COTA Exam Sections and Subjects

The COTA exam has 190 items, including single-response multiple-choice items and independent multi-select items. The domains describe the tasks and knowledge you should review.

This domain accounts for 27% of the COTA exam. It covers information gathering, activity analysis, and collaboration with the occupational therapist.

• Recognize influences on occupational performance, including values, beliefs, and spirituality. Consider development and aging, the expected course of the condition, anatomy and function, and the client's experiences and identity.

• Gather information from relevant resources. Understand your competency in assessment activities and how to engage the client.

• Analyze activity demands. Consider personal and environmental factors that affect the client's performance.

• Collaborate with the team. Review team roles, shared plans, care coordination, priorities, and the client's ability to understand health information.

• Monitor the plan with the occupational therapist. Consider the client's context, intervention effectiveness, adaptations, and precautions.

This domain accounts for 55% of the COTA exam. It covers selecting and carrying out interventions.

• Use preparatory techniques and consider the treatment setting. Review wound care, superficial heat and cold, and other physical agents.

• Support participation through leisure, play, graded activities, and groups. Review cognitive, visual, perceptual, and sensory processing, ways to compensate for or restore abilities, activity adaptations, and prevention. Review eating and swallowing, employment and transitions, transfers, wellness, and mental health.

• Carry out rehabilitation interventions, including exercise and movement retraining. Address pain, desensitization, edema, and scars. Review posture, balance, body mechanics, and breathing.

• Use orthoses and prostheses. Review the factors that guide selection and how to train the client in their use.

• Integrate seating, assistive technology, and mobility equipment into intervention. Consider suitability and training in equipment use.

• Support access through ergonomics, universal design, and modifications to the environment.

This domain accounts for 18% of the COTA exam. It covers evidence, safety, compliance, and professional responsibilities.

• Interpret research for practice. Review quality improvement and the health needs of populations.

• Manage safety risks. Review infection control, emergency response, prevention of harm, and professional burnout.

• Follow regulations and reimbursement requirements. Understand professional accountability.

• Maintain competency through professional development. Apply ethical standards to practice decisions.

Plan the largest initial share of study time for Select and Implement Interventions, which accounts for 55% of the COTA exam. Include both remaining domains in your plan.

Use practice results to adjust the time you spend on each task. If you repeatedly miss a topic in a smaller domain, add focused review. Check the task bullets as you work through your study materials.