Is Birth Method Associated with Sensory Hyperreactivity in Children 3-4 Years in an Upper-Middle-Income Country?

Background: Research has shown that pressure in the vaginal birth process aids the infant's neurophysiological adaption to extrauterine life, including their ability to regulate their responses to diverse sensory stimuli. As pressure is absent in elective caesarean section births, we hypothesised that these children may be at higher risk for developing sensory hyperreactivity (SHR), a sensory modulation difficulty which negatively impacts on the child's engagement in their occupations. This paper reports on a study which investigated associations between birth method and SHR. Method: In this cross-sectional study, 91 children aged three and four years from various language, cultural, and socioeconomic groups were recruited and categorised based on birth method (caesarean section or vaginal birth). Caregivers of each child completed the Short Sensory Profile-2 and a demographic questionnaire. The prevalence of SHR between the birth method groups was compared. Results: The prevalence of SHR was greater in the vaginal birth group (29%) than the caesarean section group (9%). Mothers in the vaginal birth group were younger (p ≤ 0.001), of lower-income level (p = 0.003), and more likely to be single (p = 0.037). During data collection with the vaginal birth group, comprehensibility of certain items in the Short Sensory Profile-2 proved challenging for many caregivers. Conclusion: The statistically significant higher prevalence of SHR in the vaginal birth group supported a null hypothesis. However, the results are questioned due to the challenges related to data collection. Given this, the study supports the need for further investigation of how sociocultural and socioeconomic factors influence the assessment of SHR in the South African context.

Structural and cross-cultural validity of the Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

BACKGROUND: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire has been translated and cross-culturally adapted to Afrikaans for the Western Cape, within the public health service context of South Africa. The aim of this study was to evaluate structural validity, internal consistency, and cross-cultural validity/measurement invariance of this new translation to increase applicability and clinical utility in a public health service context. METHODS: During this cross-sectional study, exploratory factor analysis (EFA) was conducted with parallel analysis and oblimin rotation. Confirmatory factor analysis (CFA) and multiple group confirmatory factor analysis (MGCFA) to assess cross-cultural validity/measurement invariance, was employed to test model fit with X2 goodness-of-fit statistic, root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR) and comparative fit index (CFI). Internal consistency was calculated using Cronbach's alpha. RESULTS: 109 women and 110 men (n = 219) completed the Afrikaans for the Western Cape and the South African English DASH questionnaire, used during the analysis. Unidimensionality of the Afrikaans for the Western Cape DASH questionnaire was not supported in the 218 questionnaires eligible for inclusion in the analysis [X2 (df) = 1799.10 (405); p value = < 0.01; RMSEA (90% CI) = 0.126 (0.120-0.132); SRMR = 0.09 and CFI = 0.984]. EFA revealed a two-factor structure with Eigenvalues exceeding one explaining 55% and 7% of the variance. The two-factor structure of the Afrikaans for the Western Cape DASH questionnaire was supported during CFA. Cronbach's alpha revealed good internal consistency of both factors [factor 1 = 0.97 (0.96, 0.97) and factor 2 = 0.92 (0.90, 0.94)]. MGCFA conducted between 218 Afrikaans for the Western Cape DASH and 219 South African English DASH questionnaires (N = 437) revealed that the data supports configural, metric and scalar invariance models during initial model fit assessment. Subsequent hypotheses testing comparing the nested models revealed that scalar invariance holds. CONCLUSION: The Afrikaans for the Western Cape DASH questionnaire revealed a two-factor structure with good internal consistency across the two factors and demonstrated measurement invariance with the South African English DASH questionnaire.

Work transition after hand injury: A scoping review.

