Researcher perspectives: James Bruce

James Bruce is an occupational therapist working at the Bristol Royal Infirmary. He specialises in working with critically ill patients on the Intensive Care Unit (ICU).

Alongside his role at the hospital, he has been carrying out research funded through the National Institute for Health and Care Research (NIHR).

In September 2026, we spoke to James about his journey into healthcare, his progression through NIHR-supported research opportunities, and his ambition to improve recovery for patients after critical illness.

Helping people engage with what matters to them

As a teenager studying for my A-levels, I knew I wanted to work in healthcare and was interested in building therapeutic relationships with patients. After spending time at my local hospital in Exeter and initially exploring physiotherapy, I came across occupational therapy, a profession I had never heard of before. It immediately appealed to me.

What attracted me was the opportunity to understand what makes people tick and to work with them to set meaningful goals. Occupational therapy is all about helping people engage in activities that matter to them and using those activities as part of their recovery. Every intervention is unique and tailored to the individual. I completed my degree in 2002 and have been practising ever since.

Pioneering occupational therapy in an intensive care setting

While working in a spinal cord injury unit, I became involved in intensive care rehabilitation. After moving to Devon, I took up a specialist rehabilitation coordinator role in intensive care at Torbay Hospital. At the time, occupational therapy roles in intensive care were still relatively uncommon and there was very little evidence to support them.

I helped develop a rehabilitation pathway that supported patients from intensive care through to the ward and into the community. Later, I moved to Bristol to help develop a larger specialist service, bringing lessons learned from Torbay to a major regional centre.

Getting involved in research

My journey into research started when I completed a six-month research fellowship while working in Torbay. For the first time, I had dedicated time to focus on a project and do it properly. Like many clinicians, I had previously had plenty of research ideas but very little protected time to pursue them.

The fellowship showed me that research was something I could genuinely contribute to. It also gave me the opportunity to learn directly from patients and explore questions that had been bothering me for years.

That experience led me to apply for an NIHR-funded fellowship hosted by the NIHR BRC: Bristol and allowed me to investigate one of those unanswered questions in greater depth.

Building the evidence for recovery after critical illness

My research focuses on upper limb extremity rehabilitation after critical illness.

Many intensive care patients experience severe weakness after prolonged illness, ventilation and sedation. While there is increasing recognition of the physical, psychological and cognitive effects of critical illness, we know surprisingly little about how upper limb weakness should be assessed and treated.

During my fellowship, I examined the prevalence of upper limb weakness in intensive care patients and began a scoping review to understand what evidence exists, who provides treatment, and what rehabilitation approaches are being used.

I also completed a service evaluation exploring the impact of occupational therapy provision in Bristol’s intensive care unit. This was an important step as occupational therapy provision in ICU is inconsistent across the UK with a limited evidence base to support it.

Under-researched and under-resourced

The earlier rehabilitation begins, the better the outcomes for patients. Yet occupational therapy in intensive care remains under-researched and, in some places, under-resourced.

My work aims to identify gaps in knowledge and provide the foundation for future studies. Ultimately, I hope it will help clinicians deliver more effective rehabilitation and improve recovery for people living with post-intensive care syndrome.

The people who stand to benefit most are patients recovering from critical illness and their families. Many face long-term physical and cognitive challenges after leaving intensive care, and better rehabilitation could help them regain independence and quality of life.

Strengthening the evidence base and planning for the future

I am currently completing a pre-doctoral award and hope to publish my scoping review in the coming months. Beyond that, my ambition is to develop a PhD proposal and continue building a clinical academic career that combines patient care with research.

Occupational therapy in intensive care is still an emerging field, and there are very few researchers working in this area. I want to help strengthen the evidence base that supports the profession and improve outcomes for patients recovering from critical illness.

Looking ahead, I hope to develop outcome measures and rehabilitation approaches that can be used more widely across intensive care services. For me, the ultimate goal is simple: to ensure that patients receive the best possible support during recovery and that the care we provide is backed by robust evidence.