Scielo RSS <![CDATA[South African Journal of Occupational Therapy]]> http://www.scielo.org.za/rss.php?pid=2310-383320140001&lang=en vol. 44 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Occupational therapy at the University of the Witwatersrand - The past, the present and the future</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Identifying the factors that contribute to hand writing problems experienced by students at a higher education institution in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100002&lng=en&nrm=iso&tlng=en The assessment of the handwriting of students in Higher Education Institutions has received little attention. This study therefore determined the handwriting problems reported by 300 students at the University of the Witwatersrand when writing examinations. These students were also screened for factors related to dysfunction in their hand writing using a short screening copying task and analysed for its quality and errors. A Handwriting Assessment Checklist was used to assess various factors related to handwriting such as posture and pen grasp as observed by two trained occupational therapists. Students appear to have little understanding of their handwriting problems as those reporting that handwriting affected their ability to finish examinations were not those identified as having dysfunctional handwriting. Speed of writing was significantly affected by poor positioning of the paper (p<0.03), following of text being copied related to motor dysgraphia and oculomotor function (p<0.00), maintenance of grasp on the pen (p<0.04) and accuracy when copying (p<0.02). Legibility in contrast was significantly worse due to holding the pen too close to the tip (p<0.00), pressure used when writing (p<0.0l), deterioration or change in the writing (p<0.0l) errors related to missing words (p<0.02) and spelling mistakes(p<0.003). These factors may be related to motor and/or dyslexic dysgraphia. These factors should therefore be considered with a speed and legibility score when assessing whether a student presents with a "real" handwriting problem so further appropriate assessment can determine accommodations the student needs to allow them to complete their examinations. <![CDATA[<b>Occupational therapy manager's role in and perceptions of clinical education</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100003&lng=en&nrm=iso&tlng=en This study explored the role and perceptions of clinical education by the occupational therapy (OT) managers of clinical training sites. A descriptive, quantitative survey design was used and a self-administered questionnaire was developed. The questionnaire was developed from the literature and comprised of four sections: nature of the site; clinical training at that site; management of clinical education and perceptions of benefits and challenges. The content validity of the questionnaire was established. The questionnaires were sent to the heads of OT departments (n=22) that are utilised for the clinical education of occupational therapy students. Fourteen questionnaires were returned (73.7%). Only 45.5% (n=39) of the occupational therapists employed in these sites were involved in clinical education. The most common criteria for being involved were clinical experience and where OTs qualified. Most OT managers played a supportive (36%) or logistical role (43%) in clinical education; 22% were actively involved while 28% had no involvement. The two most frequent benefits of providing clinical education were perceived to be assistance in managing the clinical load and keeping up to date, while time and staff issues were perceived to be the challenges. The importance of involvement of all tiers of management in clinical education is not widely appreciated. <![CDATA[<b>Using measurement principles to confirm the levels of creative ability as described in the Vona du Toit Model of Creative Ability</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100004&lng=en&nrm=iso&tlng=en Many occupational therapists in South Africa and the United Kingdom are using the Vona du Toit Model of Creative Ability with its associated assessments and outcome measures in their practice settings. Although there appears to be strong clinical confidence in the use of these instruments that apply the levels of creative ability in the scoring system, little evidence to date has been published on the validity of the levels. The aim of this study was to investigate three instruments based on the levels of creative ability: the Creative Participation Assessment (CPA), the Functional Levels Outcome Measure (FLOM) and the Activity Participation Outcome Measure (APOM), for evidence that the levels indeed represent increasing amounts of ability and that the scoring of the three instruments follow a linear or hierarchical pattern. A secondary data analysis was done using the threshold ordering of the Rasch Measurement Model to indicate whether the levels of creative ability exist. Results showed that all three instruments indeed represent increasing amounts of ability in a person and that the levels of creative ability exist. Although these findings are significant, it is the first in a series of analyses and the remaining assumptions in the Rasch Measurement Model still need to be tested. <![CDATA[<b>Perceptions of the Traditional Health Practitioner's role in the management of