and what follows afterwards. Use the patient's own sequence. If she says she stays until the batch is finished, ask what makes stopping difficult instead of immediately giving a timer instruction.
Task 3: explore the belief behind the behaviour
Ms Parker may equate uninterrupted work with commitment. If you miss that concern, “take breaks” can sound like advice to become less productive. Acknowledge the fear and explain the intended purpose of a planned activity pattern. Ask what she has already tried and whether a change is within her control. A response becomes collaborative when her answer influences the plan.
Task 4: connect the explanation to the example
A useful explanation has a visible link: “Because this is a long, uninterrupted task, we can look at how it is organised as well as the workstation.” This is more relevant than a general lecture on back care. Keep the degree of certainty accurate. A pattern can guide assessment without proving the cause, and a proposed adjustment can be worth exploring without guaranteeing benefit.
Task 5: choose a next step that is possible now
Agree to examine the selected task and identify a manageable starting approach. A short activity record may be useful if the patient agrees and understands the purpose. Clarify what information will be reviewed and how the next contact will be arranged, without inventing a booked appointment. Check what the patient expects from the plan; repair any belief that following it guarantees a pain-free week.
4. Extended therapist-viewpoint model with listening pauses
Only the occupational therapist's spoken lines appear below. The pauses show where the patient's answer should change what comes next. Do not read the model as an uninterrupted speech.
“Hello, Ms Parker. I'm the occupational therapist in the pain team. I'd like to understand how your back pain is affecting the things you need and want to do, then discuss where we could start. What has been most difficult for you recently?”
[Pause. Listen to the broad concern before narrowing it. If the patient chooses home life rather than work, follow that priority.]
“You feel that work is becoming harder to manage, and you're worried about what that means for your career. That sounds like a lot to carry. Could we choose one part of the working day that best shows the difficulty?”
“The weekly invoice check is the main problem. Could you talk me through the last time you did it, from when you started to what happened afterwards?”
[Pause. Allow the activity sequence to emerge. Ask focused follow-up questions only where information is missing.]
“So you work through the whole batch at the laptop, sometimes for about two hours, and you tend to stay with it until it is finished. The pain builds, and household tasks feel harder later. Have I understood that correctly?”
“What makes it difficult to pause or change tasks during the invoice check? Is it the way the work is organised, concern about losing your place, expectations from someone else, or something different?”
[Pause. The options are prompts, not conclusions. Give space for the patient to explain her own reason.]
“You feel that stopping would make you inefficient, and you're concerned that others might think you are not working hard enough. That helps me understand why a simple suggestion to take breaks may not feel easy to use. We need an approach that takes your work responsibilities seriously.”
“What have you already tried during that task, and what difference did you notice? I'd also like to understand the workstation you use and whether it has been assessed.”
“You asked whether your posture has damaged your back. From the information we have here, I cannot identify a particular structural cause or say that one position caused damage. We can take the pattern you describe seriously and assess the activity and setup without making that assumption.”
[Pause. Check whether the patient needs clarification about uncertainty. Do not replace an unsupported damage explanation with an equally unsupported statement that nothing could be wrong.]
“Occupational therapy looks at how you manage important activities and what changes might make them more manageable. For you, we could start with the invoice check: the length of the uninterrupted task, how it is organised, your workstation and what happens afterwards. That gives us something specific to work on.”
“One approach we can explore is pacing. By that I mean planning the activity in manageable parts, with suitable changes of activity or breaks, rather than carrying on until you are struggling and then having to stop everything. The aim is to support a more manageable routine, not to suggest that you are lazy or that the work does not matter.”
[Pause. Ask what the explanation means to the patient. If she hears “do less forever,” address that interpretation before discussing the plan.]
“How does that idea fit with the way your work is organised? Are there other tasks you could realistically alternate with the invoice check, or would a change need discussion with someone at work?”
“There are other tasks available, but you have not explored how to organise them alongside the batch. We can look at that as a possibility. I would not want to set a rigid schedule before understanding what is manageable for you and practical in the job.”
“A workstation review may also identify useful adjustments. A different chair might be considered if the assessment supports it, but I cannot promise that buying a chair will remove the pain. We need to consider the activity and routine as well as the furniture.”
[Pause. Explore financial or workplace concerns if the patient raises them. Do not turn a discussion of possible adjustments into a purchase recommendation.]
“Would it be manageable to keep a brief note of the invoice-checking task before we review it together: how it was organised, any changes of activity and how you felt during and afterwards? The purpose would be to understand the pattern, not to grade your effort or make you monitor every sensation.”
“If keeping notes would itself add too much pressure, tell me and we can consider a simpler way to collect the information. We want the first step to be useful and realistic.”
“We should also keep changes in symptoms separate from this established pattern. New difficulty controlling your bladder or bowels, loss of feeling around the genitals or bottom, or symptoms such as weakness or numbness affecting both legs need emergency assessment. If that happens, seek emergency help rather than waiting for a therapy review. Sudden severe or quickly worsening pain, or feeling generally unwell with it, also needs urgent medical advice.”
