South African Journal of Occupational Therapy

A review of the book: "Children in mind. Their mental health in today's world and what we can do to help" by Jenny Perkel

Munyaradzi Chimara — 2024-11-01

This book is written by Jenny Perkel, a clinical psychologist. The author puts forward the mental health challenges children face in the modern world, and makes valuable recommendations for the clinician working with children for consideration.

South African occupational therapists’ orthotic management of trigger finger and factors influencing their decision regarding splint type

Kuhlekonke V. Mathenjwa — 2024-12-04

Background: Orthotic management of trigger finger refers to the use of splints to immobilise affected joints. The prevalence of trigger finger and the assessment and treatment practices utilised by occupational therapists for this affliction in South Africa, are not yet documented.

Aim: To explore occupational therapists’ orthotic management for clients with trigger finger in KwaZulu-Natal, and the factors influencing the therapists’ decision when prescribing orthoses.

Methods: A quantitative cross-sectional study design was implemented with a sample size of 102 via a stratified random sampling approach. A survey questionnaire was administered. Data were coded using frequencies and then descriptively analysed using SPSS.

Results: Findings indicated that trigger finger is common in clinical settings and the majority (99%) of the occupational therapists use splints when managing trigger finger and as a first line of treatment (69.9%). The joint-blocking splint is preferred by 96.6% of the participants with the MCP joint-blocking splint being favoured by 55.0%. The most considered factors when deciding on the splint type are clinical presentation (99.1%),and the client’s occupation (92.4%), and the most preferred measures of the effectiveness of treatment are pain (97.1%) and range of motion (97%).

Conclusion: The study has demonstrated that the inconsistencies noted in global research also apply in KwaZulu-Natal. Therefore, further investigations on the effectiveness of splinting and a guide on deciding on splint type as well as appropriate outcome measures are necessary to ensure that clients receive optimal care through evidence-based practice.

Implications for occupational therapy practice

This study informs further understanding of the current assessment prior to splinting and treatment practices that occupational therapists in the South African context provide for their clients with trigger finger.
The study demonstrates that irrespective of the participant’s level of experience and their clinical settings, the considerations when deciding on splint types remain the same.
The results are consistent with available literature particularly with which splint type to issue. However, the development for a guide regarding the orthotic management of trigger finger covering aspects like the splint regime and the recommendations of exercises is vital as discrepancies emerged largely from these areas. The type of exercises, stages at which they may be introduced, duration and frequency should be considered for deeper engagement.
The development of this protocol will ensure consistency of treatment and evidence-based practice.

Changes in cognitive functional performance and basic activities of daily living in patients with traumatic brain injury after two methods of cognitive retraining

Denise Franzsen — 2024-12-04

Introduction: Evidence supports a bottom-up approach to assist in addressing functional cognitive deficits in patients with traumatic brain injury (TBI). There is however, little evidence supporting the use of online programmes for this purpose. The aim of this research was to describe the outcomes for cognitive functional performance and basic activities of daily living (bADL) or self-care functioning after cognitive retraining using an online programme versus task-oriented intervention for patients with acute mild and moderate traumatic brain injury (TBIs).

Methods: A quantitative, quasi experimental, longitudinal research design was used for determining within-group and between-groups changes for cognitive functional performance and bADL functioning in two sample groups with mild to moderate TBI. Intervention using an online programme (n=7) or task-oriented activities (n=15) was evaluated at three assessment intervals: on recruitment into the study (Assessment 1), on completion of inpatient hospital intervention (Assessment 2) and after four weeks of home programme intervention and fortnightly outpatient intervention (Assessment 3).

Results: Results for both groups showed a statistically significant change for cognitive functional performance assessed on the Bay Area Functional Performance Evaluation (BaFPE) while the task-oriented cognitive training group also achieved a statistically significant change in bADL scores during the first inpatient assessment period. Only the online programme group had statistically significant improvement during the home programme in the third assessment period.

Conclusion: Cognitive retraining using an online programme or task-oriented activities resulted in positive change in a therapist directed inpatient programme but a structured, graded, online programme was more effective in supporting significant improvement in cognitive functional performance when used with an outpatient home programme.

Implications for practice

Cognitive retraining using an online programme or task orientated activities have a positive outcome for cognitive functional performance in patients with mild or moderate TBI in a therapist directed inpatient intervention.
A task orientated approach for cognitive retraining appears to have positive effect on bADL outcomes.
Cognitive retraining using an online programme intervention should be considered as a home programme to improve cognitive functional performance in patients with mild or moderate TBI.

Occupational therapy in the Snoezelen® Room: Teachers’ and therapists’ knowledge and perceptions of the changes in children's behaviour and performance

Mika Solomon — 2024-12-04

Introduction:

The Snoezelen^® room, a multisensory environment (MSE), is often used in conjunction with sensory integrative techniques. Therefore, it may be of support in school-based occupational therapy intervention. Research has documented positive changes in children’s performance in the MSE. However, research to suggest that changes could be carried over to external environments is limited. This study aimed to investigate the knowledge and perception of teachers and therapists regarding changes in children's behaviour and performance after therapy in the Snoezelen^® room.

