Occupational Therapy Process and Clinical Reasoning
Domain 1 tests whether you can move from referral to discharge using defensible clinical reasoning, not whether you can recite a list of frames of reference. Items often present a practice scenario and ask for the next action, the best rationale, or the documentation that supports a decision.
Core rules
- The occupational therapy process is cyclical: referral/screening, evaluation, intervention, review, and discharge/transition. Evaluation establishes the occupational profile and analyzes performance skills, patterns, contexts, and client priorities.
- Use top-down reasoning: start with the client's desired occupations and participation, then trace supports and barriers. Impairment data are used only when they explain occupational performance.
- Clinical reasoning is plural: procedural (test selection and sequence), interactive (relationship and client response), conditional (future scenarios and prognosis), narrative (client story), ethical (competing obligations), and pragmatic (resources).
- Form hypotheses, triangulate data from interview, observation, records, and standardized measures, then revise. Document the link from data to goal to intervention.
Worked example
A client after stroke wants to cook a simple meal. Strength is reduced, but the decisive problem is divided attention and fear of hot surfaces. The OT observes meal preparation, identifies safety and attention breakdowns, and collaborates on a goal of preparing a microwave meal with setup and a checklist. Intervention combines attention training in the kitchen, environmental layout, and graded practice. Review uses meal-preparation independence and safety errors, not grip strength alone.
Traps
Choosing a modality before defining the occupational problem; treating a test score as the goal; skipping the client's priorities; and writing goals that cannot be measured. Examiners also penalize reasoning that ignores context, caregivers, or discharge setting.