The changes in the health care system occurring in response to health care reform have created an environment of opportunity for occupational therapy that has never been seen before. The U.S. health care system is now looking at health broadly. The system is beginning to define health across the continuum, as delineated in the World Health Organization’s (2001) International Classification of Functioning, Disability and Health. Outcomes are being examined not only in the traditional area of body structures and functions but also at the level of activity and participation.
At no time in history has the U.S. health care system engaged in conversations about how to facilitate healthy living at all levels of health, including healthy participation in life roles. It is clear that the ability to engage in meaningful occupations is important to health (Blaxter, 1990; Glass, de Leon, Marottoli, & Berkman, 1999; Wilcock, 2006), and occupational therapy is the profession that specializes in helping people reach a richer and healthier engagement in occupations (American Occupational Therapy Association [AOTA], 2014). Therefore, occupational therapy is critical to the creation and maintenance of a healthier population.
Contributions to the Centennial Vision
In the early 21st century, AOTA created a Centennial Vision for the profession: “We envision that occupational therapy is a powerful, widely recognized, science-driven, and evidence-based profession with a globally connected and diverse workforce meeting society’s occupational needs” (AOTA, 2007, p. 613). The steps delineated to reach this vision were designed to position occupational therapy to take advantage of the emerging opportunities created by health care reform and to be a major contributor to health care policy decisions and key player in health care systems. Occupational therapy will not be able to take advantage of the wealth of opportunities afforded by health care reform if we are not involved in the conversations concerning the development of new health care service models and the creation of health care policies. Our inclusion in these discussions will happen only if occupational therapy is better known and has a stronger base of evidence for how its interventions promote unique changes toward more healthy and satisfying lives.
The American Journal of Occupational Therapy (AJOT) contributes to the Centennial Vision through its commitment to publishing the highest quality research that provides strong evidence for occupational therapy practice. Occupational engagement is complex. Therefore, the scope of research topics that support occupational therapy is broad. Research topics that support occupational therapy include
Knowledge of the interplay between occupation and health and well-being,
Basic science delineating the mechanisms of client factors and performance skills needed to successfully engage in occupations,
Incidence and prevalence of impairments in these factors in specific populations that establish the need for occupational therapy services,
Factors that impede or facilitate engagement in occupation,
Assessments that are sensitive and valid measures of occupational engagement, and
Efficacy and effectiveness of interventions to facilitate enhanced engagement in occupations.
AJOT will continue to publish articles in all of these areas. Because the need for evidence on intervention effectiveness is paramount, AJOT will continue to place emphasis on assessment and intervention studies.
Increasing Visibility of AJOT
The efforts of the immediate past editor-in-chief of AJOT, Sharon Gutman, and of her predecessors, Mary Corcoran and Betty Hasselkus, have fostered increases in the visibility of occupational therapy practice and research. These increases have been achieved in several ways. For example, one of the most important factors in increasing the visibility of occupational therapy research has been the tremendous increase in the quality of publications in AJOT, achieved in part by the adoption of publication standards such as the CONSORT (Consolidated Standards of Reporting Trials; Moher et al., 2010) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; Moher, Liberati, Tetzlaff, Altman, & PRISMA Group, 2009) guidelines for publishing randomized controlled trials and systematic reviews. Other successful strategies have included encouraging interdisciplinary collaborations, increasing the number of online databases indexing AJOT, and increasing media exposure of research findings. In these ways occupational therapy research has become more visible and respected among other health care and education professions.
A frequently used proxy measure of the importance of research is the journal impact factor. This statistic is calculated by the Journal Citation Reports as the frequency with which the “average article” published in a journal in the previous 2 yr is cited in other indexed journals during the target year (e.g., the number of times articles published in 2012 and 2013 that were cited in 2014) divided by the number of publications in the journal in those years (Stegmann, 1997). AJOT’s 2-yr impact factor in 2013 was 1.552, and its 5-yr impact factor was 1.831. Although the 2-yr impact factor continues the upward trend of the past decade, the slight dip in the 5-yr impact factor reflects increased competition from other journals and reinforces the need for the journal to solicit and publish only the highest quality, most relevant research. AJOT is now ranked 19th of 69 journals in the Journal Citation Reports’ Social Science Division (Gutman, 2014).