mental health care users and occupation: a pilot study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100005&lng=en&nrm=iso&tlng=en Since 1992 discussions about the South African health care system highlighted the need for including traditional healers, because 80% of South Africans access them. Nonetheless, there is little formal collaboration between allopathic and traditional health practitioners. The purpose of the study was to identify traditional healers' awareness of occupational therapy, their use of occupations in their interventions, the allopathic health practitioners' perception of traditional healers' role in managing patients with mental illness and whether referrals occur between the two health systems. Convenient sampling was used to select research participants. Data for this descriptive study were gathered by means of a survey questionnaire containing open and closed-ended questions. Data were presented using descriptive statistics. This pilot study suggests that traditional healers value occupations such as personal care and some use occupations in their practice. Results indicate, however that the traditional healers are not as familiar with occupational therapists as they are with community rehabilitation workers. The study also suggests mistrust on the part of allopathic and traditional health practitioners of each other. In the absence of research into cooperation between traditional healers and occupational therapists, this study is valuable in identifying research questions about the use and value of occupation. <![CDATA[<b>Job satisfaction of nursing auxiliaries pre and post training, in a longterm mental health institution for patients with profound intellectual and multiple disabilities</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100006&lng=en&nrm=iso&tlng=en Staff working with patients with profound intellectual and multiple disabilities (PIMD) typically experience increased burnout and poor job satisfaction. Occupational therapists became concerned about the morale and work performance of Nursing Auxiliary Stimulation Staff (NASS) who are involved in the execution of the occupational therapy programme, at an institution providing residential care to 650 persons with PIMD in the North West province of South Africa. The aim of the study was to determine the impact of a staff development programme to increase knowledge, skills and attitudes to work with PIMD on their perceived job satisfaction over time. The objectives of the study were firstly to develop an in-service training programme and secondly to describe the pre-and post-intervention (educational input). METHODOLOGY: A quantitative descriptive design was used to determine job satisfaction through a questionnaire pre and post intervention. The study sample involved all 12 female NASS working at the institution. RESULTS: The results indicated a job satisfaction of 56% prior to the training programme, which increased to 78% directly after the training and 90% two months post the training. CONCLUSION: The outcome of this study indicates that the implementation of a training programme for NASS resulted in improved and sustained job satisfaction. <![CDATA[<b>Anxiety and the perceived adequacy of information received by family members during the in-patient rehabilitation of patients with brain injury</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100007&lng=en&nrm=iso&tlng=en Whilst patients with brain injury are undergoing rehabilitation, their families are expected to understand and remember complex information provided by the healthcare team. Previous studies have shown that high levels of anxiety impair a person's information recall and their ability to interpret complex information. This study aimed to describe the level of anxiety of family members of patients with brain injury admitted to a six-week rehabilitation programme. The relationship between the family members' level of anxiety and their perception of the adequacy of the information provided by the rehabilitation team, as well as the length of time since the patients' injury and their Functional Independence Measurement (FIM) score was established. Family members completed the anxiety subscale (HADS-A) of the Hospital Anxiety and Depression Scale and an Information Checklist on three separate occasions during the patients' admission. Results indicate that family members were anxious throughout the duration of the patient's rehabilitation with a decrease in average anxiety scores and a corresponding increase in the satisfaction with the information offered over this time. No significant correlation was found between the family members' anxiety and other variables, indicating that factors influencing family members' anxiety were not related to the length of time since injury and the severity of the patient's motor and cognitive outcomes. <![CDATA[<b>Factors that influence choice of placement for community service among occupational therapists in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100008&lng=en&nrm=iso&tlng=en BACKGROUND: Provision of health care to all in South Africa is a major challenge as a result of historical inequalities and a mal-distribution of health professionals and services. The disparity in the availability of these services is particularly apparent between rural and urban areas, with relatively few health professionals