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Introduction Occupational therapists around the world increasingly seek to support the participation of children with disabilities and special educational needs in mainstream education. Contemporary school-based occupational therapy practice is progressing from an individual, impairment focus towards collaborative, universal interventions at the whole class and whole school level. Participation-focused practice and collaboration is particularly important, but uncommon, in low-resource contexts such as Pakistan. Methods This article reports on collaborative action research that developed the role of occupational therapy in inclusive education in Karachi, Pakistan. A research team consisting of occupational therapists and teachers worked with five local primary schools, using the action research cycles of plan–implement–observe–reflect to develop practical strategies, materials and inclusive lesson plans to facilitate the participation of all children in all school-based occupations. Findings Support from school management and interdisciplinary collaboration were crucial for implementing change. In addition, strategies like inclusive lesson planning were found to benefit all children in class. Collaborative action research led to increased professional confidence in the teachers and occupational therapists, and skill development through developing a resource guide, running workshops and presenting at (inter)national conferences. Conclusion Collaborative action research was an effective means to develop the occupational therapy role in inclusive education practices in Pakistan, develop culturally appropriate educational resources, and upskill local therapists and teachers.

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