South African Journal of Occupational Therapy

Occupational therapy treatment protocols for cerebrovascular accidents: a rapid review of evidence

Engelbrecht Madri — 2024-08-09

Introduction: The rising prevalence of stroke in sub-Saharan Africa necessitates the exploration of the role of occupational therapy in rehabilitation of stroke. In the southern African country of South Africa, occupational therapy aligns with healthcare policies and laws, and this article presents a review of synthesized evidence of occupational therapy intervention in stroke care and rehabilitation.

Method: Rapid review methodology was used to develop a research question about cerebrovascular accident - intervention by occupational therapists., The Cochrane Library and MEDLINE databases were searched for relevant articles published between 2018 and 2023. Twenty four articles met the inclusion criteria and were analysed according to quantitative and qualitative parameters.

Results: Evidence of occupational therapy intervention with post-stroke upper limb impairment was found in 37,5% of articles. Occupational therapy for global improvement in function, cognitive rehabilitation, balance, social participation, work, and leisure comprised 45,8% of articles, and one article each reported evidence for occupational therapy addressing ADL and caregiver interventions.

Conclusion: Evidence from the past five years reflect diverse occupational therapy interventions with clients with stroke. Gaps in recent evidence remain in relation to context-specific interventions, especially from low- and middle-income countries.

Implications for practice

Occupational therapists should adopt a holistic approach to stroke rehabilitation, tailoring interventions to address the multifaceted needs and goals of individual stroke survivors. The effectiveness of individualised, occupation-based approaches across various domains are highlighted.

Therapists should stay informed about emerging technologies and evidence-based practice to enhance their effectiveness in stroke rehabilitation.
Given the prevalence of upper limb impairments post-stroke, therapists should be well-versed in diverse intervention approaches for upper limb rehabilitation, including technologies like Brain Computer Interface, Mental Practice, Mirror Therapy, and Action Observation Therapy.
Occupational therapy is vital in addressing cognitive impairments in stroke survivors, and practitioners should explore interventions such as Virtual Reality and computer-assisted cognitive rehabilitation that have shown promise in improving cognition and ADL.

26th Vona du Toit Memorial Lecture

Tania Rauch van der Merwe — 2024-08-09

The 26th Vona du Toit Memorial Lecture was peresented on 4 July 2024 at the OTASA Conference, South Africa.

School-related gender-based violence: A call for action in occupational therapy

Sylnita Swartz-Filies — 2024-08-09

School-related Gender-based Violence (SRGBV) is a sub-set of gender-based violence (GBV) that occurs in primary and secondary school settings. SRGBV is a daunting reality, a crime against humanity, and therefore a human rights issue. Responsive SRGBV programmes need to be dynamic, and determined by the needs of communities and learners. If the Department of Basic Education (DBE) wants to remain relevant in supporting communities into becoming safe spaces for all, it needs to promote safe community models with adequate flexibility. Although school-based occupational therapists are a human resource of the DBE, traditionally occupational therapists have not been involved in addressing SRGBV in school settings in South Africa. This opinion paper elaborates on the context within which school-based occupational therapists can reframe SRGBV as an occupational injustice, and develop life skills interventions that address SRGBV. Recommendations for action are made using existing frameworks such as the Participatory Occupational Justice Framework, and the INSPIRE framework of the United Nations. It encourages school-based occupational therapists to become activists that promote occupational justice, and are leaders in the prevention of and intervention for SRGBV

Reflections on the 10th World Congress of Cognitive and Behavioural Therapies: Lessons for African occupational therapists

Nicola Ann Plastow — 2024-08-09

Cognitive behavioural therapy (CBT) is a well-researched and evidence-based psychotherapy that is underutilised in Africa. CBT presents opportunities for occupational therapists to expand their practice, for example by promoting engagement in meaningful and purposeful activity (behavioural activation), engaging with a mental health care user’s thoughts during and after participation in activity (cognitive restructuring), and grading exposure to traumatic activities (exposure therapy). However, it is also critical that occupational therapists using CBT techniques culturally adapt these for their practice context and engage in professional development activities to develop their competencies as CBT practitioners. This commentary highlights recent advances in CBT practice and calls for CBT and associated techniques to be made more accessible to mental health care users in Africa.