practicing in rural South Africa. Community service was thus introduced by the Minister of Health in 2003 for all graduates in the medical and allied fields as a means to retain human resources in the public sector and address the inequality of service delivery. AIM: The purpose of this study was to determine the factors that influence choice of placement for community service amongst occupational therapists in South Africa. METHODS: Occupational therapists completing their community service year in 2012 participated in this study. Electronic surveys were formulated to explore the factors influencing choice of placement for community service. The surveys were used to determine the relationship between graduates' attitudes and experiences when selecting a placement. RESULTS: The results indicated that the majority of the participants agreed with the statements that family contact, proximity to home and exposure/experience gained during undergraduate studies were influential in the choice of placements for community service. Urban placements were favoured over rural placements. Financial incentives were found to have minimal influence on the selection of rural placements. Experiences during undergraduate studies, including the perceptions and opinions of students towards their university supervisors, and even more so their clinical supervisors, were found to have a significant influence on choice of placement. The National Department of Health could potentially use this information to review the level of success gained in achieving the initial goals of community service. <![CDATA[<b>Factors influencing model use in occupational therapy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100009&lng=en&nrm=iso&tlng=en STUDY AIM: To determine which models are used by occupational therapists who attended a workshop on the Kawa Model, in their practice, the demographic factors related to the use of these models and the reasons why they use various models in their practice. METHOD: A descriptive, single case study method was used with embedded units. The research instrument consisted of a survey questionnaire with closed and some semi-structured questions. RESULTS: The characteristics of therapists influenced their use of models. This was determined by their educational background, their level of experience and exposure in the clinical field and their work setting. Time constraints and the nature of the presenting clients also played a role. The clinicians' overall attitude towards new theory and their habituated ways were highlighted as constant factors influencing model use. The use of models provides structure and assists occupational therapists to produce proper, profession-specific, scientifically-based intervention. Models taught during undergraduate studies need to be relevant to address clients' needs in their specific context. <![CDATA[<b>A Review of current therapeutic practice for the management of chronic pain</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100010&lng=en&nrm=iso&tlng=en This literature review covers current evidence-based practice in chronic pain management, proposes a model of intervention and examines future directions for clinical practice and research in this field. The literature search was conducted over three databases; Pubmed, OT Seeker and Pedro. Literature published from 2004 to 2013 was included in the search. The majority of the articles reviewed were recent (2008 to 2013) however a few articles and one book prior to these dates were included as they are important studies and reviews that have remained key to the management of chronic pain. The initial search yielded a total of3221 articles and books. This was systematically narrowed down to 229 relevant articles and books. A total of 25 articles including three books were eventually used to review the current treatment approaches and modalities used in the management of chronic pain by occupational therapists. Modalities reviewed include graded motor imagery, pain education, yoga and the role of an interdisciplinary approach. A review revealed a need for further research in the field of chronic pain rehabilitation. <![CDATA[<b>Occupational performance factors perceived to influence the readmission of mental health care users diagnosed with schizophrenia</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100011&lng=en&nrm=iso&tlng=en Schizophrenia is a complex disorder due to the range of deficits with which mental health care users (MHCUs) present. In addition, the high rate of relapse and readmission in clients diagnosed with schizophrenia complicates the effective management of the condition. Medical factors have been evidenced to affect relapse and readmission rates however limited data exists regarding the influence of occupational performance factors. The aim of this study was therefore, to determine which occupational performance factors are perceived to affect the readmission of MHCUs diagnosed with schizophrenia. A descriptive, cross-sectional quantitative design with qualitative elements was conducted. Card sorting was implemented in two phases to a conveniently sampled population of occupational therapists and MHCUs diagnosed with schizophrenia. Data were analysed by means of descriptive statistics. It was found that social participation was perceived to be the most influential factor in the readmission of MHCUs