Occupation-based treatment approaches and outcome measures in South African hand therapy: a cross-sectional survey

Introduction: South African occupational therapists provide hand therapy in various health sectors and there is a need for a clearer understanding of the use of occupational based hand therapy among therapists. This study aimed to describe how South African occupational therapists working in hand therapy perceive and use occupation-based treatment approaches and outcome measures to assess clients’ participation in activities and occupations.  Methodology: A quantitative cross – sectional survey design was used. Using convenience sampling, the survey was distributed through occupational therapy societies and social media platforms. Respondents completed an online survey which consisted of demographic information and thereafter focused on the use of occupation-based treatment approaches and outcome measures used. Descriptive statistics were calculated using Microsoft excel.   Results: Seventy-two respondents completed the questionnaire. 80.6% of respondents believe occupation- based treatment approaches and outcomes measures are extremely important. 66% of respondents use these interventions less than half of their time. 95.8% of respondents use clinician-rated body function and structure outcome measures often/very often, 18.1% respondents use clinician-rated occupation-based outcome measures often/very often.  Conclusion: Majority of respondents regard the use of occupation-based intervention as extremely important, however less than half of them report that they use these approaches more than half of the time.  Implication for practice Occupational therapists in South Africa value occupation-based approaches in hand therapy as 80.6% of respondents believe it is "extremely important" to address clients’ occupational needs. Despite recognising the importance, therapists spend limited time using occupation-based approaches in practice as 66% of respondents reported spending less than half their treatment time using occupation-based approaches. Several barriers limit the implementation of occupation-based approaches which include lack of familiarity with occupation-based instruments, limited resources, funding constraints, and restricted treatment time. Occupational therapists working in the field of hand therapy in South Africa focus more on aspects of body functions and structures rather than activity and participation. In addition, environmental barriers to participation are not frequently addressed in treatment. There seems to be a lack of clear understanding of occupation-based approaches, moreover occupation-based outcome measures are used infrequently in South African hand therapy. When occupation-based approaches are employed work-related tasks, dressing, and self-care are commonly used in treatment, mirroring findings from American studies.