It is our goal to continue to see increases in AJOT’s impact factor to be on par with similar professional journals. A journal’s impact factor is likely to increase the more accessible a journal is. This year, AJOT will move to continuous online publishing, meaning that articles will be available sooner and on a fee-per-article basis. This move should make AJOT articles more accessible to occupational therapy clinicians and researchers and also to other professionals.
Looking Toward the Future
The need for a strong base of evidence for the importance of engagement in meaningful occupations to health and quality of life across the lifespan will only increase in the near future, particularly as occupational therapy expands into new areas of practice, such as primary care. The evidence for the efficacy and effectiveness of occupational therapy interventions is also going to increase as more occupational therapy researchers conduct high-quality clinical trials. AJOT aims to be one of the primary outlets for the dissemination of such research. I envision a future in which other health care professionals turn to AJOT as a primary reading source for knowledge of effective health care interventions.
Occupational therapy researchers need to be involved in additional areas, and we need to increase publications in these areas in AJOT. Increased emphasis in the health care system is being placed on high-functioning interdisciplinary teams that provide seamless care; thus, occupational therapy needs to be demonstrating the value of its services within those interdisciplinary programs. In addition, occupational therapy researchers need to be involved in health services economics research, which asks questions about how people get access to health care services, how much those services cost, and what happens to individuals as a result of this care (Agency for Healthcare Research and Quality, 2001). Health services economics researchers investigate the social, financial, structural, procedural, and personal behavior factors that affect access to, quality of, and cost of health care and the ways in which those factors affect health and quality of life. Occupational therapy needs to be demonstrating the potential economic value of its services to the health care system and society by fostering healthier and more productive lifestyles.
An additional need is for occupational therapy research on best practices for educating new health care professionals, both within disciplines and across professions. An exquisitely functioning interdisciplinary health care team requires members with higher level professional skills than multidisciplinary teams in which each profession operates in near autonomy (Interprofessional Education Collaborative Expert Panel, 2011). Such interdisciplinary teams require team members with a strong understanding of the scope and value of their own professions and the ability to think flexibly and interactively with other professions. To date, little high-level research has addressed best practices in higher education in general and within the health professions. Occupational therapy needs stronger evidence to provide guidance for best practice educational methods to strengthen the skills of entry-level graduates so they are ready to participate at the top of the game in the new health care environment.
Recently, the focus on interdisciplinary education has increased (Interprofessional Education Collaborative Expert Panel, 2011) as recognition grows that educating health professionals in isolation does not lead to high-functioning interdisciplinary teams. Occupational therapy needs to be involved in research examining best practices for interdisciplinary education. AJOT is interested in publishing well-conducted studies of educational practices, both within occupational therapy and in interprofessional education.
Call for Action
AJOT is making and will continue to make a significant contribution to AOTA’s Centennial Vision to make occupational therapy a well-known and well-respected profession viewed as a critical part of health care and educational teams. However, AJOT needs the help of occupational therapy researchers. I reiterate the call to the profession made by the previous editor-in-chief, Sharon Gutman (2010): Commit to publish high-level occupational therapy and interdisciplinary research in AJOT. We must fight against the barriers to such publishing. We must advocate with our interdisciplinary colleagues to publish some of their work in AJOT. Often large trials generate copious amounts of data that have to be disseminated in several manuscripts, and we should encourage our interdisciplinary colleagues to publish at least one of those manuscripts in AJOT.
In addition, we must educate tenure and promotion boards about the importance of occupational therapy research being published in AJOT. Because AJOT is the flagship journal for the occupational therapy profession in the United States, tenure and promotion boards need to understand how critical it is to our profession that occupational therapy researchers in their institutions contribute high-quality research to the journal. As more high-quality research is published in the journal, the increasing impact factor will ease tenure decision concerns and contribute to raising the profile of the profession.