diagnosed with schizophrenia. In conclusion, both medical and occupational performance factors affect readmission rates of MHCUs diagnosed with schizophrenia. Therefore to implement a client centred approach in occupational therapy, therapists may need to reconsider the priorities they address in treatment. <![CDATA[<b>Problem Based Learning - a review of students' perceptions in an Occupational Therapy undergraduate curriculum</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100012&lng=en&nrm=iso&tlng=en BACKGROUND: The Occupational Therapy department of the University of the Witwatersrand (Wits) has been following a hybrid Problem Based Learning (PBL) Model to teach its undergraduate students since 1993. It was introduced to better equip students with the skills to cope with the evolving healthcare sector in South Africa. Internationally, studies indicate that students have a positive attitude towards this method of instruction as it promotes lifelong learning skills, but South African data are lacking in this regard. SUMMARY OF WORK: A retrospective record review of existing data was used to ascertain students' opinions of the PBL process. Data were made available from a routine student assessment undertaken annually over two years. First to fourth year students completed questionnaires rating their opinions of the PBL process. SUMMARY OF RESULTS: Results identified that students were positive towards aspects of the PBL process, specifically around working in groups and carrying out self-directed learning tasks. But it was evident that this positive attitude fluctuates in the second to third year of the course as students have difficulty managing the work load before demonstrating improved coping skills in their final year. However, a majority of the students had a negative perception of the PBL process overall. CONCLUSIONS: A variety of factors could be impacting on the students' overall perceptions of the PBL curriculum, possibly related to the hybrid nature of the course, and the work load. It is clear they also are distrustful of the process in supporting their skill and knowledge development. <![CDATA[<b>The other side of the coin: OT students' perceptions of problem-based learning</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100013&lng=en&nrm=iso&tlng=en BACKGROUND: Problem-based learning (PBL) was introduced into the Occupational Therapy (OT) curriculum at the University of Witwatersrand in 1993 as a hybrid course which included PBL as well as traditional teaching methods. There is a collective opinion in the department, that PBL is the best teaching method if OT students are to become independent, critical practitioners. But how do the students really feel about PBL? AIM: The purpose of this study was to determine the perceptions of 1st, 2nd, 3rd and 4th year occupational therapy students of PBL. This study formed the qualitative part of a larger study, which was mainly quantitative, descriptive and longitudinal in design. METHODOLOGY: Secondary analysis was performed on the occupational therapy departmental records collected during 2011 and 2012 for 290 students. This study focussed on the qualitative analysis of data from two open-ended questions. Five categories were derived from the quantitative part of the larger study and included Group Work, Facilitator, Learning Objectives, Self-directed Learning and The OT Course. These were used as categories and the data were analysed according to a categorisation matrix. RESULTS: The qualitative analysis of the results identified that students had mixed feelings about PBL as a teaching and learning method. In this study students felt that group work, self-directed learning and fieldwork contributed to their learning while objectives, feedback and workload were aspects of PBL students felt needed to be changed as these impeded their learning. <![CDATA[<b>A proposal for an undergraduate stroke rehabilitation curriculum appropriate for South African occupational therapy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100014&lng=en&nrm=iso&tlng=en The incidence of stroke will likely increase in the next few decades as the expected health of sub-Saharan Africans is predicted to deteriorate as a result of increasing infectious and poverty-related diseases. In addition, studies have shown that the risk factors for vascular disease as well as the increasing age of the population will add to this problem. Effective curriculum planning regarding stroke rehabilitation in tertiary educational institutions training occupational therapy students should be a pertinent topic in South Africa. This paper explores the opinions of clinicians and experts in the field of neurology about the occupational therapy stroke rehabilitation curricula. It also aims to clarify and evaluate opinions regarding occupational therapy stroke rehabilitation curricula, by raising awareness of the issues pertaining to the current educational curricula. Two combined methods were used which included a curriculum audit and a panel discussion. Specific information was extracted from the audit regarding the requirements for training in stroke rehabilitation, revising the number of stroke rehabilitation theories taught, the use of updated and uniform terminology across all universities, and lastly the need to teach and use standardised assessments to measure effectiveness of stroke