Helen Buchanan

Survey Instruments for Knowledge, Skills, Attitudes and Behaviour Related to Evidence-based Practice in Occupational Therapy: A Systematic Review.

The purpose of this study was to evaluate, through a systematic review, assessment instruments for evidence-based practice (EBP). The specific objectives were to (1) identify survey instruments testing EBP knowledge, skills, attitudes and behaviour; (2) determine the attributes measured by each instrument; (3) evaluate the psychometric properties of the instruments; and (4) evaluate the methodological quality of the instruments. Using the Cochrane approach, searches were conducted in Pubmed, EBSCOHost and Scopus from inception to February 2014. Papers were screened by two independent assessors, and data were extracted by one researcher. Forty papers reporting 34 instruments met the inclusion criteria and were included in the qualitative synthesis. Most instruments measured EBP behaviour (n = 33) and attitudes (n = 21). This review provides a single source of information to enable researchers to select the most robust descriptive instruments to measure EBP learner attributes. Instruments used only with occupational therapists may have resulted in some instruments being missed. For further research, it is recommended that attention is given to developing objective instruments with a focus on knowledge and skills. Copyright

Comparison of an interactive with a didactic educational intervention for improving the evidence-based practice knowledge of occupational therapists in the public health sector in South Africa: a randomised controlled trial

BackgroundDespite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks.MethodsA matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants’ places of employment. Audit raters were blinded, but participants and the provider could not be blinded.ResultsTwenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI = -4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P = 0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI = -7.7, 27.0) but this was not significant (P = 0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T = 4.0, P <0.001; DE: T = 12.0, P = 0.002) but no significant differences in attitudes or behaviour.ConclusionsThe results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect.Trial registrationPan African Controlled Trials Register PACTR201201000346141, registered 31 January 2012. Clinical Trials NCT01512823, registered 1 February 2012. South African National Clinical Trial Register DOH2710093067, registered 27 October 2009. The first participants were randomly assigned on 16 July 2008.

The uptake of evidence-based practice by occupational therapists in South Africa

Abstract The occupational therapy profession has made considerable advances towards becoming an evidence-based profession. Yet, much of the efforts to develop evidence-based occupational therapy (EBOT) have occurred in upper-income countries and there is a noticeable lack of publications from resource-constrained countries. Possible reasons for this will be explored using South Africa (SA) as an example. The activities that have been undertaken to promote EBOT in SA are described and the barriers and facilitators to its uptake in this context are discussed. The article will conclude by outlining strategies to realise the vision of occupational therapy as a global evidence-based profession

Embracing Cultural Diversity: Meaningful Engagement for Older Adults With Advanced Dementia in a Residential Care Setting

Providing person-centered care (PCC) that focuses on meaningful engagement in residential care settings for older adults with moderate to advanced dementia is an internationally recognized challenge. In this study, we aimed to identify best-practice scenarios for supporting older adults with moderate to advanced dementia from culturally and linguistically diverse backgrounds who lived in care facilities. A mixed-methods study with a concurrent triangulation strategy was adopted. Data collection occurred with care partners by means of a preworkshop questionnaire, an appreciative-inquiry workshop, and an adapted Delphi technique. The findings indicate that care partners valued the care facilities’ residents’ needs for doing, being, and belonging. Collaborative data generation reflected the setting-specific PCC practices. Leadership team members agreed that enabling inclusion and celebrating cultural diversity were important but that cultural humility needed to be promoted.

The validity and clinical utility of the Disabilities of the Arm Shoulder and Hand questionnaire for hand injuries in developing country contexts: A systematic review

Study Design: Systematic review. Introduction: The Disabilities of the Arm Shoulder and Hand Questionnaire has multiple language versions from many countries around the world. In addition there is extensive research evidence of its psychometric properties. Purpose of the Study: The purpose of this study was to systematically review the evidence available on the validity and clinical utility of the Disabilities of the Arm Shoulder and Hand as a measure of activity and participation in patients with musculoskeletal hand injuries in developing country contexts. Methods: We registered the review with international prospective register of systematic reviews prior to conducting a comprehensive literature search and extracting descriptive data. Two reviewers independently assessed methodological quality with the Consensus‐Based Standards for the Selection of Health Measurement Instruments critical appraisal tool, the checklist to operationalize measurement characteristics of patient‐rated outcome measures and the multidimensional model of clinical utility. Results: Fourteen studies reporting 12 language versions met the eligibility criteria. Two language versions (Persian and Turkish) had an overall rating of good, and one (Thai) had an overall rating of excellent for cross‐cultural validity. The remaining 9 language versions had an overall poor rating for cross‐cultural validity. Content and construct validity and clinical utility yielded similar results. Discussion/Conclusions: Poor quality ratings for validity and clinical utility were due to insufficient documentation of results and inadequate psychometric testing. With the increase in migration and globalization, hand therapists are likely to require a range of culturally adapted and translated versions of the Disabilities of the Arm Shoulder and Hand. Recommendations include rigorous application and reporting of cross‐cultural adaptation, appropriate psychometric testing, and testing of clinical utility in routine clinical practice.

