State of the Journal, 2022

When I wrote my first State of the Journal report in 2020, I reflected that the world, but more specifically the United States, was in an unprecedented state of turmoil due to the health care crisis caused by the coronavirus disease 2019 (COVID-19), as well as the mounting social and political turmoil caused by factors such as racial inequalities, the ongoing minoritization of populations, and violence in all its forms. It is astounding to me that two years later these issues are still prominent and are now coupled with additional stresses related to basic human rights and the stability of our democracy.

As a woman who is a member of the LGBTQ+ community, a mother to a black adult son, and a mother to a rising kindergartener, I do not have the luxury of ignoring the various threats this year has imposed upon myself and my family. While my role as Editor-in-Chief of the American Journal of Occupational Therapy (AJOT) is professional and apolitical, I believe that the State of the Journal should be considered within the context of what is happening in the world around us and the impact it has on our members, colleagues, and clients. As such, I will reflect briefly on two issues that have featured prominently this past year and have the potential to impact occupational therapy practitioners: (1) the overturning of Roe v. Wade and (2) gun violence in America.

The U.S. Supreme Court decision on June 24, 2022, to overturn the federal right to abortion established in Roe v. Wade led to the immediate banning of abortion in eight states and is anticipated to result in restricted abortion access in 50% of states across the country (Tanne, 2022). It is worth noting that this decision has been widely criticized by medical bodies within and outside the United States, including the American College of Obstetricians and Gynecologists (2022), the American Medical Association (2022), and the American College of Physicians (2022). The American Psychiatric Association (APA) has also come out as strongly opposing the decision, noting that the “freedom to act to interrupt pregnancy must be considered a mental health imperative with major social and mental health implications” (APA, 2020, 2022).

The impact of this decision has several possible ramifications for occupational therapy practitioners. First, as a profession comprised of 85% women, it would be naïve to think that this decision would not have direct mental and physical health implications for some of our members. There may also be professional implications, as some practitioners may choose not to live in, be educated in, or practice in states where their health care autonomy is not guaranteed. Second, restricting safe abortion access has serious health consequences for pregnant women, including morbidity and mortality (World Health Organization, 2021). Occupational therapists working in acute care settings may see the impact of unsafe abortions in the form of clients presenting with hemorrhage, sepsis, genital trauma, and necrotic bowel as well as psychiatric trauma (Haddad & Nour, 2009). There are also concerns that, in a country where 12%–17% of children already live in poverty (Center on Poverty and Social Policy, 2022), restricting abortion access could lead to economic and social burdens for families, communities, and health care systems. As with many other health-related issues, these burdens and risks are estimated to disproportionally affect communities of color, particularly Black and Hispanic women (Stevenson, 2021).

As we saw with the onset of COVID-19, major changes to our social and health care landscape present an opportunity to consider the importance of meaningful occupation within our daily lives, and to engage in research that evaluates the potential impacts of these changes across a wide range of practice areas. As the flagship journal of the American Occupational Therapy Association (AOTA), AJOT welcomes the rigorous research examining the impact of policy decisions on occupational therapy practice as well as other research that would support occupational therapy professionals in making informed, evidence-based decisions about best practice.

According to the Centers for Disease Control and Prevention (CDC), the firearm homicide rate increased by 35% between 2019 and 2020, the highest recorded increase in more than 25 years (CDC, 2022). The CDC suggests that the COVID-19 pandemic, and the mental and economic stressors that ensued, may have contributed to this increase. Yet even as the pandemic restrictions have been lifted, gun violence in America remains high. Although they only make up a small percentage of all firearm deaths, mass shootings have featured prominently in American news and social media over the past year. The shooting at Robb Elementary School in Uvalde, Texas, which led to the deaths of 19 students and 2 teachers, added to the more than 310,000 children who have experienced gun violence at school since the year 2000 (Cox et al., 2022).

While the focus of violence-related media is often on the victims, professionals in various health care fields, including nursing and psychology, have noted the mounting impact on survivors, communities, and the nation as a whole (Draucker, 2019; Cimolai et al., 2021). Cimolai and colleagues (2021) note that “The vicarious trauma that impacts family, friends, and children around these events is often persistent and if not expeditiously addressed could lead to chronic posttraumatic stress, depression, and anxiety.” They go on to note that symptoms of stress in children and youth may manifest as behaviors such as hyperarousal, hypervigilance, impairments in sleep or eating habits, aggression, loss of developmental milestones, and regressive behaviors (e.g., thumb sucking).

Occupational therapy practitioners are likely going to see the manifestations of trauma caused by gun violence. It is imperative that we support mental health within schools and communities and contribute to research aimed at better understanding how occupational therapy can improve the health and well-being of our clients as well as impact policy at the systems level. The Safer Communities Act (S.2938), signed into law on June 25, 2022, is a bipartisan effort to invest in community mental health and includes policies that expand access to school-based and community mental health services (Saffer & Parsons, 2022). This policy, and the funding supporting it, will likely create new opportunities for occupational therapy practitioners working in pediatrics (e.g., schools, early intervention) and community-based mental health settings, and it is essential that we capitalize on this opportunity. This is only one example of how occupational therapy practitioners can have an impact in supporting the communities in which we work.

