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Thirteen OMIs (~1,500 participants) were identified, revealing a substantial geographical bias toward the Global North. Although 61.5% (\n                    <jats:italic toggle=\"yes\">n =<\/jats:italic>\n                    8) were classified as Category A (Recommended), only the Evidence-Based Professional Thinking Tool (EIPT) demonstrated a \u201chigh\u201d level of certainty of evidence. Critical shortcomings persist: while only one instrument reported minimal important change values, none identified minimal important differences. Current assessment tools exhibit methodological weaknesses and limited parameters for interpreting scores. Given that the evidence base is largely in a pilot stage, future research should prioritize cross-cultural adaptation, establish interpretive thresholds, and include observable, performance-based measures to improve the quality of assessment and evidence-based practice in occupational therapy education and clinical settings. Trial registration: PROSPERO (CRD420251270730).\n                  <\/jats:p>","DOI":"10.1177\/15394492261490104","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T11:06:53Z","timestamp":1792235213000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Instruments for Assessing Professional Reasoning in Occupational Therapy: A Systematic Review"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5007-8160","authenticated-orcid":false,"given":"Soledad","family":"S\u00e1nchez-Zamorano","sequence":"first","affiliation":[{"name":"Escuela de Salud, Universidad de O\u2019Higgins, Rancagua, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4450-1021","authenticated-orcid":false,"given":"Andrea","family":"Mart\u00ednez-Riquelme","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Universidad de Santiago de Chile, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7115-1197","authenticated-orcid":false,"given":"Mar\u00eda-Paz","family":"Ossand\u00f3n-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Departamento de Kinesiolog\u00eda, Universidad Metropolitana de Ciencias de la Educaci\u00f3n, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8733-8746","authenticated-orcid":false,"given":"Pedro","family":"Moruno-Miralles","sequence":"additional","affiliation":[{"name":"Departamento de Enfermer\u00eda, Fisioterapia y Terapia Ocupacional, Universidad de Castilla-La Mancha, Talavera de la Reina, Espa\u00f1a"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"crossref","unstructured":"American Occupational Therapy Association. 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