STUDY DESIGN: Systematic scoping review. INTRODUCTION: Many factors are potentially associated with successful work-related transitions following hand injury. There is no current, comprehensive review of the literature to guide clinical practice. PURPOSE OF THE STUDY: To comprehensively identify the current body of research evidence supporting return to work (RTW) after hand injury and identify gaps. METHODS: A systematic search identified relevant, peer-reviewed, full text, English language primary qualitative or quantitative literature published since 2006. All authors independently determined whether studies should be included, assigned them to a hierarchy of evidence and extracted data. Decisions were defended and disagreements resolved in team meetings. Literature was summarized into key themes using common intent and constructs. RESULTS: Of 259 potentially-relevant articles, 38 were relevant. Study designs included prospective observational, cross-sectional, and retrospective (n=9 each), mixed methods (n=3), qualitative (n=4), and opinion pieces (n=4). There were no experimental studies. The most commonly-reported key themes were prognostic factors for RTW (25 papers) and assessment tools (18 papers). Remaining themes of impact of injury on the individual, patient perspectives, other stakeholder perspectives, healthcare provider education, and treatment were reported in fewer than 10 papers each. There was little commonality in how research was conducted or reported. Gaps included lack of information on effective interventions, which prognostic factors should be routinely measured, and which assessment and outcome items to routinely use in practice. CONCLUSION: Despite the impact of hand injury on capacity to RTW, there is limited evidence to inform successful work-related transitions.

Work transitions after serious hand injury: Current occupational therapy practice in a middle-income country.

INTRODUCTION: Work-related transitions following serious hand injury can be complex for people with hand injuries and rehabilitation professionals supporting the return-to-work process. This study explored South African occupational therapy practice related to work transitions after a serious hand injury. METHODS: In this collective case study, maximum variation sampling was used to select seven occupational therapists involved in facilitating work-related transitions for people with serious hand injuries. Participants selected at least five cases that illustrated the breadth of their practice in terms of work transitions; these cases formed the focus of the semi-structured interviews. Data were analysed using inductive content analysis. Exemplar quotations were extracted to support emergent key themes. RESULTS: There was one overarching theme-Ongoing appraisal of the fit between function and inherent work demands-which comprised three stages: (1) determining and facilitating readiness to work; (2) managing the risk and trauma of returning to work, and (3) implementing reasonable accommodation. The central theme comprised six strategies that were used to optimise the transition process and achieve the best possible outcome. CONCLUSION: The study highlighted the importance of work-related transitions that are context-driven, flexible, and involve multiple stakeholders. The occupational therapists demonstrated how they drew on their knowledge of local contexts to solve problems and generate effective individual strategies over the rehabilitation period. The findings may be applicable to other low- or middle-income countries where the return-to-work process may not be as predictable as high-income countries.

Cognitive Interviewing during Pretesting of the Prefinal Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand Questionnaire following Translation and Cross-Cultural Adaptation.

When patient-reported measures are translated and cross-culturally adapted into any language, the process should conclude with cognitive interviewing during pretesting. This article reports on translation and cross-cultural adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire into Afrikaans (for the Western Cape). This qualitative component of a clinical measurement, longitudinal study was aimed at the pretesting and cognitive interviewing of the prefinal Afrikaans (for the Western Cape) DASH questionnaire highlighting the iterative nature thereof. Twenty-two females and eight males with upper limb conditions were recruited to participate at public health care facilities in the Western Cape of South Africa. Cognitive interviews were conducted as a reparative approach with an iterative process through retrospective verbal probing during a debriefing session with 30 participants once they answered all 30 items of the translated DASH questionnaire. The sample included Afrikaans-speaking persons from low socioeconomic backgrounds, with low levels of education and employment (24 of 30 were unemployed). Pragmatic factors and measurement issues were addressed during the interviews. This study provides confirmation that both pragmatic factors and measurement issues need consideration in an iterative process as part of a reparative methodology towards improving patient-reported measures and ensuring strong content validity.

Work-related Transitions Following Hand Injury: Occupational Therapy Scoping Review.

BACKGROUND.: Occupational therapists who facilitate work-related transitions after hand injury require robust evidence to inform practice. PURPOSE.: To identify the occupational therapist's contribution to facilitate work-related transitions for persons with hand injuries and identify gaps in existing knowledge. METHOD.: A systematic search was conducted from 2008 to 2018 to identify articles and doctoral theses published across 14 databases. Data was analysed descriptively. FINDINGS.: In total, 15 studies from 16 countries (14 high and 2 upper-middle income) were identified. Four strategies to facilitate work-related transitions were identified. Clear differences were evident across country groupings. IMPLICATIONS.: The paucity of research limits evidence-based practice, especially in low- and middle-income countries, which indicates the need for further research.

Changing demographic trends among South African occupational therapists: 2002 to 2018.