[Pause. If a new concerning symptom is disclosed, stop routine planning and arrange the appropriate urgent response.]
“Let me summarise. Your priority is the weekly invoice check, especially the long uninterrupted period and the effect on the rest of your day. You want to remain effective at work. We have discussed assessing the task and workstation and using a brief record to help choose a manageable approach. We have not agreed a fixed exercise programme or promised that the pain will disappear.”
“What feels like the most useful first step to you? And how would you explain the purpose of pacing in your own words? I want to check that it sounds like a practical plan we can work on together, rather than another instruction that does not fit your life.”
Model review: The therapist uses the invoice example to understand an uninterrupted task and a concern about productivity. The explanation and next step follow from those answers. The model avoids blaming posture, guaranteeing a cure or treating willingness as the only barrier to change.
5. Speaking tips: make the patient's answer visible
Use a narrowing sequence. Begin with daily life, identify a priority, then ask about a recent episode. Starting with very detailed workstation questions may feel irrelevant before the patient has chosen the activity.
Keep the example concrete. “The weekly invoice check” is easier to explore than “work.” It also gives you a clear reference when explaining why the assessment may be useful.
Ask about the obstacle to using advice. A suggestion can be understandable but impractical. Work organisation, confidence, cost and other responsibilities can change the next step.
Describe patterns without announcing causes. “You notice pain building during that task” reports what the patient said. “That task is damaging your spine” adds a conclusion you do not have evidence for.
Check the meaning of your recommendation. The patient may interpret pacing as giving up. Ask what they understand and correct that meaning before adding more information.
6. Useful sentences and when to use them
“Which activity would make the biggest difference if it became easier to manage?” Use this to identify a priority without assuming that the most visible task is the most important.
“Could you describe the last time that happened?” Use this to obtain a real example. Follow the sequence rather than interrupting with a prepared solution.
“What tends to happen afterwards?” Use this to understand the wider effect of the activity. A task may be completed at a cost to later routines.
“What would make that change difficult in practice?” Use this when discussing an option. The question invites a barrier without implying that the patient is uncooperative.
“That gives us something specific to assess.” Use this to show how the information will be used. Explain the next assessment step rather than leaving the phrase abstract.
“The pattern is useful information, but it does not by itself establish the cause.” Use this when the patient asks whether an activity proves damage. Pair it with a constructive next step.
7. Common mistakes and practical repairs
“Just improve your posture.” This skips the activity and may imply blame. Repair: explore the task and workstation, then discuss assessment of suitable changes.
“You need to rest until all the pain has gone.” This gives an unassessed rule and may encourage prolonged inactivity. Repair: explain that activity planning should fit the clinical assessment and individual needs.
“Work for exactly twenty minutes every time.” This invents an individual prescription. Repair: agree how to establish a manageable starting pattern and review it.
“A new chair will cure this.” This guarantees a result and ignores the task structure. Repair: explain that workstation changes are one possible part of a broader assessment.
“You are not taking enough breaks.” This assumes a failure of effort. Repair: ask what makes changing activity difficult and use the answer.
“Your job will be safe.” This promises an outcome outside the consultation. Repair: acknowledge the concern and explore appropriate workplace discussion or support without predicting the employer's decision.
8. Second attempt: the priority is now a home activity
Keep the established back-pain history and absence of new emergency features. Change the patient's priority. Ms Parker now says that work is more manageable, but “housework is impossible.” When asked for a recent example, she describes carrying a full laundry basket upstairs and then trying to finish all the laundry in one session. Her main goal is to manage the routine without needing the rest of the day to recover.
Your task: Explore this activity afresh. Clarify the sequence, setting, difficult step, existing approach and available support. Explain how the information changes what you need to assess. Do not repeat laptop or chair advice, invent a safe lifting limit or give an unassessed carrying technique. Agree an appropriate next activity-planning step.
Reveal the teaching response and reasoning
“It is helpful to know that work is more manageable and that the laundry is now the main concern. Could you talk me through the last time you did it, including moving the basket and what happened afterwards? I would like to understand which part is hardest before suggesting changes. We can then look together at the task and how it is organised, rather than assuming the work plan fits this activity too.”
The response accepts the new priority and asks for information relevant to it. It uses the same communication method with different content. The clinician still needs to assess suitable options; an activity example is not enough to prescribe a technique.
A weaker response returns to the chair or instructs the patient to take the basket in a particular way without assessment. A stronger response identifies the changed activity and lets its demands shape the discussion.
Recording review
Listen for the transition from a broad statement to one concrete activity. Did you ask what mattered most, or choose for the patient? Find the first explanation you gave and identify the patient detail that made it relevant. Finally, compare the two attempts. The questions and next assessment step should change with the activity, while your respect for uncertainty and clinical safety remains consistent.
Your next step
OET Speaking for Occupational Therapists — Course 3
Explore the complete course outline and related practice topics.
Source: 60 OET OT SP.epub, Jobins Training. Examples labelled original or illustrative were written for this article. Independent exam preparation; no affiliation with or endorsement by the examining body. Practice does not predict an official score.