Implications for practice

The relationship between participation and mental health is gaining prominence within the field of CBT. Occupational therapists should position themselves as experts in the therapeutic use of activity.
Occupational therapists using CBT techniques should culturally adapt their practice to meet the mental health needs of people living in Africa.
Occupational therapists using CBT techniques should follow internationally recognised pathways to CBT professional development, and register as Affiliated Members of the Cognitive Behavioural Therapy Association of South Africa

Expanding the visibility and accessibility of the SAJOT

Blanche Pretorius — 2024-08-09

An overview of articles published in the latest edition of the SAJOT: Volume 54 Number 2. Published August 2024

Face- and content validity of the University of the Free State In-Hand Manipulation Assessment instrument (UFSIHMAI) for children in South Africa

Marieta M Visser — 2024-08-09

Introduction: No standardised assessment instrument that covers all the components of in-hand manipulation (IHM) with evidence of instrument development and psychometric properties appropriate for South African children is currently available for occupational therapists. The University of the Free State In-Hand Manipulation Assessment Instrument (UFS IHMAI) is in the process of development to gain recognition as a standardised assessment instrument for children in South Africa. This article reports on the first and second stages of the face- and content validation process of the UFS IHMAI.

Method: A quantitative descriptive study design with a convenient sampling method was used. Participants provided their expert judgment by completing an EvaSys© online questionnaire.

Results: Fifty-five occupational therapists with experience in paediatric hand function, and registered with the HPCSA and OTASA participated. The participants agreed (above 80% consensus) that the instrument's content is relevant and representative to assess all components (separately and as a whole) of IHM that it was intended to measure. Participants' comments and practical recommendations will form an important knowledge-base for the instrument developers to use in the third stage of content validity, namely revising and refinement.

Conclusion: The results confirmed the face- and content validity of the UFS IHMAI and supported the further development and psychometric testing of the assessment instrument for children in South Africa.

Implications for practice:

This article builds upon prior studies in which therapists in South Africa have recognised the necessity for an in -hand-manipulation (IHM) assessment. It offers a concise overview of instrument development theory and delineates the iterative process employed in developing the first draft of the University of the Free State In-Hand Manipulation Assessment Instrument (UFS IHMAI). Additionally, this article furnishes background details regarding the proposed instrument's content, administration, and scoring guidelines. It also incorporates therapists’ perspectives as end-user, providing informed perceptions and consensus on the content validity of the proposed instrument. The suggestions provided by the participating therapist working within the South African context can be employed by the researchers to inform the revision, reconstruction, and refinement of the instrument. Subsequently, the revised version will undergo another round of content validity testing (with experts in instrument development, and in the field) and other psychometric testing. As instrument development is an iterative and ongoing refinement process, the implication of this research might only become apparent after further studies.

The therapeutic impact of occupational therapy groups on the activity participation of persons with major depressive disorder in an acute mental health setting

Annalie F. Meyer — 2024-08-14

ABSTRACT

Introduction: Participation in meaningful activities is compromised in mental health care users living with major depressive disorder. In acute mental health settings, occupational therapy groups are the main treatment modality used to address occupational dysfunction or activity participation in these mental health care users. However, the evidence for the therapeutic impact of occupational therapy groups on activity participation is limited.

This study aimed to determine change in the activity participation of mental healthcare users with major depression attending occupational therapy groups based on the Occupational Therapy Interactive Group Model during their admission to an acute private mental health setting.

Method: A quasi-experimental, longitudinal, pre-post group study design was employed to collect data from a sample of 70 participants diagnosed with major depressive disorder. The Activity Participation Outcome Measure (APOM) was used to measure change in activity participation in this study.

Results: A significant improvement in activity participation was evident from admission to discharge across all the domains of the APOM. Correlations between the independent variables and improvement in APOM scores indicated stronger correlations for the number of groups attended by participants than their length of stay. Additionally, closed groups yielded a stronger correlation with improvement in APOM scores in comparison to open groups.

Discussion: Occupational therapy groups play an integral role in the road to healing for mental health care users diagnosed with major depression admitted to acute private mental health settings.

