One of the most popular interventions provided by occupational therapists for pediatric clients is Ayres Sensory Integration® (ASI). Strict fidelity measures consisting of procedural and structural elements must be adhered to when using it. These fidelity measures distinguish Ayres Sensory Integration® from other sensory-based interventions. This study involved the development of a survey instrument and outlined the challenges that Malaysian occupational therapists face when using Ayres sensory integration® (ASI). The questionnaire development involved the processes of assessing its validity and reliability. A total of 161 occupational therapists working in various healthcare settings responded to the survey by answering a self-administered questionnaire. The results identified eight themes or issues: (1) Inadequate Training, (2) Resource Issues, (3) Physical Constraints, (4) Time Constraints, (5) Limited Information/ Support Provided By Family, (6) Limited Support From Management, (7) Limited Information/Support Provided By Suppliers, and (8) Issues in Implementing Evidence-Based Practice. Identifying the challenges of implementing ASI is an important aspect of improving occupational therapy assessments and interventions, which would establish the effectiveness of the interventions provided.

Introduction: A popular intervention for paediatric clients, Ayres Sensory Integration® (ASI) must adhere to sensory integration (SI) fidelity. This study describes fidelity adherence in ASI intervention by occupational therapy practitioners in Malaysia. Methods: A questionnaire on ASI fidelity was developed before being tested for its validity by seven experts and for its internal consistency and test-retest reliability by 30 occupational therapists. The questionnaire was then used nationally to collect data on ASI practitioners. Data were collected from 161 occupational therapists working in various settings. Results: The mean of the sub-scales I-CVI was excellent, ranging between 0.97 and 1.00. The total S-CVI/Ave of the form was also reported as excellent, at 0.98, with subscales S-CVI ranging between 0.75 and 1.00. Cronbach’s alpha was 0.80 for the questionnaire’s internal consistency and the ICC for test-retest reliability ranged from 0.80 to 0.95. The survey received 161 responses, indicating that most respondents perceived themselves as having ‘moderate competence’ and showing ‘high interest’ in ASI implementation. Most fidelity aspects were addressed in their practices. Majority of the respondents adhered to the process elements. It was indicated that three aspects of physical space under the structural elements could not be provided by most occupational therapists in the study. Conclusion: To implement evidence-based practice, adherence to fidelity when providing ASI is important to ascertain its effectiveness. Improvements to ensure optimal space, ASI certification, and more related training are the first steps that can be taken by the related agencies to ensure effective ASI intervention could be delivered.