South African Journal of Occupational Therapy

GUEST EDITORIAL SA Journal of Occupational Therapy Laying claim to occupational therapy practice, one rapid review at a time

Shaheed Soeker — Mon, 08 Jul 2024 00:00:00 +0000

No Abstract

Clinical evaluation, useability, and utility of the Work Ability Screening Profile II (WASP II)

Denise Franzse, Thavanesi Gurayah, Kerry Magill, Patricia de Witt — Mon, 08 Jul 2024 00:00:00 +0000

Introduction: The Work Ability Screening Profile (WASP) was conceptualised and developed by occupational therapists at the University of Durban Westville to provide a basic vocational screening assessment. Its purpose was to screen competence in generic work skills which reflected performance in activities essential to workplace participation relevant to the South African context. The assessment was revised in 2005 and renamed the WASP II. It was decided this screening assessment tool would be continuously reviewed using action research with clinicians involved in the ongoing evaluation so ensure validity and reliability for the population with which it is used. This study considered the clinical evaluation, useability and utility of the WASP II in order to inform further revision.

Method: A cross sectional survey was used to gather data from 70 occupational therapy clinicians familiar with or using the WASP II in clinical practice.

Results: A sample of 70 respondents indicated the WASP II was suitable to assess current work ability and production speed with a variety of clients with physical and mental health dysfunction. Ten of the 12 subtests were used by at least 40% of the time by the 28 respondents who used the WASP II frequently. These respondents reported good to adequate useability in terms of cost, sensitivity to clients’ educational level and ease of understanding instructions, incorporation into clinical practice contexts while supporting clinical reasoning and judgement. The accommodation of clients’ language and provision of standard scores were indicated as inadequate. Utility was considered adequate for all aspects including discrimination of moderate to severe dysfunction, informing the choice of other assessmentsas well as supporting vocational rehabilitation intervention. The WASP II outcomes were also understood by other service providers, employers, referring parties as well asclients.

Conclusion: While the WASP II was considered appropriate for use in the South African context and has adequate useability and utility, some subtests need to be updated and revised in terms of the standard times and content validity for current practice in the work environment.

Activities of daily living with grasp types and force measurements during object manipulation

Monique M. Keller, Roline Y. Barnes, Corlia Brandt — Mon, 08 Jul 2024 00:00:00 +0000

Background: Limited scientific evidence guides hand rehabilitation towards improved hand function, and safe early return to work. Grasp types, the subunits of object manipulation and the forces which may improve functional outcomes, have been identified as missing links that may inform rehabilitation after second to fifth metacarpal fractures, through progression of basic and instrumental activities of daily living (ADL). The aim of the study was to collect ADL forces through grasp types to inform hand rehabilitation for second to fifth metacarpal fractures.

Methods: This cross-sectional, quantitative study included 32 conveniently sampled healthy adults aged 20 and 59 years. Thirty-one (31) ADLs, both basic and instrumental, each associated with a predominant grasp type, were tested. The participants donned two testing gloves, with force sensing resistors (FSRs) glued to the fingertips, the ADLs were performed, and forces measured. The researcher imported the force data into an Excel spreadsheet for both descriptive and inferential analyses with STATA.

Results: Fourteen males and 18 females, with a mean age of 37 years, participated. Statistically significant differences between genders were found for seven grasp types. Three thumb-adducted power palm grasps, three thumb-abduction precision pad grasps, and one thumb-abduction power palm grasp constituted the testing. Light and heavy ADLs and their associated grasp types were identified.

Conclusion: To ensure optimal hand function, early safe return to ADLs should be the goal of second to fifth metacarpal fracture rehabilitation and may be achieved by incorporating active grasp types as exercises with graded resisted grasp types and ADLs.