As we move forward into a new year, it is important to stay positive and take advantage of the opportunities our profession provides us to impact our clients and our communities. We must also be mindful of how stress in all its forms (e.g., economic, social, personal) can impact our ability to do our jobs. Burnout and compassion fatigue are salient factors facing occupational therapy practitioners, as discussed by Shin and colleagues (2022) in a recent AJOT article. We may find that as laws change and vary across states, some practitioners may be stressed and challenged in ways that others may not be. Finding ways to support each other and understand the systematic challenges facing ourselves, our clients, and our peers is essential. AJOT remains committed to supporting occupational therapy practitioners by publishing research to advance practice, education, policy, and other issues important to professional growth and helping to translate that work into the professional arena.

2022 was another busy year for the journal. In January, we transitioned to a new online article submission platform, ScholarOne, which has proven to be a more seamless system for our authors, editors, and reviewers. This transition took a coordinated effort from our entire editorial board, as well as our former managing editor Caroline Polk and our new managing editor Cecilia González.

January 2022 also saw the launch of our special issue on Health Services Research, which was guest edited by Dr. Brittany Hand, Dr. Cynthia Li, and Dr. Tracy Mroz. Published in Volume 76, Issue 1, this collection of articles examines important topics related to access, quality, and cost-effectiveness of care. The special issue highlights the state of health services research in the field of occupational therapy and reveals key insights to advance occupational therapy practice using health services research. We are also in the process of preparing our next AJOT special issue, which will focus on autism and mental health. Guest edited by Dr. Anne Kirby and Dr. Claudia Hilton, this special issue will be published in the March/April 2023 issue of AJOT (Volume 77, Issue 2).

In 2022, AJOT recruited and trained four new associate editors: Dr. Cynthia Li (University of Texas Medical Branch), Dr. Areum Han (University of Alabama at Birmingham), Dr. Nancy Bagatell (University of North Carolina, Chapel Hill), and Dr. Ayelet Ben-Sasson (University of Haifa, Israel). These editors bring new expertise to AJOT’s Editorial Board in the areas of mental health, health services research, neurorehabilitation, technology, developmental disorders, and sensory processing. Their research expertise spans both qualitative and quantitative designs as well as critical review methodologies.

To support the translation of research into practice, we have continued the AJOT Authors & Issues series, which can be accessed through our YouTube channel. Since December 2021, we have published 10 interviews with AJOT authors, tallying more than 2,500 views. Each article featured in the series has also been made available for Open Access on the AJOTwebsite, making translation into practice even more accessible.

In the fall of 2022, AJOT also launched the new AJOT Instagram account (ajoteditor). Through this social media platform, we post short research summaries of articles published in AJOT and connect with users through feeds, stories, and polls. This is all part of our ongoing commitment to engage readers and make the work we publish accessible as content clinicians can put into practice. We also hope that as more people access and engage with AJOT content, authors will see an increase in the number of times their work is read and cited.

A journal’s impact factor (JIF) is based on the number of times, on average, articles have been cited. The 2-yr and 5-yr JIF scores are most frequently reported and used to rank journals in terms of relevance or prestige. The calculation is based on dividing the number of times articles were cited in the given period (i.e., 2-yr or 5-yr) by the number of articles published by the journal.

AJOT’s 2-yr impact factor increased from 2.246 in 2020 to 2.813 in 2021 (Journal Citation Reports, 2022). Our 5-yr impact factor fell incrementally from 3.776 to 3.596, but still remains higher than any other year prior to 2020 (see Table 1). Within the top-ten most cited AJOT articles, three were related to instrument development and two were scoping reviews.

Journal Citation Reports (JCR) ranks journals in various categories based on their JIF as well as other factors such as citation and article counts, publisher information, and subject categories. In the category of Rehabilitation, AJOT ranks 14th among all ranked journals (n = 72), and first among all occupational therapy journals worldwide.

CiteScore is another journal evaluation metric based on citations recorded in the Scopus database. CiteScore 2021 is the number of citations in 2018–2021 for articles published in 2018–2021 divided by the number of articles published in 2018–2021 (Scopus, 2021). In 2022, AJOT’s CiteScore increased from 2.6 to 2.7, placing the journal in the 89th percentile of occupational journals. With this ranking, we maintain our position as third out of the 21 ranked journals as well as the top journal focused solely on the profession of occupational therapy.

Analysis of website usage allows us to gauge how stakeholders are accessing AJOT articles and interacting with our online platform. According to Google Analytics, the number of visits to the AJOT website increased from 689,538 in 2019 to 891,700 in 2020, a 29.32% increase. The new AJOT website launched in September 2021. The number of visits to the new site from October 1, 2021, through October 1, 2022, totaled 983,563. The number of visits to the new site from January 1, 2022, through October 31, 2022, totaled 840,935. With an average of 84,094 visits per month in 2022, as of November 1 the new site was on course to exceed the number of users for previous years.

