State of the Journal, 2020

On July 1, 2020, after 6 years of service to the journal, Lorie Richards stepped down and the American Journal of Occupational Therapy (AJOT) transitioned to a new Editor-in-Chief. Dr. Richards took many steps to increase the methodological rigor and quality of the research in AJOT and ensured that the journal maintained its position as the most highly ranked occupational therapy journal in the world, as measured by its journal impact factor (JIF). As the new Editor-in-Chief, I acknowledge the inherent challenges in taking the helm of a journal that means so much to our association and our profession, yet I also see many opportunities to build on what has been achieved. Although the annual State of the Journal article typically serves to inform readers about the journal’s accomplishments in the past year, I will also use this as an opportunity to tell you where I would like us to go.

This editorial should be considered within the context of what has happened in the world this year. Among a multitude of political, economic, and environmental challenges, the novel coronavirus SARS-CoV-2 has inserted itself into every facet of our lives, affecting nearly every occupation in which we and our clients engage. As a profession, we are having to reimagine and reconfigure how we practice, how we educate, and how we lead. The full extent of the impact of the coronavirus on research has yet to be seen. It is likely that some research will be decelerated because of new safety regulations, yet new opportunities will likely arise as the importance of occupational engagement becomes a global discussion point. As new research emerges, I intend for AJOT to serve as a platform for clinicians, students, and academics worldwide to read about and publish best practices in the profession moving forward.

The significance of an academic journal is quantified by a variety of metrics that help to reflect its relative standing in its field. The JIF, published each year in Journal Citation Report (JCR), is the official research evaluation tool in several countries and is used to rank technical journals by prestige. Although the JIF has been criticized by some as problematic (Bohannon, 2016), impact factor scores still serve as a recognized marker of a journal’s relevance to the field. The JIF is calculated on the basis of how many times articles published in the journal were cited over the past 2-year or 5-year term.

The 2-year JIF is calculated by first determining the number of times the journal’s articles published in the preceding 2 years were cited; that number is then divided by the total number of articles published in the same 2 years. The 5-year JIF is calculated similarly for citations over a longer span of time. The 2-year JIF reflects only those articles that are referenced quickly. In fields such as rehabilitation, in which human research takes time to conduct and publications are slow to be produced, the 5-year JIF may be a better indicator of a journal’s impact.

From 2018 to 2019, AJOT’s 2-year JIF increased from 1.952 to 2.231, and its 5-year JIF increased from 2.868 to 3.220 (Table 1; Clarivate Analytics, 2020). With 4,947 citations in 2019, AJOT currently ranks 1st of 7 occupational therapy journals and 3rd of 71 rehabilitation journals indexed in the JCR Social Sciences Citation Index. AJOT also ranks 18th of 139 rehabilitation journals indexed in the JCR Social Sciences Citation Index and the Science Citation Index Expanded. Systematic reviews were highly cited, as were articles related to interventions for autism spectrum disorder.

Another journal evaluation metric, CiteScore, was launched in December 2016 by Elsevier. Similar to the JIF, the CiteScore is based on the average annual number of citations per article for articles published in a journal. CiteScore, however, is based on the citations recorded in the Scopus database rather than in the JCR, and citations are collected for articles published in the preceding 3 years. Currently AJOT’s CiteScore is 2.50, placing the journal in the 86th percentile of occupational therapy journals, maintaining its rank of 3rd of 18 journals (Scopus, 2020). It is worth noting that Scopus’ definition of occupational therapy journals is broad; for example, the highest ranked journal in this Scopus category is the Journal of Occupational Rehabilitation. The category also includes the Journal of Vocational Rehabilitation and Physiotherapy Practice and Research.

Although the JIF and CiteScore hold an important space in academia, they are, most simply put, citation indexes, not measures of quality or importance to the profession. Citations, by nature, are the outcome of research being published and of other researchers, both internal and external to occupational therapy, using that work to build knowledge. Although this process of knowledge building is essential to the growth and security of the profession, the publication and citation of research alone lack significance if that research is never translated into practice. AJOT has worked to bridge the gap between research and practice by collaborating with the American Occupational Therapy Association (AOTA) Evidence-Based Practice Program to publish systematic reviews, practice guidelines, and Evidence Connection articles, all of which digest large bodies of literature into articles geared toward informing practice.