The occupation of self-employment in South African informal microenterprises

Luther Lebogang Monareng, Daleen Casteleijn , Denise Franzsen — Mon, 08 Jul 2024 00:00:00 +0000

Introduction: Self-employment, in which individuals work for themselves in a small business or microenterprise to earn an income or generate a salary, has been encouraged to facilitate employment opportunities in South Africa. However, participation in self- employment within the community served by professionals such as occupational therapists is limited by many factors, including effective government initiatives, such as implementing the Small Enterprise Development Agency (SEDA) policies. To enable individuals and community participation in this type of work for those with occupational dysfunction, mainly persons with disabilities, professionals such as occupational therapists need to understand the structural, contextual and occupational outcomes related to self-employment. Based on the Framework for Occupational Justice, this study explored the occupation of self-employment in microenterprises in the low- resourced urban community of Alexandra Township.

Method: A quantitative descriptive non-experimental design study was used to identify informal microenterprises in the community using a transect walk and community mapping. Structured interviews were conducted to complete a questionnaire with key informants (service providers and business owners) who provided perceptions on factors that impacted the occupational outcomes of microenterprises.

Results: Structural and contextual factors from the participants' experience resulted in unjust occupational outcomes, which indicates that occupational rights, particularly participation, choice and balance, were negatively affected by the lack of opportunities, such as jobs. Occupational marginalisation and imbalance were reported since many businesses lacked adequate and appropriate space for trade. Some business owners, however, reported just occupational outcomes related to the occupational right for meaningful occupation in providing a service to the community and financial income to support themselves and their families.

Conclusion: Occupational therapists need to play various active roles in raising the consciousness of unjust occupational outcomes and support for just occupational outcomes that are achieved in engagement in self-employment in informal microenterprises.

Cultural perspectives and experiences of mental healthcare in Kwa-Zulu Natal, South Africa

Ashira Moonsamy, Thavanesi Gurayah — Mon, 08 Jul 2024 00:00:00 +0000

Background: Healthcare systems reflect worldviews, specifically in mental health, where norms dictate what is normal and abnormal. The era of coloniality promoted Western dogma over collectivist cultures, which were marginalised. This study explored the perspectives and experiences of Black, isiZulu-speaking, South Africans who utilised multidisciplinary services, based on a Western-based therapy model at a private psychiatric facility in KwaZulu Natal.

Methods: A qualitative descriptive design was utilised. Purposive sampling was utilised to recruit 10 participants. Data was collected through semi-structured interviews. Braun and Clarke’s six phases of thematic analysis were used to guide the data analysis.

Findings: Three themes with sub-themes emerged from the data: personal perceptions, which explored how isiZulu-speaking people made sense of mental health and mental illnesses. Cultural perceptions were the collectivist method of problem-solving, which stressed the importance of spiritual beliefs. Health-seeking behaviour considered the experience of the isiZulu-speaking mental health care user. Cognitive dissonance prevailed due to the difference between westernised mental health treatment and traditional healing systems.

Conclusion: The family and community are intertwined in participation, reputation, and healing. There is an emphasis on enduring hardship and following traditions, which are preserved by valued elders. Disregarding these norms can outcast the Zulu individual who strives toward inclusion within the community.

Clinical utility of MODAPTS during work assessment: Perceptions of South African occupational therapists

Mon, 08 Jul 2024 00:00:00 +0000

Introduction: Clinical utility is an important attribute in selecting an assessment tool. The study aimed to determine the perceptions of South African occupational therapists of the clinical utility of Modular Arrangement of Predetermined Time Standards (MODAPTS) work samples when assessing a client’s work ability. The research objectives were to determine whether MODAPTS is perceived to be credible, practical, useful, and easy to use.

Methodology: A quantitative, cross-sectional, descriptive research design was used. Non-probability sampling with elements of voluntary response- and snowball sampling was used to recruit respondents. An electronic questionnaire was developed using Qualtrics, which was distributed electronically via the Occupational Therapy Association of South Africa, WhatsApp and Telegram.