Implications for Practice:

Incorporating the Occupational Therapy Interactive Groupwork Model (OTIGM) in the treatment of patients with major depressive disorder, especially with closed groups, enables members to experience a sense of security and continuity, which can enhance therapeutic outcomes.
Integrating tools such as the APOM in clinical settings to measure the efficacy of interventions and identify areas needing further attention, will build evidence-based practice.

Incorporating stress management techniques, such as mindfulness, relaxation therapy, Tension Release Exercises (TRE) and sensory activities, into the therapeutic regimen can be highly beneficial in the treatment of the acute symptoms of major depressive disorder

South African occupational therapy students' reflections on ethical tensions experienced during fieldwork

Aaqil De Vries — 2024-08-14

Introduction: Ethical tensions are routinely encountered by occupational therapists and students in fieldwork and may impact patient care and team morale, and lead to practitioner burnout. Ethics education is a means to reduce ethical tensions in fieldwork. Despite this, however, limited research exists regarding ethical tensions and ethics education amongst students in the South African context.

Methods: The study was conducted to explore South African occupational therapy students' reflections on ethical tensions experienced in fieldwork practice. A qualitative, descriptive design was used to review thirty-five ethics reflective journals by fourth-year occupational therapy students at a university in South Africa. Students identified ethical tensions, reflected on these using Sokol’s decision-making framework and Kolb’s Cycle of Experiential Learning, and incorporated their learning into practice. Data were analysed thematically. Trustworthiness was ensured through triangulation of researchers, multiple data sources, and an audit trail.

Findings: Three central themes emerged: (1) Ethics from the perspective of the student, (2) Ethical tensions experienced during fieldwork, and (3) How students navigated ethical tensions.

Conclusion: This study provides an insight into the ethical tensions and reflections of fourth-year occupational therapy students during fieldwork. Findings inform healthcare educators and clinicians regarding students’ perceptions about ethics education and the tensions experienced during fieldwork.

Implications for practice

Students experienced ethical tensions during fieldwork and navigated these ethical tensions by following institutional procedures, acquiring knowledge through research, drawing from the “well” of experience, and reflective practice.
The study offers a narrative for encountering and resolving ethical tension during
The main distinction between the two classifications persists when reviewing the support given to the participant who has been empowered to resolve the ethical tension whilst receiving consultation from their site clinician and the institution.
Findings inform healthcare educators and clinicians regarding students’ perceptions about ethics education and the tensions experienced during fieldwork.

Environmental facilitators and barriers to community reintegration experienced by stroke survivors in an under-resourced urban metropolitan sub-district

Patricia A De Witt — 2024-08-09

Background: Despite inpatient rehabilitation many stroke survivors struggle with community reintegration on returning home. The environment to which the stroke survivor returns affects and may limit participation in home and community-based activities.

Aim: To describe stroke survivors’ lived experiences of the environmental barriers and facilitators to community reintegration in an under resourced urban metropolitan sub-district in the Western Cape, South Africa.

Methods: A descriptive, qualitative study design with a phenomenological emphasis used semi-structured interviews to collect the data from purposefully selected stroke survivors who had been discharged for more than one year following inpatient rehabilitation. Supporting data were collected from interviews with two occupational therapists providing rehabilitation services to the stroke survivors. Deductive priori coding of semi-structured interviews with 11 stroke survivors, based on the environment subsystems described in the Person-Environment-Occupation-Performance (PEOP) model explored the barriers and facilitators to their community reintegration.

Findings: Of the six environmental sub systems in the PEOP model the systems and policy, access to information and health education, social determinants of health in the form of poor rehabilitation planning and loss of income as well as the built and natural environment presented the greatest barriers to the stroke survivor participants community reintegration. However, reintegration was facilitated by social support and social capital, social determinants of health in the form of support groups as well as assistive technologies.

Conclusion: Community reintegration continues to be a challenge for stroke survivors in an under-resourced urban sub-district due to environmental barriers associated with factors such as poor social support, inadequate implementation of policies and systems, poor compliance with home programmes, low socioeconomic status, poor access within the built and natural environment and inappropriate assistive devices. Several facilitators that occupational therapists can focus on to enable community reintegration included ensuring effective social support, access to community-based organisations, the introduction of home visits and provision of appropriate assistive devices.

Implications for practice

All stroke survivors must receive a comprehensive discharge plan to facilitate adequate access to continued rehabilitation and support for successful community reintegration.

