EDITORIAL COMMENT

 

The need for high quality clinical research in occupational therapy

 

 

The editors of this journal, South African Journal of occupational Therapy (SAJOT), have been working with the Occupational Therapy Association of South Africa (OTASA) Research Committee to determine the main research methodologies and levels of evidence of articles published in relation to the research priorities identified by the Research Standing Committee. With the advent of the NHI and universal coverage in health care, it is essential that research evidence for occupational therapy be available from within the South African context¹. However, most of the articles submitted to and published in SAJOT are in the ranks of lower levels of evidence which includes largely qualitative, small group research. Very few articles that provide Level 1 and 2 evidence, such as systematic reviews or randomized control trials, are published.

Occupational therapists contemplating research projects should focus on research priorities identified in South Africa which could help to expand and add depth to the evidence-base for our profession in a meaningful way. This could support not only better, more effective practice, but also client compliance as well as justifying costs to funders such as medical aids and the proposed NHI services in public health care and buy-in. Therapists need to promote change and ensure that effective rehabilitation continues to be included in a cost-effective manner at all levels of health care by engaging in clinical research which provides evidence for best practice. A project to support the inclusion of rehabilitation in primary health care mapped rehabilitation recommendations into 82 standard treatment guidelines (requested by the national essential medicines list committee) included occupational therapists. Much work is still to be done in providing supporting evidence for the treatment guidelines which are based on diagnostic categories².

Basing research priorities in occupational therapy on frameworks such as the International Classification of Functioning, Disability and Health (ICF) - which can support rehabilitation services in the NHI - has also been suggested. In the United Kingdom, research priorities had been developed to provide research from a service perspective rather than from a medical or disability perspective, which is another option in supporting the provision of evidence for the effectiveness of occupational therapy. This project³ suggests research considering unanswered questions about treatments or interventions including:

• How does occupational therapy make a difference and have impact on everyday lives?

• How can occupational therapists ensure that person-centred practice is central to how they work?

• How can occupational therapists work more effectively with the family and carers of people who access services?

• What are the long-term benefits of occupational therapy intervention?

• What are the benefits or impact of occupational therapy in primary care settings?

• How can occupational therapy services be more inclusive of both mental and physical health?

• What is the role of occupational therapy in supporting self-management? (e.g., helping people with illness to manage their health on a day-to-day basis)

• What is the role or impact of occupational therapy in reducing hospital admissions?

• How can occupational therapists work most effectively with other professionals to improve outcomes for people who access services?

• What is the cost-effectiveness of occupational therapy services? ^3:5

Whether research is diagnostic, framework or service-based, it must provide sound scientific evidence to secure support from scientific bodies, funders and decision-makers and support best practice. High quality study methodologies from levels 1-3 for research evidence should be considered when planning research to make a real difference to the ability of occupational therapists to provide services in South Africa.

Our profession's future existence is in our hands. We have a choice here: do we go forward as onlookers, entrusting others with the task of shaping our future, or do we join in and keep control.

Denise Franzsen

University of Witwatersrand, Johannesburg, South Africa. http://orcid.org/0000-0001-8295-6329

Blanche Pretorius

Editor in Chief, SAJOT. https://orcid.org/0000-0002-3543-0743

 

REFERENCES

1. Kruger, M., 2022. Universal Health Coverage, National Health Insurance, and Sustainable Workforce. Challenges in Medical Ethics: The South African context, p.29.         [ Links ]

2. Conradie, T., Charumbira, M., Bezuidenhout, M., Leong, T. and Louw, Q., 2022. Rehabilitation and primary care treatment guidelines, South Africa. Bulletin of the World Health Organization, 100(11), pp.689-698.         [ Links ]

3. Watson, J., 2021. Research priorities for occupational therapy in the UK. British Journal of Occupational Therapy, 84(1), pp.3-5.         [ Links ]