Results: Data were based on 52 completed questionnaires, analysed through descriptive statistics. MODAPTS was perceived as practical, useful, credible, and asy to use in practice. Main barriers to the use of MODAPTS included the timeliness of developing work samples, lack of MODAPTS training, and having other more useful and reliable assessment tools. Experienced occupational therapists used MODAPTS more often than inexperienced occupational therapists.

Conclusion: Clinical utility of work samples developed using MODAPTS has been confirmed. This supports the use of work samples developed using MODAPTS as part of work assessments as a cost- effective, practical tool.

Occupational therapists’ perspectives on knowledge transfer in clinical practice in the Free State, South Africa

Azette Swanepoe, Corlia Janse van Vuuren, Shoba Naya — Mon, 08 Jul 2024 00:00:00 +0000

Background: The transfer of all types of knowledge in occupational therapy practice is complex, and there is little agreement globally on the most important types of knowledge that inform clinical practice. This study aimed to uncover the perspectives of occupational therapists in the Free State, South Africa on knowledge transfer in clinical practice.

Methodology: Q methodology was used to collect data from 14 occupational therapists utilising Q Method Software.

Results: Factor analysis revealed two factors with eigenvalues of greater than 1. Factor 1 had an eigenvalue of 2.97, and factor 2 had an eigenvalue of 1.48. These two factors were constructed from six and five participants’ Q Sorts respectively, with the highest factor loads for factor 1 and factor 2. Thematic content analysis of these two factors identified two themes, namely: client-centred philosophy and practice informed through clinical reasoning.

Conclusion: The strategic use of Q methodology presented empirical evidence of the transfer and utilisation of all types of knowledge in clinical practice in the Free State, South Africa. The results indicated the transfer of propositional, procedural, personal, and client knowledge strengthens client-centred practice and manifests in clinical reasoning. Furthermore, the results indicate an interdependence between the types of knowledge, meaning that it is important that therapists utilise all types of knowledge and not rely on only one form of knowledge when they work with patients to promote well-being.

Perceptions on transitioning from impairment-based to occupation-based practice in public healthcare within KwaZulu-Natal

Phana Lucy Gumede, Chantal Juanita Christopher, Deshini Naidoo — Mon, 08 Jul 2024 00:00:00 +0000

Introduction: Holistic healthcare service delivery requires rehabilitation personnel to consider all the components of health that influence the client's quality of life. However, there is limited literature on approaches to implementing rehabilitation services within South African public healthcare. This study explored rehabilitation personnel's (such as occupational therapists, speech therapists, physiotherapists) use of occupation-based practice impairment-based practice and the barriers and facilitators associated with their practice choice.

Methods: A qualitative research design was conducted through semi- structured interviews (13 participants), a focus group (4 participants) and community mapping. Purposive sampling was utilised to select participants in the iLembe district, KwaZulu- Natal, South Africa. Data were analysed using deductive thematic analysis.

Findings: Three themes emerged from the study; Attitudes towards impairment-based practice, Reflections on OBP, and The way forward. The need to focus on all the components of health rather than just the disease and the benefits of using the occupation-based practice approach were highlighted. Additionally, different factors required to implement holistic rehabilitation services and the barriers to OBP were identified.

Conclusion: Although the study identified OBP benefits, various barriers associated with its implementation were identified. Rehabilitation personnel, community stakeholders, and clients must work together to improve OBP implementation in public healthcare by combating the barriers identified in the study.

Occupational therapy interventions for Autism Spectrum Disorders - a Rapid Review

Janke van der Walt, Madri Engelbrecht, Hester van Biljon, Shaheed M. Soeker — Mon, 08 Jul 2024 00:00:00 +0000

Introduction: This rapid review aimed to synthesise evidence for occupational therapy intervention in the management of autism spectrum disorders. The review forms part of a series of rapid reviews commissioned by the Occupational Therapy Association of South Africa to help inform decision making as South Africa prepares for a new health system.