Between January 1, 2022, and September 1, 2022, AJOT had 251 total submissions, slightly less than the number of submissions during the same timeframe in 2021 (N = 280). This is likely due to the transition to our new online article submission platform, which occurred in January 2022, and the drop in submission that occurred around that timeframe. Submission and acceptance rates for the full publication years 2017 to 2022 are presented in Table 2. AJOT received submissions this year from all over the world, representing 23 different countries. Australia (n = 4), Canada (n = 3), Taiwan (n = 2), and Turkey (n = 2) have the highest number of accepted articles outside the United States for 2022. On par with previous years, acceptance rates are slightly higher for U.S. authors (49.41% of accepted articles) compared with international authors (38.0% of accepted articles). However, acceptance rates decreased 15.9% for U.S. authors in 2022, while remaining stable for international authors.

In calendar year 2022, AJOT published Volume 76, which included six regular issues and three supplements. Within the regular issues, 100 research articles and 25 nonresearch articles (e.g., editorials, The Issue Is features, and clinical practice guidelines) were published. Of the 100 research articles published, 23% were instrument development or psychometric studies, 20% were effectiveness studies, 18% were critical literature reviews (e.g., systematic or scoping reviews), and 17% were basic science articles focused on establishing relationships between conditions and occupational limitations, prevalence or incidence of conditions or client factors, predictors of outcomes, or taxonomies. A full breakdown of the types of articles published in 2022, including the evidence-levels for these papers, is presented in Table 3.

Funding for the work published in AJOT has remained relatively stable, with 47 total funding sources reported in Volume 76. Interestingly, the number of studies funded by the National Institutes of Health (NIH) was the lowest in recent history (n = 6), while the number of studies funded by foundations (n = 13) reached an all-time high. International funding sources continue to make up about a third of all funding sources identified in AJOT publications, which is commensurate with the number of papers authored by international authors. A full listing of funding sources is presented in Table 4.

The success of AJOT is highly dependent on the work of our volunteer board (associate editors) and official reviewers. In 2022, the editorial team continued to meet its overarching goal to reduce the time from manuscript submission to acceptance. In total, authors submitting their papers to AJOT can expect to have a first decision about their paper in less than 6 wk; papers making it through the review process are generally accepted within a 3-mo timeframe (time from initial submission to final decision, including revisions and rereviews; see Table 5 for details).

AJOT has been serving the profession for 75 years. As the complexity and demands of our profession have evolved over the years, so have the standards set by the journal. We are proud to publish work that our readers can feel confident was conducted in a rigorous and fidel manner. As we move into 2023, we will continue to hold a high bar for research rigor, while still producing content in ways that are translatable to clinical practice. The AJOT website provides access to hundreds of articles, conference abstracts, clinical practice guidelines, evidence-based connection documents, and special collections. In 2023, we will continue to host monthly AJOT Authors & Issues sessions to take a deep dive into topics and issues important to the profession, and we will provide regular research updates through our new Instagram account. All of these initiatives will support our overarching goal of not only publishing research, but also providing a product that can be translated into practice.

One goal we will carry over from 2022 is exploring ways to engage more occupational therapy students with the journal and provide mentorship opportunities for new reviewers. As these initiatives come to fruition, they will be promoted on the AJOT website and shared via AJOT and AOTA social media platforms.

New goals for 2023 are for AJOT to closely examine our Author Guidelines and copyediting policies, to provide more explicit policy statements (e.g., diversity, equity, inclusion, and justice), and to help guide how and why information on race and ethnicity is collected and presented in the journal. As noted by Kaplan and Bennett (2003), it is a journal’s responsibility to ensure that authors do not write about race in a way that perpetuates racism. We want to create resources and implement practices so that our field can move toward a “contextualization of race and racism” to “ensure equity in representation and dissemination and [to] amplify the voices of [minoritized] people. . . in research” (Johnson et al., 2021, p. 157). We also need to look internally at our own copyediting processes to ensure that, in our effort to strengthen and clarify articles prior to publication (e.g., through grammar or syntax edits), that we are not removing culturally relevant language, changing the meaning of the original author’s work, or detracting from the author’s narrative (Das, 2021). We look forward to taking on these important goals.

In summary, our editorial board has outlined the following specific goals for the 2023 volume year:

• ▪ Promote engagement with the journal through our new AJOT Instagram account.

• ▪ Host monthly AJOT Authors & Issues discussions.

• ▪ Update AJOT documents and resources to reflect best practices for bias-free language and the use of race and ethnicity data in research publications.

• ▪ Publish special issue on Mental Health in Autism and solicit articles for two new special issues (2024) on Recovery of Function After Acquired Neurological Injury and Play in Occupational Therapy.

• ▪ Increase student engagement with AJOT.

• ▪ Provide additional resources and mentorship for new reviewers.

AJOT articles continue to be well cited, resulting in the journal’s highest ever 2-yr impact factor (2.813) and our ranking as the top occupational therapy journal in the world. Moving forward, AJOT remains committed to its key mission, which is to publish peer-reviewed research so that occupational therapy professionals can make informed, evidence-based decisions about best practice. As the professional landscape is affected by social and political events, AJOT will consider how best to support practitioners and publish timely content to help encourage discourse within the profession.