BACKGROUND: South Africa's quadruple burden of disease, coupled with health system challenges and other factors, predicts a high burden of disability within the population. Human Resources for Health policy and planning need to take account of this challenge. Occupational therapists are part of the health rehabilitation team, and their supply and status in the workforce need to be better understood. METHODS: The study was a retrospective record-based review of the Health Professions Council of South Africa database from 2002 to 2018. The data obtained from the Health Professions Council of South Africa was analysed for the following variables: geographical location, population groups, age, practice type and sex. Data was entered on a Microsoft Excel spreadsheet and analysed using the Statistical Package for the Social Sciences (SPSS version 22.0). RESULTS: In 2018, there were 5180 occupational therapists registered with the Health Professions Council of South Africa with a ratio of 0.9 occupational therapists per 10 000 population. There has been an average annual increase of 7.1% over the time period of 2002-2018. The majority of occupational therapists are located in the more densely populated and urbanised provinces, namely Gauteng, Western Cape and KwaZulu-Natal. Most of the registered occupational therapists are under the age of 40 years (67.7%). The majority (66%) are classified as white followed by those classified as black and coloured. Females make up 95% of the registered occupational therapists. Nationally, 74.8% of occupational therapists are deployed in the private sector catering for 16% of the population while approximately 25.2% are employed in the public sector catering for 84% of the population. CONCLUSIONS: Under-resourcing and disparities in the profile and distribution of occupational therapy human resources remain an abiding concern which negatively impacts on rehabilitation service provision and equitable health and rehabilitation outcomes.

Stand Tall-A Virtual Translation of the Otago Exercise Program.

BACKGROUND AND PURPOSE: The Otago Exercise Program (OEP) is effective at preventing falls and fall-related injuries. The resources and personnel required for program delivery and challenges inherent in monitoring participant adherence and compliance pose significant barriers to increasing the number of older adults participating in the OEP. Alternative delivery systems using virtual platforms may pose a solution. The purposes of this article were to (1) describe the "Stand Tall" intervention, a virtual translation of the OEP; (2) describe Stand Tall participant characteristics and fall-related risk at baseline; and (3) identify changes in physical performance measures associated with fall risk from baseline to 8-week follow-up. METHODS: This was a quasi-experimental, single-group, pretest-posttest design. Forty-two older adults at risk for falls were recruited. Participants were oriented to Stand Tall by study personnel and then monitored and progressed virtually with face to face check-ins. Participants independently logged in and completed a prescribed a set of exercises 3 times a week for 30 minutes for a total of 8 weeks. RESULTS AND DISCUSSION: The average participant age was 75.0 (9.1) years and self-reported 2.3 (1.7) chronic conditions. There were more men than women (52.4%) in the study. Participants were primarily non-Hispanic white (90.5%), had a college education (61.9), 40% reported falling in the past 6 months, and 60% screened positive for mild cognitive impairment. Participants were beginning to show decline in function with average single-leg stance less than 10 seconds and 30-second chair rise scores below normative values. Participants demonstrated high adherence rates (>88%) and significant improvements in physical performance measures associated with fall risk. These results may be limited to a less frail population and the study was not powered to demonstrate a reduction in falls. CONCLUSIONS: Results support that an avatar-delivered version of the OEP is effective, feasible, viable, and enjoyable for community-dwelling older adults. These types of platforms should be considered as potential mechanisms to increase availability of fall prevention programs.

Embracing Cultural Diversity - Leadership Perspectives on Championing Meaningful Engagement for Residents Living with Advanced Dementia.

Resource constraints and high staff turnover are perceived as substantial barriers to high quality residential aged care. Achieving relationship-focused, person-centered care (PCC) is an ongoing challenge. This paper reports on an international project that explored how residential care leadership understand meaningful engagement for residents with dementia from culturally and linguistically diverse (CALD) backgrounds. This paper critically appraises the process, and outcomes, of an adapted Delphi method. Participants were the residential care leadership (i.e. staff in supervisory capacity) from four international facilities. Participation in the Delphi process was limited even though surveys were designed to require minimal time for completion. No participants opted for the alternative option of being interviewed. Findings indicate that residential care leadership recognised the importance of meaningful engagement for residents from CALD backgrounds. Limitations of time, resources and policy infrastructure were cited as barriers to achieving PCC. These findings suggest that facility leadership understand the importance of PCC, but identify multiple barriers rather than enablers for delivering PCC. Alternative methods, such as collecting data in interactive sessions allowing real-time discussion should be initiated to more effectively engage residential care leaders for a collaborative approach to explore PCC practices.

