Occupation-based practice in hand therapy - perspectives from a South African occupational therapy survey.

Introduction: Hand injuries affect occupational engagement and participation, yet anecdotal evidence reports a focus on body structures and functions within hand therapy. Failing to address occupational challenges may result in sub-optimal patient outcomes. In line with the growing body of evidence of positive outcomes relating to occupation-based practice (OBP), this article aimed to describe the knowledge, attitudes and practices towards OBP of occupational therapists treating hand-related conditions in South Africa. Methods: In this quantitative, cross-sectional study, South African occupational therapists treating hand conditions were recruited. Data were collected via an emailed survey developed for the study. Data were analysed descriptively. Results: Sixty-seven responses met the inclusion criteria, a response rate of 62%. Most respondents worked in the private sector (73%) with many holding postgraduate qualifications (54%). Lack of access to evidence and a preference for biomedical literature impacted on acquiring knowledge on OBP. Attitudes towards OBP were mostly positive. Barriers were contextual, patient-related and therapist-related. Practice focussed predominantly on performance components and aimed to reduce impairment rather than promoting occupational engagement. Conclusion: Current hand therapy services in South Africa reflect a biomechanically-focused practice that is mis-aligned with occupational therapy philosophy. In line with existing research, OBP should be adopted more routinely in hand therapy in South Africa.