Method: Level I and II research studies published from 2017 - 2022 were considered for inclusion. Electronic database searches were conducted on the Cochrane database. The identified records were screened in Rayyan according to inclusion and exclusion criteria. Quality assessment of the selected articles was done with the CASP appraisal tool. Data were extracted to a custom Microsoft Excel® worksheet and analysed quantitatively by percentage/frequency and qualitatively by thematic analysis of statements.

Results: Thirty-eight records were selected. These included 30 systematic reviews and eight randomised controlled trials. Twelve intervention domains across four age groups were identified with sensory integration and social skills interventions most frequently examined. Interventions were delivered across various venues, including mediation and technology (e.g., telehealth interventions). A number of different outcome measures were used.

Conclusion: There is evidence to support the effectiveness of occupational therapy interventions for autism spectrum disorder across the lifespan for twelve different domains.

Occupational therapy practice with burn injuries: A Rapid Review

Mon, 08 Jul 2024 00:00:00 +0000

Introduction: The Occupational Therapy Association of South African commissioned a task team to gather evidence that would inform upcoming National Health 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 all types of burn injuries, at all levels of care, and for all age groups.

Method: Using the South African Department of Health template and the Cochran Rapid Reviews method guide, a search for level 1 and 2 evidence sourced articles from CINAHL (EBSCO), MEDLINE (EBSCO), the Cochrane Library (Wiley) and OTSeeker data bases through the Stellenbosch University library with hand searching of references in the selected articles. Rayyan was used for the screening and selection of articles. The CASP appraisal tool was used for risk bias and quality assessment of the selected articles. Data was captured in Excel and Word, and analysed and synthesised in Microsoft Excel and Taguette. Results were presented in the form of an online workshop to stakeholders and discussions and questions incorporated into the discussion and conclusion of this review.

Results: Eleven articles were selected and their quality assessed. Seven categories of evidence of occupational therapy interventions were extracted from selected articles: pain, oedema, scaring and abnormal skin sensations, joints and range of motion, psycho-social and functional impact of burn injuries, the education of burn injury victims and their families, and vocational rehabilitation. All interventions took place in healthcare facilities. Nine articles referred to occupational therapists working in multi- disciplinary teams. Occupational therapist worked with children and adult burn injury victims and with a variety of type of burn injury from acute to post discharge phases.

Conclusion: There is level 1 and 2 evidence conderming occupational therapy intervention with burn injury victims with all ages and at all stages of injury within healthcare facilities. None of the evidence found is from the South African context. Such levels of evidence are needed to promote occupational therapy intervention in primary, preventative and community contexts.

The role of occupational therapy serving LGBTQIA+ people: Retrospective perceptions of an occupational therapist

Sannet Tintinger, Thabani Ncwane, Naazneen Ebrahim — Mon, 08 Jul 2024 00:00:00 +0000

Introduction and aim: LGBTQIA+ people constitute a minority group that navigate their occupational engagement within a historically entrenched system of oppression. This opinion piece addresses a subject matter that is increasingly garnering attention from the international health science community, yet it remains insufficiently explored in South African occupational therapy dialogues. The aim of this paper is to stimulate critical reflection among occupational therapists on the discourses that underpin our daily practice. By utilising the person-environment-occupation model, we seek to demonstrate the unique and essential role of occupational therapy in serving LGBTQIA+ people within the South African context.

Conclusion: Although occupational therapists are trained to consider all aspects of a person, discussions around gender are rarely emphasised in undergraduate training or clinical practice. This opinion piece demonstrates the roles that occupational therapists may play when working with LGBTQIA+ people to provide services that are holistic and relevant to their needs and contexts. Recognizing the impact of everyday occupational therapy practices on LGBTQIA+ individuals is crucial, requiring a commitment to inclusivity and continuous reflection within the field of occupational therapy.

Book Review

Helen Roome — Mon, 08 Jul 2024 00:00:00 +0000

No Abstract