Shared decision making and the practice of community translation in presenting a pre-final Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire: a proposal for improved translation and cross-cultural adaptation.

BACKGROUND: Translation and cross cultural adaptation of patient reported outcome measures (PROMs) involves a step referred to as harmonisation, following forward and backward translation of the measure. This article proposes the introduction of methods not previously included in the process of harmonisation. The aim of the study was to introduce shared decision making (SDM) and the practice of community translation (CT) during the harmonisation of the Afrikaans for the Western Cape version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, a PROM that measures symptoms and activity and participation in persons with upper limb conditions. METHODS: A broader approach to harmonisation is proposed by incorporating CT and SDM in addition to existing methods toward harmonisation. Participants (n = 8) involved in the harmonisation meeting included the principal investigator, a linguistic expert, occupational therapists with knowledge of the target population, context and the DASH questionnaire and members of the target population with and without upper limb conditions. A partnership was formed with the participants (a principle of SDM) and the principles of non-parallel CT and the CT approach were applied during harmonisation. Employing CT principles ensures that the norm for the translation is set by the population the translation is intended for. RESULTS: Forward and backward translation of the DASH questionnaire presented a version of the measure in the target language for consideration during harmonisation. There were however a significant number of conceptually problematic items on the version presented at the meeting. Only seven items (7 of 30) remained unchanged. CONCLUSION: SDM and CT was used during the harmonisation of the Afrikaans for the Western Cape DASH questionnaire. Both these practices could have relevance in the translation and cross-cultural adaptation of PROMs where the translation is intended for persons from low socio-economic backgrounds and low levels of education.

Strategies occupational therapists employ to facilitate work-related transitions for persons with hand injuries: a study protocol for a scoping review.

INTRODUCTION: Hands make it possible to be employable and productive, to communicate non-verbally and to perform fine motor tasks required in day-to-day activities. Sustaining a hand injury can be detrimental to function including the ability to work. As the literature on work-related transitions is scattered across a range of journals, it is difficult to get a sense of how much literature there is, what is known and where the gaps lie. This scoping study will provide a single source of up-to-date evidence to inform health professionals about the strategies occupational therapists employ to facilitate work-related transitions for people with hand injuries. METHODS AND ANALYSIS: The methodological framework by Arksey and O'Malley (2005) will form the structure of the scoping review. The search strategy has been developed in collaboration with a subject librarian. The following databases will be searched: EBSCOhost including only Medline, CINAHL and Health Source: Nursing/Academic Edition; PubMed, Scopus, The Cochrane library and Web of Science. Reference lists will be examined, and grey literature sources will be searched to ensure that literature missed in the database searches is included. Covidence will be used to manage the project. Full-texts will be uploaded for literature that meets the inclusion criteria. A process of blind review will be used to ensure that consistency and rigour is upheld. ETHICS AND DISSEMINATION: The findings of the scoping review will be disseminated in an article, within 2019, to be published in a peer-reviewed journal. The findings will be presented at conferences to ensure the optimal dissemination of the scoping review's conclusions.

Novice occupational therapists: Navigating complex practice contexts in South Africa.

BACKGROUND/AIM: The transition from student to occupational therapy practitioner is challenging. In South Africa, this transition is undertaken in rural and underserved areas, as graduate health professionals are deployed by the government for a year of compulsory Community Service. This study set out to establish the characteristics of these practice settings, the resources available for occupational therapy services, the availability and quality of supervision, and participants' perceived ability to communicate with their patients and negotiate cultural differences. METHODS: A cross-sectional survey design was utilised and a questionnaire was sent to all occupational therapists completing Community Service in 2013 (N = 240). Data were analysed using Stata 12 and IBM SPSS Statistics 21.0. Frequencies and percentages were calculated for categorical variables and associations tested with Odds Ratios and the Pearson's Chi square test. Responses to open-ended questions were post-coded. RESULTS: A 44.3% (n = 103) response rate was achieved. Practice settings often provided few resources. Although most participants had supervisors (89.6%), many did not find supervision satisfactory (65.9%). Communication difficulties featured strongly (73.9%), but the majority of participants felt they possessed basic cultural competence. CONCLUSION: Participants worked within complex practice settings that were frequently resource-restricted with less than satisfactory supervision. Practice required cultural competence and an ability to work across language barriers. Undergraduate curricula need to be tailored to equip new graduates to navigate these contextual realities. Furthermore, human resourcing strategies need to be evaluated and effective supervision and support structures need to be developed.

