AOTA Offers Choosing Wisely List of Practices to Question

A list of five practices to avoid created to improve the quality and safety of services and offer guidance to clients

BETHESDA, MD—In its continuing mission to help occupational therapy practitioners provide the highest quality care to clients, the American Occupational Therapy Association (AOTA) announces today its recommendations for quality, evidence-based occupational therapy services. The list, “Five Things Patients and Providers Should Question,” was developed through the Association’s participation in Choosing Wisely®.

Choosing Wisely is an initiative of the  ABIM Foundation to help providers and patients engage in conversations that support smart and effective care choices. Recognizing the importance of providers and patients working together, AOTA has joined Choosing Wisely to help improve the quality and safety of occupational therapy services.

“By joining this campaign, AOTA recognizes the importance of taking an active role in promoting quality health care that is supported by evidence, not duplicative of other tests, free from harm, and truly necessary,” said Sherry Keramidas, PhD, FASAE, CAE, Executive Director for AOTA. “These recommendations promote the holistic, client-centered approach to health care that makes occupational therapy distinct.”

Through extensive member feedback, AOTA has listed five services that occupational therapy practitioners should not provide, and that patients should question if offered: 

  1. Don’t provide intervention activities that are non-purposeful (e.g., cones, pegs, shoulder arc, arm bike). Using valued activities is at the core of occupational therapy. Meaningful activities are motivating, build endurance and increase attention.
  2. Don’t provide sensory-based interventions to individual children or youth without documented assessment results of difficulties processing or integrating sensory information. Sensory issues are complex, and an intervention that does not address the correct problem can be ineffective or even harmful.
  3. Don’t use physical agent modalities (PAMs) without providing purposeful and occupation-based intervention activities. Using heat, cold, mechanical devices, electrotherapeutic and other agents without incorporating a purposeful activity is not occupational therapy.
  4. Don’t use pulleys for individuals with a hemiplegic shoulder. Overhead pulleys often lead to shoulder pain among stroke survivors and other individuals with hemiplegia, and should be avoided. Gentler, controlled range of motion exercises and activities are preferred.
  5. Don’t provide cognitive-based interventions (e.g., paper-and-pencil tasks, table-top tasks, cognitive training software) without direct application to occupational performance. Occupational therapy interventions related to cognition should be part of an activity that is important to the person.

For more information on AOTA’s participation in Choosing Wisely, visit


Founded in 1917, the American Occupational Therapy Association (AOTA) represents the professional interests and concerns of more than 213,000 occupational therapists, assistants, and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting professional and educational standards, and serving as an advocate to improve health care. Based in Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, go to