There must be a specific referral to primary health care rehabilitation services on discharge from hospital.
Occupational therapists at community level have the responsibility to:
- advocate for, or assist stroke survivors to self-advocate, the removal of intersectoral environmental barriers that limit their community reintegration and community participation,
- where possible provide services in the home and involve midlevel workers when conducting home visits to enable successful reintegration into the home and resumption of occupational roles where possible,
- look to other resources in their community that can assist in facilitating the community reintegration of stroke survivors to enable access to health, education, productive activities, and social and leisure participation opportunities,
- improve their collaboration with the communities that they service.

Occupational therapists’ perceptions of a school-to-work transition programme for learners at a special educational needs school

Henry Msimango — 2024-08-09

Introduction: South Africa has a high unemployment rate and few post-school employment opportunities for learners with disabilities. School-to-work transition programmes in special educational needs schools prepare learners with disabilities for work in the open labour market, optimizing post-school employment opportunities. Occupational therapists are the main key role players in facilitating school-to-work transition programme in many contexts of education.

Aim: This study explores the perceptions of occupational therapists of a school-to-work transition programme at the school for learners with special needs.

Methods: This study was a descriptive qualitative study. The researchers conducted semi-structured interviews with six occupational therapists involved in delivering the programme at the school. To ensure ethical compliance, we obtained clearance from the UP-Research Ethics Committee. The collected data underwent reflective thematic analysis for interpretation.

Findings: Three prominent themes surfaced during the study's analysis: (1) The Significance of the Programme: Participants highlighted the importance and benefits of the program. (2) Facilitators affecting school-to-work transition programme: Various factors that positively influenced the smooth transition from school to the workforce were identified and discussed. (3) Barriers to school-to-work transition programme: Participants also pointed out obstacles and challenges that hindered the successful transition from school to the workforce.

Conclusion: The school-to-work transition programme was influenced by personal, environmental, and occupational barriers and facilitators. The findings highlighted that the benefits of the programme should be viewed in a broader context, as learners mature and develop self-confidence. The value of the programme thus extends beyond employment opportunities.

Implications for practice

The research findings inform barriers that need to be focused on in order to have a successful and effective school-to-work transition programme. There are facilitators that show the perceived effectiveness of the school-to-work transition programme, that could assist in motivating for more assistance from stakeholders of the school.

Rehabilitation and work reintegration within the disability claims management process: A South African Private Insurer Perspective

Dineshree Reddy — 2024-08-09

Background: Maintaining or promoting employment in the presence of disability or reducing the impact of disability on employability should be the adopted focus to decrease the negative impact that disability has on the economy and just as important on the livelihood and well-being of exposed insured individuals. Group risk disability insurance protects an employee’s income when illness or injury result in work disability. To achieve this factors that promote the success of rehabilitation and support for return-to-work of employees following illness and injury needs to be understood from an insurance perspective.

Objectives: To explore principles of disability claims management during the rehabilitation and work reintegration stage using a multi-stakeholder approach for the purpose of successful return to work.

Methods: An exploratory qualitative design was used to collect data via semi-structured interviews with 26 purposively selected participants. Interviews were audio-recorded, data were transcribed and analysed thematically. Qualitative research was used to understand the necessary role players in the work reintegration process, factors that hinder and promote work reintegration and best practice principles for Disability Claims Management (DCM)

Results: Three themes emerged from the study; (i) role players and their functions with collaboration is integral to disability claims management, (ii) various factors promote and restrict return-to-work planning, and (iii) best practice principles in the DCM pathway that promote return-to-work. These principles include behavioural economics as the central principle, with resource identification and competency, governance, role engagement and education and awareness as supporting principles.

Conclusion: Collaborative and integrated approaches by role players within a workers’ family unit, health system, employer structure and insurance compensation are required for positive return-to-work outcomes. The various role players are responsible for creating policies, structures, intervention strategies, and environments that foster return-to-work.

Implications for practice

An integrated approach is required for optimal RTW outcomes as employers’ policies restrict work integration.
A collaborative approach by all role players involved in DCM, focusing on positive RTW outcomes is required in the RTW process
Occupational therapists can influence employer incapacity and disability policies in order to keep people employed and productive in the presence of medical conditions with the application of reasonable accommodations where necessary.
Occupational therapists are suitably positioned to outline workplace environment and other supports required to guide and support employees through rehabilitation and RTW and in ensuring that employees who can remain at work while on a partial or fully insured benefit, can engage optimally in aspects of work function.