rehabilitation techniques. Several common topics arose from the panel discussion, including the need for a suitable stroke rehabilitation theory, the difficulties in supervising students due to outdated and conflicting use of stroke rehabilitation terminology, and the importance of focussing the curricula on the needs of the South African community. <![CDATA[<b>The influence of blended learning on student performance in an undergraduate occupational therapy curriculum</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100015&lng=en&nrm=iso&tlng=en Change is scary, especially when the world of technology, lecturers (digital immigrants) and students (digital natives) come together with learning in mind. Developing blended learning by integrating e-learning into an existing undergraduate Problem Based Learning (PBL) curriculum requires adaptable lecturers and the time for students to become habitual users of the Virtual Learning Environment (VLE). The occupational therapy curriculum at the University of the Witwatersrand has traditionally been delivered via PBL, but the increasing need to improve throughput rates and meet the diversity of learning needs of the students has driven the strategy towards blended learning. This study investigates the effect of habituation (student experience in using e-learning automatically) on student performance in one PBL module. A retrospective two-cohort design was used to review the students' access to the VLE and their performance on the summative assessments of the PBL module of two concurrent academic cohorts. Data were analysed descriptively and statistically for significance (Mann-Whitney U) and effect size (Cohen's d and Hedge's g). There was a significant difference between the two cohort's access to the VLE (p<0.002) indicating higher habituation to blended learning in the second cohort, who had more exposure to e-learning due to their second year of using VLE. There was a small but relevant effect size (average d=0.3l) in all three measures of student performance when comparing the two cohorts. The average of the student marks on each measure shifted from a failing to a passing average. This study shows that the habituation of blended learning into an existing curriculum results in improved academic performance. <![CDATA[<b>New insights in collective participation: A South African perspective</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100016&lng=en&nrm=iso&tlng=en The concept of co-occupations or collectives occupations is gaining global recognition in occupational science and occupational therapy. However, little is known about the interpretation and understanding of this concept by occupational therapists in South Africa. The study aimed to explore community based occupational therapist's understanding of the concept of collective participation in occupations. Purposive sampling was used to select participants. Data, gathered through semi-structured interviews, were analysed thematically. The study yielded two themes namely; 'The whole is more than the sum of the parts' and 'I joined because of me, I stayed because of them'. Theme 1, describes the nature of the concept of collective participation while theme 2 describes the reasons for people to engage in collective participation. All participants agreed that collective participation is an everyday occurrence within South Africa. The study found that mutuality and connectedness is needed for effective co-creating, which in turn is essential for collective participation in occupations. It is through this connectedness that a collective becomes more than the sum of the parts. The study also found innate needs for human beings to 'belong' and to 'survive' and an enabling and supportive environment are motivators for people to participate collectively in occupations. <![CDATA[<b> Teach your child to read with movement, fun & games - A games-in-a-book reading programme</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2310-38332014000100017&lng=en&nrm=iso&tlng=en The concept of co-occupations or collectives occupations is gaining global recognition in occupational science and occupational therapy. However, little is known about the interpretation and understanding of this concept by occupational therapists in South Africa. The study aimed to explore community based occupational therapist's understanding of the concept of collective participation in occupations. Purposive sampling was used to select participants. Data, gathered through semi-structured interviews, were analysed thematically. The study yielded two themes namely; 'The whole is more than the sum of the parts' and 'I joined because of me, I stayed because of them'. Theme 1, describes the nature of the concept of collective participation while theme 2 describes the reasons for people to engage in collective participation. All participants agreed that collective participation is an everyday occurrence within South Africa. The study found that mutuality and connectedness is needed for effective co-creating, which in turn is essential for collective participation in occupations. It is through this connectedness that a collective becomes more than the sum of the parts. The study also found innate needs for human beings to 'belong' and to 'survive' and an enabling and supportive environment are motivators for people to participate collectively in occupations.