Methodology:

A descriptive quantitative cross-sectional survey design by purposive sampling was used. Teachers and therapists working with children who received occupational therapy intervention in the Snoezelen^® room participated.

Results:

Descriptive and inferential statistics were utilized to determine strong positive, significant correlations found between the total impact of the Snoezelen^® room and the children’s level of arousal, as well as their behaviour and scholastic performance, as conveyed by 30 participants. After therapy in the Snoezelen^® room, improvement in level of arousal was ranked as the biggest change, which appeared to improve for hours upon return to the classroom.

Conclusion:

Children’s arousal levels changed positively due to sensory input, which carried over to the external environment. Due to this, most teachers and therapists perceived that the Snoezelen^® room positively changed behaviour and scholastic performance, through improved level of arousal.

Implications for practice:

The use of Snoezelen^® rooms in schools, combined with sensory integration therapy (SIT), enhances children's self-regulation, which in turn positively impacts behaviour and academic performance.
Strong, positive correlations were found between children's level of arousal and improvements in their behaviour and scholastic performance. Thus, Occupational therapy interventions in the Snoezelen^® room significantly contribute to children’s ability to self-regulate, a key factor in achieving positive classroom behaviour and learning outcomes.
Teachers and therapists perceive Snoezelen^® rooms as beneficial, with 96.7% supporting their presence on school campuses to improve child behaviour through better self-regulation.
Consistent with extensive research surrounding self-regulation of children, acquiring self-regulation skills in the early years lays the foundation for positive classroom behaviour and academic performance later

Overview of this issue

Blanche Pretorius — 2024-12-04

Overview of SAJOT Volume 54 No 3

26th Vona du Toit Memorial Lecture - July 2016

Theresa Lorenzo — 2024-12-04

This lecture places the work of occupational therapy support staff on the national workforce development agenda. It argues that the reach of occupational therapy in advancing social transformation can be extended through certified capacitation of different levels of occupational therapy staff. Evidence-based perspectives of the competences of support staff are shared to foreground their contribution to disbability-inclusive development. Recommendations for securing their formal training and recognition in the South African health workforce are offered and suggestios are made to extend their sense of belonging to the occupational therapy profession in meaningful and purposeful ways so that their role is unequivocally addressed in practice, education and research.

An exploration of undergraduate health science students’ experiences of blended learning andragogy: A rapid review

Iesrafeel Abbas — 2024-12-04

Introduction:

Blended learning is defined as the combined use of in-person and online learning, through interactive multimedia and face-to-face engagement with curriculum content. Recently, higher education institutions have experienced major inevitable changes in teaching and learning approaches, sparking interest in the exploration of these approaches- including blended learning.

Aim:

To explore undergraduate health sciences students’ experiences of blended learning.

Method:

A rapid review of articles published in English was conducted between 18^th-22^nd February 2022 using the following databases: Pubmed, Ebscohost, Web of Science, Scopus, Africawide Information and CINAHL. Articles found were exported to Endnote, version 20.2.1. The Preferred Reporting Items for Systematic Reviews and Meta-analysis flow chart was used to document the search. The Critical Appraisal Skills Programme was used to appraise the articles, which were analysed using thematic analysis.

Findings:

Eight quantitative articles were analysed and categorised on the hierarchy of evidence. Three themes emerged: 1. Student engagement and perceptions of blended learning, 2. Student academic performance, and 3. Challenges of blended learning.

Conclusion: Positive experiences of blended learning were reported, including: significant improvement of student academic performance, higher levels of satisfaction and an increased student engagement. Ineffective online learning platforms and/or technological devices resulted in students experiencing anxiety and frustration.

Implications for practice

Blended learning may be a feasible option to maintain and enhance students learning experience.
Students’ academic performance could improve with blended learning
Blended learning could increase students’ engagement within the andragogical field.

Occupational therapy practice in psychiatric day hospitals: A scoping review

July Masango — 2024-11-16

Introduction: The aim of this scoping review was to explore whether clear guidelines for the practice of occupational therapists in psychiatric day hospitals exist, both locally and globally.

Methodology: Searches were conducted in January 2024; 38 articles were screened and 22 were identified for data extraction. Articles were imported onto Covidence software. Data charting was done, and data were exported into a Microsoft Excel sheet, where content analysis was performed based on the review’s objectives. Synthesis of the results was done through discussion and reported according to the PRISMA for Scoping Reviews guidelines.

Results: Thirty-eight articles were included but only 22 were relevant. Group therapy, individualised therapy, vocational and community workshops were identified as common modes of intervention in psychiatric day hospitals. Occupation-based activities are integral to intervention. However, there was no explicit definition regarding the role of occupational therapy and practice guidelines for psychiatric day hospitals.

