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Announcing the Upcoming Release of the 2022 NBCOT Practice Analyses

The National Board for Certification in Occupational Therapy, Inc. (NBCOT®) is a national not-for-profit organization that provides certification for occupational therapy professionals. NBCOT strives to serve the public interest in its diversity by advancing just, equitable, and inclusive client care and professional practice through evidence-based certification practices and the validation of knowledge essential for effective and safe practice in occupational therapy. In keeping with this mission, and in accordance with professional testing standards (e.g., Standards for Educational and Psychological Testing), we conduct an entry-level practice analysis every five years to ensure that the knowledge assessed by our certification programs is representative of current practice.

What is a Practice Analysis?

A practice analysis is the primary method used by assessment professionals to identify and prioritize the important tasks of a job or profession and the essential knowledge or skills required to perform the essential job functions satisfactorily. For certification purposes, a practice analysis is used to establish a clearly delineated set of domains, tasks, and associated knowledge statements necessary to carry out the responsibilities of the job to the standards required for certification. By linking the certification exams to current entry-level practice, the practice analyses provide the foundation for the validity of the certification exams. For this reason, standards governing the accreditation of certification programs (e.g., National Commission for Certifying Agencies Standards for the Accreditation of Certification Programs, ISO/IEC 17024:2012 Conformity assessment — General requirements for bodies operating certification of persons) require that accredited programs like NBCOT base the content of their certification exams on a current practice analysis study.

About the NBCOT Practice Analyses

To attain the COTA® or OTR® credential, an individual must graduate with an entry-level degree in occupational therapy from an ACOTE®-accredited program, submit an official final transcript, agree to abide by the NBCOT Practice Standards and Code of Conduct, and obtain a passing score on the COTA or OTR certification exam. The certification exams focus on entry-level areas of professional practice that are critical to ensuring that COTAs and OTRs, their clients, their employers, their fellow employees, and the profession are not harmed through actions or services provided by the certificant. To ensure that the certification exams meet this goal, NBCOT conducts a periodic study of the core tasks that comprise entry-level practice for each program and the knowledge required to perform those tasks.

The OTR and COTA practice analyses were conducted simultaneously. The process began in late 2021 when NBCOT OTR staff and members of the board of directors reviewed the current OTR and COTA exam content outlines and provided suggestions for consideration by the practice analysis panels. The staff and board reviews focused on both operational considerations (e.g., including testable knowledge) and external factors (e.g., changes to entry-level practice).

In early 2022, separate practice analysis panels were convened for the OTR and COTA certification programs. Panelists were volunteers who represented varied practice settings and geographic areas in the United States, and the demographic composition of the panels was representative of the larger certificant populations. Each panel included recent certificants, educators in occupational therapy programs, and practitioners who work closely with or supervise new certificants.

The panels were tasked with reviewing and updating the existing performance domains, the core tasks performed by entry-level certificants, and the knowledge required to perform those tasks. The panels also considered the feedback from the internal NBCOT reviews. The result of each panel meeting was an updated content outline reflecting tasks performed by entry-level OTRs and COTAs and knowledge required to perform the core tasks identified in each of the performance domains.

National Validation Surveys

The revised OTR and COTA content outlines developed at the panel meetings formed the basis for the development of two national validation surveys. The primary purpose of the surveys was to validate the domains, tasks, and knowledge statements developed by the OTR and COTA practice analysis panels. The survey also included questions about the respondents’ practice settings, work experiences, and demographic characteristics. The online surveys were sent to all COTAs and OTRs who had been certified for 36 months or less at the time of developing the survey, as this sample represented the individuals most likely to be familiar with the requirements and demands of entry-level practice. The surveys ran for approximately one month, during which time an initial invitation and three reminder emails were sent. Respondents who completed the entire survey were awarded professional development units to use toward their certification renewal and had their name entered into a drawing to win one of five $100 Amazon gift cards.

Development of the 2022 OTR and COTA Examination Content Outlines

The results of the surveys were analyzed and both the OTR and COTA samples were determined to be representative of the population of entry-level certificants. The surveys asked respondents to indicate the relative importance of each domain of practice. In addition, respondents were asked to rate the importance of the identified job tasks to entry-level practice and specify how frequently the task would be performed by an entry-level certificant. Finally, the respondents were asked to evaluate whether the knowledge identified by the practice analysis panels was essential for successful performance of the relevant task. These results were then mathematically combined, using well-established methods, to determine the proportion of the certification exams that should be allocated to assessing each domain, according to its overall criticality.


The 2022 OTR and COTA practice analyses were conducted using well-established methods consistent with professional testing and accreditation standards. These studies provide validity evidence for the content of the certification exams by empirically establishing and documenting the linkage between the exams and current entry-level practice. The 2022 OTR and COTA examination content outlines will be released to the public on the NBCOT website by the end of January 2023, along with executive summaries documenting the methods and findings of the studies.