Appropriateness of the standard manual wheelchair for occupational performance by wheelchair users in the Thulamela Municipality of the Vhembe District, Limpopo, South Africa

Helga Lister — 2024-08-15

Background: Wheelchairs are an essential assistive device that assists with the facilitation of engagement in occupation especially those that require mobility. Anecdotally, there have been identified gaps in implementation of areas of wheelchair service delivery which included the referral, assessments, prescription, user and provider training, follow up and maintenance. Therefore, there was a need to investigate the appropriateness of the standard manual wheelchair for occupational performance in Thulamela Municipality Vhembe District, Limpopo.

Methods: An observational cross-sectional descriptive design using simple random sampling was used to select n=60 wheelchair users who were issued with standard manual wheelchairs between 2014 and 2018. The Wheelchair Outcome Measure was used to investigate the participants' level of satisfaction in engagement in ADL and IADL and the suitability of the wheelchair in terms of the user’s comfort and satisfaction with positioning and prevention of skin breakdown. Descriptive statistics were used to analyse the data.

Results: The wheelchair users viewed activity participation in the home as important and were generally satisfied with their standard manual wheelchairs while performing occupational activities at home and outside the home. A total of (n=46; 78%) of the participants felt comfortable in their wheelchair.

Conclusions: Wheelchair prescription should take into consideration the occupational choices of the user. Further qualitative studies to explore the factors that determined the participants' choices for their activity participation goals should be undertaken.

Implications for practice

Implementation of training programmes is necessary for new occupational therapy staff in each facility within the Thulamela district to ensure they acquire the competence to prescribe wheelchairs effectively.
Occupational therapists should prioritise clients' occupational preferences when prescribing wheelchairs, with due cognisance of the importance the wheelchair user places on activity participation both at home and in the community.
Occupational therapists need to prescribe wheelchairs that facilitate participation in a wide range of occupational choices ranging from self-care activities, leisure activities like watching TV in the home to visiting friends and family and attending community events.

Online Assessment and Feedback Experiences of Occupational Therapy Students

Hoosen Tasneem — 2024-08-09

Introduction: The COVID-19 pandemic brought about a global crisis in higher education, where students were required to transition to emergency remote teaching (ERT). This study explored students' experiences of online assessments and feedback during the pandemic to inform future practice.

Methodology: This study utilised a descriptive cross-sectional quantitative design with purposeful sampling to describe student's experiences of online assessments. Data were collected from occupational therapy students in 2022. The Assessment Experiences Questionnaire was sent to all eligible participants (n=166). Data were analysed using SPSS version 28.

Results: Students reported that 'tackling' assignments made them apply their learning more deeply (79.75%; n=63). More than half of the students learned more from doing assignments than studying course material (61.25%; n=49). Majority of students felt they did not receive timely feedback through online assessments (67.5%, n=54), which impacted their learning. More than half of the students use feedback in preparation for assignments (56.25%; n=45), hence timely and quality feedback is needed.

Conclusion: Occupational therapy students had a positive experience of online assessments; however, the transition was challenging. It is recommended for lecturers to consider the challenges of online assessments, the number of assessments and timely feedback for an effective online learning process.

Implications for Practice

For online learning to be effective, relevant and timely access to resources and support systems are required. These include internet access, resources like laptops and smartphones which facilitate engagement with remote learning.
The provision of institutional and academic support can positively influence students' experiences of online learning.
Timing and quality of feedback is essential to the online learning experience. Delayed feedback can negatively impact learning, emphasising the importance of timely feedback to aid student growth and improved learning outcomes.
Students experiences and perceptions of how they receive feedback change over time. Thus, personalised feedback focusing on improvement rather than comparison to peers should be emphasised in the learning environments to which they are exposed.
The importance of effective time management in students is emphasised for online learning and students need to be equipped with these skills for this mode of learning.

A review of the book Written Out : The Silencing of Regina Gelana Twala written by Joel Cabrite. Review by Phumla Motsa

Phumla Motsa — 2024-08-09

A review of the book from an Occupational Therapist's perspective.