Demand for rehabilitation services is expected to increase within the next decade primarily due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in health service delivery models [1–4]. In Canada, rehabilitation personnel constitute the third largest health professional group after nurses and physicians. Despite the size of this workforce, studies have consistently reported ongoing shortages of physiotherapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs) across all jurisdictions [5–7]. Similarly, recruitment and retention of rehabilitation professionals has been considered a challenge internationally, nationally and provincially. At the international level, the literature reports recruitment and retention difficulties of rehabilitation therapists in countries such as Australia, New Zealand, United Kingdom and the United States [8–13]. Provinces across Canada face similar issues; with Ontario projected to face the most difficulty due to its population growth rate .
Based on the Canadian Institute for Health Information's Health Personnel Trends in Canada from 1993 to 2002 report, numerous factors have been suggested to influence demand for physiotherapy and occupational therapy services. Factors that may influence increase demand for physiotherapy include: shift in health service delivery models from hospital to community care; earlier patient discharge; increased expectations from aging Canadians concerning more active lifestyles; growing private practice sector and continued shortages for PTs in both private and public sectors in rural, remote and urban settings across Canada . In 1993, an Ontario study stated that in order to meet demands of changing health care policy, medical technology and demographic changes in the population, the PT profession required an annual growth rate of 4.4% until the year 2000 . However, the national health personnel databases revealed that the actual average annual growth rate of active PTs in Canada from 1995 to 2004 was only 2.5%, approximately half of the projected requirement suggested to meet demand .
Similarly, in Ontario in the early 1990s an increase in demand for OTs was projected because of the reported shortage in OTs and high attrition rate . The shortage of OTs was explained by another Ontario study to be the result of the changing philosophies of care and management for the disabled, and a clearer understanding of the role of OT in the physical and mental well-being of the disabled . In terms of actual shortages, some authors have reported ongoing vacancies and recruitment difficulties for OTs [11, 18] while others have reported an increase in demand for both PTs  and OTs .
Speech language pathology is facing similar service demands. A report released in March 2003 by the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) concluded that based on prevalence rates for Ontario residents with speech, language and related disorders, the demand for service would increase by 13% while the number of SLPs would decrease by 4% resulting in an overall reduction in service of 15% . The American Speech-Language-Hearing Association (ASHA) has been tracking SLP vacancies. In their 2005 ASHA Speech-Language Pathology Health Care survey, 48% of respondents indicated that they had funded unfilled positions for SLPS in their agency . The same survey also reported that 65% of respondents in home care indicated that job openings were more numerous than job seekers in their geographic area.
While labour market demand and supply are influential factors on recruitment and retention decisions, the development of strategies requires an understanding of conceptual frameworks or theories to categorise and explain how other underlying factors impact health worker's mobility. For example, Lehmann et al.'s model described that health worker's decisions to accept and stay in remote areas in the public sector depends on two interrelated aspects: the impact of the different environments (i.e. individual, local, work, national and international) and the location of decision-makers (i.e. local government, Ministry of Health, HR directorate, public service and other ministries). Behavioural and social science theories, such as those explained by Tett and Meyer, found that job satisfaction and organizational commitment each contribute independently to the prediction of the intention to resign (turnover), however job satisfaction was a stronger predictor than organizational commitment. Based on this notion, considerable research has been devoted to identifying factors that affect job satisfaction among rehabilitation professionals. While there is no single, agreed upon model of job satisfaction, a variety of theoretical models have been studied to explain concepts and relationships associated with overall job satisfaction. The two most commonly used theories of job satisfaction for rehabilitation professionals are the Herzberg's Motivation-Hygiene Theory and Mottaz's concepts of work values and work rewards .
