Assessment of in-hand manipulation by occupational therapists in paediatric practices in South Africa
Assessment of in-hand manipulation skills is fundamental in determining the appropriate treatment for a child with fine motor delays. For a child, in-hand manipulation is the complex movements required to effectively perform scholastic (e.g. writing), self-care (e.g. buttoning), and play tasks (e.g. puzzle-building), with precision. There is a growing interest in in-hand manipulation; thus, there is an increased effort to develop a modified classification system and various preliminary instruments. Handwriting studies were also performed that recognise in-hand manipulation as an essential performance component. However, there is limited research available that provide insight regarding the assessment of in-hand manipulation among South African occupational therapists. The main research question was to describe how paediatric occupational therapists in South Africa assesses in-hand manipulation of children. A descriptive quantitative research design was used to answer the proposed research question. The objectives were to describe the paediatric assessment instruments that have been published in literature, the assessment methods used by South African occupational therapists in paediatric practices, their preferences for a suitable instrument and if there were any associations between these results and the different practice sectors that the occupational therapists work in. This study was conducted in the form of two academic articles. The first study followed a non-empirical approach for a theoretical article, with the scoping review as the chosen method. Emphasis was placed on providing an overview of the different in-hand manipulation instruments described in the literature. Each identified in-hand manipulation instrument was critically evaluated pertaining to what extent the in-hand manipulation components are included in the study, the clinical utility that related to how accessible and practical the instruments were and what psychometric properties were established for each instrument. The second article used an empirical study approach with a quantitative cross-sectional study design. To ensure that the sample population represented the population of paediatric occupational therapists in South Africa, a non-probable, purposive sampling method was used. The data was collected using an online survey method. Test-retest reliability of the questionnaire was performed to determine the stability of the answers. Hence, the participants were asked to complete the questionnaire a second time, ten days after completing the first round. Ethical approval was obtained, and confidentiality was ensured. The data was analysed by a qualified biostatistician. The questions that tested reliable were further discussed in the article and indicated which formal and informal methods of assessment were used by paediatric occupational therapists, while also reporting on the contextual and practical aspects of the assessment process. The preferences for a suitable in-hand manipulation instrument for children were also reported and can be used for future studies as instrument design principles. In addition to the two publishable articles, this dissertation includes a supplementary file section in which the results of the second study’s last objective is reported, namely the associations between the different practice sectors (Academic, Community, Private, Public, Public-Private) and the current methods used by occupational therapists and their preferences for suitable instruments. The decision to separate the results was made as the data extracted from the study was too extensive to be discussed in a single empirical scientific article while remaining within the journal guidelines. Therefore, these results were reported on and added to the supplementary file section, with the intention to be discussed in a third article. Recommendations and clinical implications for practitioners, both South African and globally, are discussed in each article. Areas of future research are identified to advance the professions’ body of knowledge and provide valuable guidance when future instrument development research is undertaken.