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.