The validity and clinical utility of the Disabilities of the Arm Shoulder and Hand questionnaire for hand injuries in developing country contexts: A systematic review.

STUDY DESIGN: Systematic review. INTRODUCTION: The Disabilities of the Arm Shoulder and Hand Questionnaire has multiple language versions from many countries around the world. In addition there is extensive research evidence of its psychometric properties. PURPOSE OF THE STUDY: The purpose of this study was to systematically review the evidence available on the validity and clinical utility of the Disabilities of the Arm Shoulder and Hand as a measure of activity and participation in patients with musculoskeletal hand injuries in developing country contexts. METHODS: We registered the review with international prospective register of systematic reviews prior to conducting a comprehensive literature search and extracting descriptive data. Two reviewers independently assessed methodological quality with the Consensus-Based Standards for the Selection of Health Measurement Instruments critical appraisal tool, the checklist to operationalize measurement characteristics of patient-rated outcome measures and the multidimensional model of clinical utility. RESULTS: Fourteen studies reporting 12 language versions met the eligibility criteria. Two language versions (Persian and Turkish) had an overall rating of good, and one (Thai) had an overall rating of excellent for cross-cultural validity. The remaining 9 language versions had an overall poor rating for cross-cultural validity. Content and construct validity and clinical utility yielded similar results. DISCUSSION/CONCLUSIONS: Poor quality ratings for validity and clinical utility were due to insufficient documentation of results and inadequate psychometric testing. With the increase in migration and globalization, hand therapists are likely to require a range of culturally adapted and translated versions of the Disabilities of the Arm Shoulder and Hand. Recommendations include rigorous application and reporting of cross-cultural adaptation, appropriate psychometric testing, and testing of clinical utility in routine clinical practice.

Embracing Cultural Diversity: Meaningful Engagement for Older Adults With Advanced Dementia in a Residential Care Setting.

Providing person-centered care (PCC) that focuses on meaningful engagement in residential care settings for older adults with moderate to advanced dementia is an internationally recognized challenge. In this study, we aimed to identify best-practice scenarios for supporting older adults with moderate to advanced dementia from culturally and linguistically diverse backgrounds who lived in care facilities. A mixed-methods study with a concurrent triangulation strategy was adopted. Data collection occurred with care partners by means of a preworkshop questionnaire, an appreciative-inquiry workshop, and an adapted Delphi technique. The findings indicate that care partners valued the care facilities' residents' needs for doing, being, and belonging. Collaborative data generation reflected the setting-specific PCC practices. Leadership team members agreed that enabling inclusion and celebrating cultural diversity were important but that cultural humility needed to be promoted.

Survey Instruments for Knowledge, Skills, Attitudes and Behaviour Related to Evidence-based Practice in Occupational Therapy: A Systematic Review.

The purpose of this study was to evaluate, through a systematic review, assessment instruments for evidence-based practice (EBP). The specific objectives were to (1) identify survey instruments testing EBP knowledge, skills, attitudes and behaviour; (2) determine the attributes measured by each instrument; (3) evaluate the psychometric properties of the instruments; and (4) evaluate the methodological quality of the instruments. Using the Cochrane approach, searches were conducted in Pubmed, EBSCOHost and Scopus from inception to February 2014. Papers were screened by two independent assessors, and data were extracted by one researcher. Forty papers reporting 34 instruments met the inclusion criteria and were included in the qualitative synthesis. Most instruments measured EBP behaviour (n = 33) and attitudes (n = 21). This review provides a single source of information to enable researchers to select the most robust descriptive instruments to measure EBP learner attributes. Instruments used only with occupational therapists may have resulted in some instruments being missed. For further research, it is recommended that attention is given to developing objective instruments with a focus on knowledge and skills. Copyright © 2015 John Wiley & Sons, Ltd.

Locally manufactured wheelchairs in Tanzania - are users satisfied?