In addition, we are exploring ways to enhance AJOT’s web features to allow for more engagement between researchers and practitioners. According to Google Analytics, visits to the AJOT website (https://ajot.aota.org/) surpassed 1.5 million in 2019, with an average of 2.23 sessions per user. We have also seen increases in website access in 2020: between January 1 and June 30, 450,076 users visited the website, nearly 100,000 more than during the same period in 2019 (350,487).

Analysis of the website statistics also helps us understand who is accessing AJOT’s content. Although the majority of website users in 2019 were from the United States (73.9%), a quarter of users were international, with significant representation from the United Kingdom, Australia, Spain, Taiwan, Canada, Brazil, France, South Korea, France, and China. This is an important reminder that although it is a publication of AOTA, a U.S. association, AJOT is truly an international journal.

Between January 1 and June 30, 2020, AJOT received 198 submissions, slightly more than the 190 submissions received during the same time frame in 2019. Submissions and acceptance rates for 2015 to 2020 are presented in Table 2.

Like its overall readership, AJOT authors originate from around the world. In 2020, 52.3% of AJOT manuscript submissions had corresponding authors based in the United States; the remaining 47.7% of submissions had international corresponding authors representing 23 other countries, including Spain (7.6%), Taiwan (6.6%), Israel (6.1%), and Australia (5.6%). Although generally commensurate with submission statistics, U.S. authors had a slightly higher acceptance rate (65.3% of total accepted papers) than international authors (34.7% of total accepted papers).

Volume 74 of AJOT was published in calendar year 2020 and consisted of six regular issues and three supplements. The regular issues contained 93 research articles and 17 non–research articles (Table 2). Non–research articles included editorials, The Issue Is articles, and features such as the Evidence Connection articles. Of the 93 research articles published, just more than one-quarter (25.8%) were systematic or scoping reviews, representing a 34% increase from the previous year. The number of effectiveness studies and basic research articles decreased (Table 3). Of the 39 articles that were either systematic reviews or articles examining intervention effectiveness, 41% provide Level I evidence, a lower percentage than in recent years. The percentage of Level IV studies doubled; many of these descriptive studies analyzed outcomes from single-subject design studies or case reports. Lower level studies often describe new areas of research and provide a foundation for higher level clinical trials moving forward.

The trend toward publication of fewer clinical trials (Level I evidence) may correspond to changes in funding observed for articles published in 2020. As noted in Table 4, the number of studies funded by the National Institutes of Health and U.S. foundations and associations was reduced by half compared with 2019. Whether this decrease suggests a national trend or is specific to our journal remains to be seen. The number of studies supported by international funding sources remained relatively stable from 2019 to 2020, although internationally funded research now represents a greater percentage of articles published in the journal. We did see an increase in the number of research studies supported by private donations and other sources such as hospitals, suggesting that researchers may be finding other avenues to support their work.

At any given time, AJOT is managing more than 1,000 articles in the submission, review, preproduction, and production phases. It might be surprising that AJOT operates with only two dedicated staff—the Editor-in-Chief (part-time) and the managing editor, with freelancers handling the copy editing and proofreading. The majority of work for the journal is completed by our volunteer board of 14 associate editors and our growing cadre of more than 300 official reviewers. Like our readership, our volunteers represent multiple specialty areas within occupational therapy and are based around the world. The quality of our review process continues to depend on editors and reviewers who are willing to share their skills in the service of the profession.

Between January 1 and June 30, 2020, AJOT reviewers completed 394 reviews. During this time frame, 573 review requests were sent to reviewers, suggesting that nearly a third of review requests are being declined. Although this decline rate is commensurate with previous years, it does present a problem both for the journal and for authors, because it lengthens the overall review timeline. The high number of declines and nonresponses by reviewers is likely the result of multiple work demands, compounded now by the multitude of personal and professional changes instigated by the coronavirus (e.g., having to spend more time revising courses, caring for children while working from home). As part of ongoing attempts to reduce the time from submission to decision, AJOT continues to add members to its official reviewer pool and is in the process of revising reviewer forms to increase the ease and speed of the review process. We will continue to ensure that every article submitted to AJOT receives two quality peer reviews, and when reviewers are difficult to find, editorial board members may serve as the second reviewer to speed up the review process. AJOT’s editorial board is committed to providing a fair and expedited review process, and we are committed to improving the submission-to-acceptance time for all manuscripts. (Table 5).

