Therapeutic Climbing in Pediatric Practice: Therapist Perspectives on Mechanisms, Delivery, and Contextual Factors - A Qualitative Study.

Therapeutic climbing is increasingly used in pediatric occupational therapy, yet implementation practices and reasons for non‑adoption remain underexplored. This qualitative study examined how Austrian pediatric occupational therapists position therapeutic climbing within occupation‑centered, movement‑based practice; how they deliver it in community contexts; perceived benefits and mechanisms; and barriers to adoption, including non‑user perspectives. Semi‑structured interviews were conducted with 24 state‑certified pediatric occupational therapy practitioners (12 climbing users, 12 non‑users) and analyzed inductively using reflexive thematic analysis. Therapists described therapeutic climbing as a structured, safety‑oriented, movement‑based occupational therapy intervention delivered in individual, dyadic, and small‑group formats, typically progressing from separation and everyday task preparation through warm‑up to graded climbing, with explicit readiness criteria for height and rope work under high supervision. Belaying was used as closely overseen responsibility training. Reported benefits co‑occurred across domains: motor coordination and praxis, sensory regulation, attention and other executive functions, self‑efficacy, social responsibility, and strong motivation linked to therapeutic climbing's sport‑like framing in real‑world settings. Therapists attributed these effects to belay‑based trust and responsibility, graded exposure to height, dense problem‑solving with immediate feedback, visible progress, and ecological delivery in public gyms. Adoption depended on accepting facility partners, intensive logistics and training, safety/liability governance, and uncovered venue costs. Non‑users largely endorsed therapeutic climbing's rationale but cited lack of personal climbing practice, limited gym access, training and safety demands, and unreimbursed fees. Overall, therapeutic climbing was viewed as a promising, participation‑oriented approach; principal constraints were systemic rather than conceptual. Rigorous comparative studies with clear fidelity and context reporting are needed to identify mechanisms and specify for whom and under what conditions therapeutic climbing adds value.