Theme one: We don’t know what we have

The table below describes the first theme which came out strongly during the focus group; we don’t know what we have. This theme arose from two central ideas, firstly that South African occupational therapists have to find standardized upper extremity assessments that are current, those that exist and will be suitable to their situation and secondly, that occupational therapists require more training to increase or further their knowledge into the assessments that are available, as well as the skill required to execute these assessments.

Table 9 Theme one: Codes and Quotes

Theme Central Ideas Codes Quotes

1. Knowledge – We don’t know what we have CI.1.1 South African occupational therapists do not know what assessments CD.1.1 Occupational therapists are not reading literature and are not producing research.

FGP-5 “I think (occupational therapists) OTs are just bad researchers in general.”

67 are out there

and are not using what they have to identify what will work in their context.

occupational therapists are not using tests to assess content validity.

that we don’t have anything South African based, and that’s where one of our biggest challenges come from, is that’s done everywhere else, but it’s not here. We haven’t managed to get three tests together, use them and make a South African test that is more relevant for the kind of people who are here.” CI.1.2 Occupational therapists need to use current standardized upper extremity assessments CD.1.3 Adopt three or four assessments for different levels of upper extremity impairment.

FGP-4: “I think something that will facilitate use specifically in our environment is that on your assessment form, you have the prompts there and that maybe you select 3 assessments, one for very low functioning, then low functioning etc…”

CD.1.4 Finding the right tools; the

assessments that will work in the setting.

FGP-2: “I think you need to search for a test that will fit your situation.”

FGP-5: “I think it’s finding the right tools, I think that’s really the key, it’s like at a rehab,

management sitting down using experience taking into

consideration the setting and the patients and saying this is the right tool for this place, at a government level, saying this is the right tool, outpatient rehab – this is the right tool. I think there’s like so many tests out there, so many that we don’t know that maybe have been devised for apraxic, aphasic patients, so it’s just a matter of knowing what’s out there.” CI.1.3 Training and increasing one’s knowledge on current assessments is imperative CD.1.5 Training – public setting always has young therapists

FGP-3: “(we need) Training.” “In our setting our therapists are new every year…”

CD.1.6 Type of training is important– not just workshops. Having dynamic training on actual experience and having experienced therapists guide younger therapists. Practical training.

FGP-5: “Just on training, and it’s something that came up in my research as well is the type of training, so it’s not just about having workshops… but it’s about doing the right kind of training so that experienced as well as inexperienced therapists are able to benefit from each other…having more dynamic training based on actual

68 experience.”

FGP-3 “I think workshops should be a third lectures and 2 thirds practical because I think we sit in front of the power point far too much.” CD.1.7 Undergraduate course – basics. Postgraduate learning– training in specific assessments

FGP-3: ”I also think undergrad for me is a good basis, basics in everything, ah, and that your specialization, be it with a M or whatever the case might be, ah, or just plain workshops can happen after that.”

FGP-3: “I think they

[undergraduate students] need to be aware, you know, that there is such a concept such as

standardized tests for spinal, stroke, whatever the case might be…and if you have good clinical reasoning you will expand on that after

qualification…hopefully.” CD.1.8 Upper

extremity assessment tools workshop would be beneficial.

FGP-4 “…I feel there is a gap, I meet neuro patients and I’m like, I do feel there is a gap, on what tools can I use, especially when we’re writing reports…if a workshop was offered now, let’s say a ‘a review of upper limb assessment tools’ I think there would be a lot of therapists there.”

CD.1.9 Occupational therapists are not well trained

FGP-3 “And I also think people are using tests when they’re not well trained to use them.” CD.1.10 You have to

be trained and know it well.

FGP-2 “…you need to be trained on how to use it and you need to know it well. And, often they’re quite complicated to start off with, once you know them well and you’ve done it with about 10 patients it will go much smoother but those first 10 patients you sit there reading, so it’s taking you double, triple the amount of time and when you only have a maximum of a certain amount of time…in private we have 45 minutes or less.”

69 The general feeling amongst the participants was that training at an undergraduate level is and must be very basic and general regarding standardized upper extremity assessment and that it is the occupational therapist’s responsibility to further this education at a postgraduate level. The participants further discussed the idea of improving their knowledge of standardized assessments which are currently available as the feeling was that there could be one or two already accessible that would suit their specific needs and settings. In order to improve or facilitate the use of standardized upper extremities in general, the participants felt that more training is required.