In January 2019, AJOT transitioned to online-only publishing. Although production time has decreased, there still are costs associated with article production and online publishing that influence the number of articles we are able to accept. The journal has been affected by the coronavirus pandemic in the form of budget cuts that were implemented in March 2020. These cuts have forced us to reduce the number of manuscripts we accept for each issue in the 2021 volume to 15. We hope that as our world, country, and national association rebound from the impacts of the coronavirus, we will be able to return to our normal publication of 17 to 19 articles per issue and our overall time from submission to publication will not be significantly affected.

The coronavirus is not the only challenge the world is currently facing. In the United States, the killings of George Floyd, Breonna Taylor, and Ahmaud Arbery (among others) have generated a national discourse on racial injustice and inequalities. As a journal, we must examine our own history and practices to identify areas in which we can do better. As part of this process, an AJOT Diversity, Equity, and Inclusion Advisory Committee has been formed to better guide our actions moving forward. We have already begun a process of systematically analyzing the makeup of our leadership and improving the transparency of our processes. Part of that transparency is making sure all individuals understand the editorial and leadership roles within the journal and have an equal opportunity to become involved at various stages of the editorial process. Figure 1 was developed to outline the different roles individuals may hold within the journal. Our goal is to be intentional in ensuring that a diverse group is in the pipeline to hold leadership positions with the journal. In addition, AJOT will work intentionally to solicit manuscripts that address issues related to occupational engagement in diverse communities and to feature research focused on diversity, equity, and inclusion issues as they relate to our profession.

As it did for editors-in-chief who came before me, my new role provides an opportunity to set a vision for the journal during my 3-year term. In accepting this role, I was moved by an article by Harvey Marcovitch, an editor for the BMJ Publishing Group and associate editor of the British Medical Journal. In “What Medical Journal Editing Means to Me,” Marcovitch (2008) noted that an editor’s first loyalty should be to readers, prioritizing readability over mere production of a repository of data for the scientific community.

Although it is essential that AJOT maintain its high standards for publishing rigorous research, our JIF cannot be the only metric we use to evaluate AJOT’s impact on the profession. AJOT must offer new ways to engage readers and help authors communicate their science to a broad audience, and I envision that over the next 3 years, authors and readers will engage with AJOT in new and innovative ways. For example, there is an opportunity for website users to spend more time on the site, not only finding articles but also engaging with the content. Features such as methods videos, podcasts, research briefs, discussion forums, and virtual issues are all being considered. Regardless of the format, new content will be digestible, accessible, and easily searchable so that practitioners can use knowledge to inform practice, because informed clinicians will ultimately lead to better patient care (Marcovitch, 2008).

The AJOT editorial board has outlined the following specific goals for the 2021 volume year:

• Revise review forms to make the review process more expedient and align critiques with standard evaluation tools

• Recruit new official reviewers who are demographically diverse and who have expertise in content or methods currently lacking in our review panel

• Solicit manuscripts in the areas of health services research; diversity, equity, and inclusion issues; occupational justice; and original research on the effectiveness of interventions that are important to the profession yet underrepresented in our journal

• Update the AJOT website and possibly transition to a new platform that will allow for more features and user engagement.

On the basis of current statistics, we are on track to have the highest number of submissions to AJOT in the history of the journal. This increase, although welcome, will be challenging because we are able to accept fewer submissions and reviewers are busier than ever. The editorial team is committed to maintaining AJOT’s status as the world’s leading occupational therapy journal and will continue to examine and revise our procedures to ensure fair and expedient article reviews. Our journal will continue to operate in the national and international context, to serve authors and readers from around the world, and to publish content that is relevant to clients’ participation in occupations and to the profession of occupational therapy.