Conclusion: The general scope of occupational therapy remains the same for overnight hospitals, day hospitals and community-based centres. It is mainly occupation-centred, function-orientated, and patient-centred. However, there remains ambiguity on specific practice principles and guidelines that clearly define the role of occupational therapists in day hospitals. There is a need for occupational therapy practice guidelines specific for psychiatric day hospitals.

Implications for Practice

The study provides valuable insights into the current knowledge and availability regarding the role and scope of practice for occupational therapy in the rapidly expanding psychiatric day hospital setting, emphasising areas for further development.
Tangible evidence was identified on therapeutic principles, practice approaches, program content, and guidance for resource allocation in psychiatric day hospitals, which can be translated into practical guidelines.
Ultimately, the results inform occupational therapy service delivery, solidify the profession’s role in psychiatric care, and contribute towards National Health Insurance (NHI) policy development.

Identifying the gap in assessing activities of daily living in resource-constrained rural settings: An integrative review of existing frameworks and instruments

Jennifer Claire McAdam — 2024-12-04

Introduction: The non-availability of indoor piped water and electricity results in alternate forms of personal care and domestic tasks in resource-constrained rural settings. This article examines the applicability of existing measures for the contextual assessment of basic and instrumental Activities of Daily Living (bADLs and iADLs) in these settings.

Method: An integrative review guided by the approach of Lubbe et al (2020) was conducted. Structured database searches of CINAHL, Scopus and Sabinet identified published articles which were subjected to eligibility criteria. Microsoft Excel was used to synthesize data.

Results: The search strategy yielded 591 articles that met the inclusion criteria, from which 187 ADL instruments were identified. Three instruments suited to resource-constrained rural settings were identified.

Conclusion: Occupational therapists should consider that existing ADL frameworks and instruments appear silent on the impact of limited access to household amenities in resource-constrained settings. This constitutes epistemic injustice as many rural households globally do not have potable water or adequate household energy supply. Global South occupational therapy curricula must include contextually relevant ADL frameworks and development of contextually relevant instruments should be prioritised.

Implications for Practice

The findings suggest that existing ADL instruments have limitations when utilised in the Global South, particularly in resource-constrained rural settings. As such, occupational therapists practicing in such settings need to interpret instrument scores with caution and apply contextual clinical reasoning in the best interests of service users. Furthermore, training institutions in the Global South must ensure that the limitations of existing ADL frameworks, models and instruments are made overt within curricula and that research efforts are directed towards the development of contextually relevant ADL instruments.

Occupational therapy in adult palliative care. A rapid review

Hester M Van Biljon — 2024-12-04

Introduction: The Occupational Therapy Association of South Africa commissioned a task team to gather evidence that would inform the upcoming National Health Insurance policies on the role and practice of occupational therapists. This rapid review aimed to identify level 1 and 2 peer-reviewed published evidence that describes occupational therapists’ practice and intervention in adult palliative care.

Method: Systematic reviews and randomised control trials were searched for through the Stellenbosch University library. CINAHL (EBSCO), MEDLINE (EBSCO), the Cochrane Library (Wiley) and OTSeeker databases were used and hand searching of references in selected articles was done. Rayyan.ai was used for the screening and selection of articles. The CASP appraisal tool was used for quality assessment of the selected articles. Data was captured in Excel and Word and analysed and synthesised in Excel and Taguette.

Results: 15 articles were identified for data extraction in this rapid review. The CASP quality appraisal showed a good rating. Occupational therapists working in palliative care were reported to address: Functionality, activity participation and quality of life, symptom management related to disease and the treatment thereof, environmental modification and adaption, assistive devices and equipment, education and caregiver support and education, lifestyle adaptation, return to work or higher education/training.

Conclusion: South Africa has a unique palliative burden of care due to diseases that shorten life expectancy. Due to the unique and varied beliefs held by South Africans about illness and end of life, evidence from high income countries needs to be supplemented with local knowledge to frame the role and intervention of occupational therapists in palliative care. Evidence to support and define the role of occupational therapists claims this needs to be a matter of priority.

Implications for practice

Contextually relevant palliative care intervention needs to be included in the undergraduate curriculum for occupational therapists and once they go to community service, they need to be supported in this.
Development and upskilling of occupational therapy clinicians in contextually relevant palliative practice at all levels of care need to be an available and accessible continuous professional development (CPD) activity.
Occupational therapy clinicians working on the frontlines of palliative care need to be encouraged and supported to collect and present evidence for their practices in formats and at forums where it can be used to shape policies that affect palliative adult care locally and globally.

OTASA POSITION PAPER

OTASA — 2024-12-04

This position paper on Occupational Therapy in Neonatal Care was ratified by Council in March 2024.

OTASA POSITION PAPER

OTASA Council — 2024-12-04

No Abstract available