1 INTRODUCTION
Occupation-based practice (OBP) is a treatment approach which
encompasses the therapeutic use of occupation.1,2. It
is used mostly by occupational therapists.1,2 OBP
aligns with the profession’s philosophical foundation, which is guided
by the belief that health and well-being are strongly associated with
the occupations people perform.3 In South Africa, most
hand therapists are occupational therapists.4 Due to
the dearth of occupational therapists in South Africa and the resultant
demand to manage consistently large caseloads, it is essential that
therapists are equipped to provide hand-injured patients with the most
effective, cost-efficient care. Evidence-based practice is proposed as
one way of ensuring that optimum care is delivered, and received, at
every healthcare contact.5
Hand injuries are common and often catastrophic in South Africa due to
poor work conditions and high rates of road traffic accidents and
interpersonal violence.6 Hand therapy in South Africa
is potentially complex because of the range of occupations which exist
and injuries which can occur; occupational therapists therefore need to
be conversant with current evidence in order to provide the most
effective, and cost-efficient, care.
The strong presence of occupational therapists in the hand therapy arena
should equate to an occupational focus in practice and research. However
this does not appear to be the case. A mapping review of hand therapy
publications over a ten year period exploring the alignment of evidence
underpinning practice, found that hand therapy research is dominated by
exercise and orthotic interventions focusing on specific
diagnoses.9 Similarly, surveys conducted in Australia,
Israel and the USA8,9,10found
that intervention and research focussed on body structures and
functions. The same trend was shown in a recent South African study
which found that hand therapy assessments addressing activity and
participation (occupation) were used infrequently.11
OBP is supported by a growing body of evidence that suggests that it is
more effective than component-based
practice.3,21,25,41,42,43,44 Therefore, identifying
gaps in knowledge, attitudes and/or practices is essential in the
development of strategies for effective interventions. Our intention was
to obtain a comprehensive understanding of how occupational therapists
were implementing OBP in South Africa, when dealing with injured hands.
This knowledge could assist in strengthening the quality of occupational
therapy hand rehabilitation provided in South Africa (in terms of
improved occupational performance and occupational engagement outcomes).
In order to determine this, an instrument that could assess these
components was required. However, an extensive literature search found
no comprehensive survey instrument from any country which assessed
knowledge, attitudes and practices (KAP) about OBP. The main emphasis in
the literature on OBP appeared to be on individual aspects of OBP such
as knowledge12,13,
attitudes/perceptions14,15,16 and practices, with a
specific focus on either assessment or treatment
alone.9,11 Thus there was a knowledge gap in terms of
the availability of a comprehensive survey instrument to measure
occupational therapists’ KAP in OBP.
This article reports on the development of a new instrument to measure
the KAP of hand therapists using OBP, relevant to South African
contexts.