Novice therapists in a developing context: Extending the reach of hand rehabilitation

Introduction Hand rehabilitation needs in some parts of the world extend beyond the impact of specialised hand therapists. This study aimed to establish what hand rehabilitation services novice occupational therapists in South Africa were providing; the supports and barriers for such services; and, therapists’ perceptions of being equipped for hand rehabilitation. Methods A descriptive cross-sectional study was conducted, and an online questionnaire was sent to all occupational therapists in their first year of practice (n = 240). Data were analysed with Stata 12 and IBM SPSS Statistics, version 21.0. Responses to open ended questions were post-coded. Results A 43.3% response rate was obtained. Participants (n = 104) treated an average of 20 clients requiring hand rehabilitation per month often without adequate equipment (73%). Central nervous system (91.3%), bone and joint (72.8%) and arthritic conditions (72.4%) were treated most frequently. Most participants felt confident (64%) and competent (79%) in hand rehabilitation. Conclusion Participants were undertaking hand rehabilitation that in other contexts is considered to require specialised skills. To ensure quality rehabilitation, supervision and mentoring of novice therapists and appropriate professional development opportunities are required.

The first WFOT Congress in Africa: History in the making:

As a founding member of the World Federation of Occupational Therapists (WFOT), the Occupational Therapy Association of South Africa is honoured to be co-hosting the 17th WFOT Congress in Cape Town, South Africa, from 21–25 May 2018. It marks an historic moment, as the first WFOT Congress to be held on the African continent. The congress theme, Connected in diversity: positioned for impact, will address key international areas, including social and occupational injustice and health and well-being. The theme acknowledges the multiple interpretations and inter-connectedness of occupational therapy in relation to human relationships and human occupation. As occupational therapy perspectives continue to evolve internationally, and especially in the Global South, new directions for research and practice are emerging. Developments grounded in critical perspectives are increasingly creating spaces for reflexivity and dialogue. The WFOT 2018 Congress provides an international platform to further theorise about human occupation and investigate the ways in which it ‘has translated into research, practice and curricula reform’ (Ramugondo et al., 2015: 1). The WFOT 2018 team acknowledges the financial constraints, and also the consequences of language barriers that exist in accessing and attending the congress. With this in mind we are exploring having keynote addresses available via podcast. And, recognising that congress participation may in itself be viewed as a collective occupation (Ramugondo and Kronenberg, 2015), the WFOT 2018 team aspires to further promote access to the congress through presentations reflecting issues relevant to diverse contexts. The Congress programme affords opportunities for delegates to discuss research and practice issues relating to human occupation in context and the roles of occupational therapy and its partners in shaping participation in societies. Together with exploring the impact of practice and research and processes of engagement, it provides the opportunity to examine and celebrate the profession’s positions in interdisciplinary and transdisciplinary education, research and practice. While occupational therapy in South Africa, and in many African countries, has Eurocentric origins, the profession is increasingly being repositioned through contextually relevant research and

Fostering evidence-based practice in community-based rehabilitation: Strategies for implementation

Occupational therapists around the world are taking up the challenge to implement an evidence-based practice approach to the development of occupational therapy services. The emphasis in applying evidence-based practice within occupational therapy has been strongly biomedical in focus. In South Africa, many occupational therapists work in communities where their work is largely community-based rehabilitation. With no examples of how evidence-based practice can be applied in such settings, therapists have struggled with how it may be used to inform their practice. This paper explores the concepts of evidence-based practice and community-based rehabilitation, and illustrates how evidence-based practice can be applied within community-based rehabilitation. Examples are provided to show how evidence-based practice can realistically be applied in community-based rehabilitation programmes with the intention of empowering therapists to begin using evidence as a basis for their practice. It further explores how evidence-based practice can be used by occupational therapists to inform decision-making related to the development of community-based rehabilitation programmes and services. Key words: evidence-based practice, community-based rehabilitation, occupational therapy, practice-based evidence