Occupation-based hand therapy in South Africa: challenges and opportunities

Abstract

Occupation-based hand therapy (OBHT) is an approach to practice that integrates multiple frames of reference, while remaining rooted in an occupational therapy perspective. There are a number of benefits and challenges that have been recognised in hand therapy settings. The use of an occupation-based approach in the field of hand therapy is of interest to all occupational therapists practising in this field. This commentary explores the challenges and opportunities of OBHT as an approach in the assessment and treatment of clients with hand conditions in the South

The use of the ICAM Splint Programme in Zone IV to VII Extensor Tendon Repairs: Patient outcomes and clinician experiences in a specialised hand unit in SA

“…Within the country, there are also challenges that are common in developing contexts. These include fragmentation of health services, over-burdened and under-resourced facilities, a lack of knowledge and poor referrals as well as delays in surgical interventions in some cases 4,6 .…”

“…These injuries may be challenging to manage due to the complex anatomy of the extensors as any minimum discrepancies in tendon length and tension can cause significant functional deficits following injury and repair 5 . In addition to the complex anatomy, there are various contextual factors within SA that makes rehabilitation of upper limb injuries different to that of developed countries 6 . As a result, this may influence the rehabilitation of extensor tendon repairs.…”

Return to Work for People with Hand Injuries in South Africa: Occupational Therapy Strategies

“…A noteworthy factor to consider is the reported negative perceptions of employers in South Africa towards healthcare workers. This may be due to a lack of understanding of what occupational therapists are able to contribute to productive work function 19 , an aspect that needs to be addressed in order to build collaboration between employers and therapists in negotiating work-related transitions.…”

“…Low-and middle-income countries such as South Africa, have large numbers of informal workers and are strongly reliant on manual labour. Considering that manual labour requires strong and dextrous hand function, sustaining a hand injury typically requires medical intervention and rehabilitation which impacts on the person's capacity to work 19 . The high prevalence of unemployment within South Africa has been shown to adversely impact unskilled workers' rehabilitation as they can easily be replaced 20 .…”

Workplace-based Rehabilitation for Upper Limb Conditions in the South African context

“…Rehabilitation of upper limb conditions in South Africa has traditionally been based at hospitals and clinics 15 , often with inadequate resources and support 16 . While occupational therapy's goal is to enhance participation in occupational performance, practitioners working with upper limb conditions typically focus on occupational enablers, such as range of motion and strength 17 .…”