A number of rehabilitation studies have used the Herzberg's Motivation-Hygiene Theory, also known as the two-factor theory of motivation to explain associations between motivation, job satisfaction and retention factors among OTs, PTs and SLPs [27–31]. Frederick Herzberg et al. explained that there were two independent incidents occurring at peoples' jobs: one that made them feel good or satisfied, and another that made them feel bad or dissatisfied at work . Intrinsic factors that motivate people such as achievement, recognition, work itself, responsibility, advancement and personal growth were called the "motivators" which lead to feelings of satisfaction. Extrinsic factors such as work conditions, company policies, supervision, interpersonal work relations, salary and job security, known as "hygiene" factors, were claimed to prevent dissatisfaction. "Motivators" directly affect a person's motivational drive to do a good job, therefore they are believed to be more important than hygiene factors.
Mottaz on the other hand, accounted for individual differences in job satisfaction among workers and based his study on two dimensions: "work rewards" and "work values". "Work rewards" are perceived characteristics of the job and have three conceptual clusters which include task, social and organizational rewards . Mottaz describes "task rewards" (intrinsic) as having five independent characteristics including: skill variety, task identity, task significance, autonomy and feedback. Examples include interesting and challenging work, self-direction and responsibility, creativity, opportunities to use one's skills and feedback. In the same study, Mottaz stated that "social rewards" (extrinsic) are derived from the interpersonal relationships established with others at work. Having supportive colleagues and supervisors is an example of this dimension. Lastly, "organizational rewards" (extrinsic) are tangible rewards that are provided by the employer/organization to facilitate performance. Such factors include working conditions, pay and fringe benefits, career advancement and security. The second dimension of job satisfaction is based on "work values", which is the importance that individuals place on their work rewards . For example, some rehabilitation therapists may value extrinsic rewards such as pay and benefits as more important than intrinsic factors like clinical autonomy and challenging work. Although the Herzberg and Mottaz conceptual frameworks are organized differently, their job satisfaction variables are very similar (i.e. work conditions, pay, interpersonal relationships, etc.) and they both classify these factors as having intrinsic or extrinsic elements.
Despite the growing body of literature on recruitment and retention factors in various industries, there is a minimal amount of research studying these factors specifically among rehabilitation professionals. One published study however, did look at extrinsic and intrinsic job satisfaction factors on recruitment and retention of rehabilitation professionals (OTs, PTs and SLPs). Results from this study showed that intrinsic factors such as professional growth and having a work environment in line with personal values are more significant in predicting career satisfaction than extrinsic factors such as pay and continuing education. These same intrinsic factors are also significant in predicting retention in rehabilitation professionals. Another study looking at recruitment and retention of allied health professionals in the rural areas in New South Wales identified that the main reasons why people liked working in rural areas were because of the attractive environment and helpful team members. However 82% of employees reported that having their partner move away was the number one reason for leaving a rural job. A similar study was conducted among OTs and PTs in Northwestern Ontario. Findings from this study indicated that factors contributing to initial decision on location of practice include availability of leisure/recreation activities, proximity of family origin and influences of spouse/partners. Study results also showed that the main reasons therapists left their job were to be closer to their family, lack of job opportunity and spousal influence.
Solely understanding factors that influence recruitment and retention decisions is not sufficient in the development of a HHR plan for rehabilitation professionals. In order for the plan to be effective and sustainable in addressing these factors, the most important and feasible workforce strategies needs to be identified.
There have been a number of reports on health human resources (HHR) planning, recruitment and retention strategies for physicians [35, 36] and nurses , however information regarding rehabilitation professionals is lacking. Canadian reports indicate that the main reason for significant gaps in this field is the absence of current and reliable data available on supply, demand and labour force participation trends for rehabilitation therapists [38–40]. There is some research that has investigated theoretical models of job satisfaction on recruitment and retention [28, 32]; however few studies have looked at how these models have been implemented. Other studies have examined the relationship of gender, workplace setting (i.e. hospital, ambulatory, rehabilitation, acute and long-term care) and geographical location (i.e. rural or urban) on job satisfaction and retention among rehabilitation professionals [41–43]. Furthermore, no empirical studies have examined conceptual frameworks for organizing recruitment and retention strategies for rehabilitation therapists. To address this gap, this research identified recruitment and retention strategies from the literature for rehabilitation professionals and determined their importance and feasibility using expert panels.