BACKGROUND: The government of Tanzania created opportunity for the production of wheelchairs that would be appropriate to the local needs and environment. OBJECTIVES: The study assessed the extent to which the wheelchairs met the activity and participation needs of the users, as well as the users' level of satisfaction with the provision, repair and maintenance of these wheelchairs. METHODS: A descriptive cross-sectional analytical design was utilized to collect data through the administration of a questionnaire among 75 adult wheelchair users. RESULTS: Participants had used wheelchairs for an average period of 9.3 years. Most participants (61%) had sustained spinal cord injuries, and used three-wheeler chairs (76%). More than 90% reported that their wheelchairs positively influenced their activity and participation needs, and 85% were satisfied with their ability to carry out daily activities. Participants expressed satisfaction with the durability of the wheelchairs (89%), and the professional services received (71%), but not with follow-up services (77%). There was difference in satisfaction with features of 3-wheeler and 4-wheeler rigid chairs (p=0.030). CONCLUSION: The wheelchairs positively impacted participants' activity and participation needs. Participants were sat isfied with the features of the wheelchairs but not with follow-up services. The concerns of dissatisfied users should be addressed.

Measuring evidence-based practice knowledge and skills in occupational therapy--a brief instrument.

BACKGROUND: Valid and reliable instruments are required to measure the effect of educational interventions to improve evidence-based practice (EBP) knowledge and skills in occupational therapy. The aims of this paper are to: 1) describe amendments to the Adapted Fresno Test of Competence in EBP (AFT), and 2) report the psychometric properties of the modified instrument when used with South African occupational therapists. METHODS: The clinical utility of the AFT was evaluated for use with South African occupational therapists and modifications made. The modified AFT was used in two studies to assess its reliability and validity. In Study 1 a convenience sample of 26 occupational therapists in private practice or government-funded health facilities in a South African province were recruited to complete the modified AFT on two occasions 1 week apart. Completed questionnaires were scored independently by two raters. Inter-rater, test-retest reliability and internal consistency were determined. Study 2 was a pragmatic randomised controlled trial involving occupational therapists in four Western Cape Department of Health district municipalities (n = 58). Therapists were randomised in matched pairs to one of two educational interventions (interactive or didactic), and completed the modified AFT at baseline and 12 weeks after the intervention. An intention-to-treat analysis was performed. Data were not normally distributed, thus non-parametric statistics were used. RESULTS: In Study 1, 21 of 26 participants completed the questionnaire twice. Test-retest (ICC = 0.95, 95 % CI = 0.88-0.98) and inter-rater reliability (Time 1: ICC = 0.995, 95 % CI = 0.99-0.998; Time 2: ICC = 0.99, 95 % CI = 0.97-0.995) were excellent for total scores. Internal consistency based on time 1 scores was satisfactory (α = 0.70). In Study 2, 28 participants received an interactive educational intervention and completed the modified AFT at baseline and 12 weeks later. Median total SAFT scores increased significantly from baseline to 12-weeks (Z = -4.078, p < 0.001) with a moderate effect size (r = 0.55). CONCLUSION: The modified AFT has demonstrated validity for detecting differences in EBP knowledge between two groups. It also has excellent test-retest and inter-rater reliability. The instrument is recommended for contexts where EBP is an emerging approach and time is at a premium. TRIAL REGISTRATION: Pan African Controlled Trials Register PACTR201201000346141 . Registered 31 January 2012. Clinical Trials NCT01512823 . Registered 1 February 2012. South African National Clinical Trial Register DOH2710093067 . Registered 27 October 2009.

Comparison of an interactive with a didactic educational intervention for improving the evidence-based practice knowledge of occupational therapists in the public health sector in South Africa: a randomised controlled trial.

BACKGROUND: Despite efforts to identify effective interventions to implement evidence-based practice (EBP), uncertainty remains. Few existing studies involve occupational therapists or resource-constrained contexts. This study aimed to determine whether an interactive educational intervention (IE) was more effective than a didactic educational intervention (DE) in improving EBP knowledge, attitudes and behaviour at 12 weeks. METHODS: A matched pairs design, randomised controlled trial was conducted in the Western Cape of South Africa. Occupational therapists employed by the Department of Health were randomised using matched-pair stratification by type (clinician or manager) and knowledge score. Allocation to an IE or a DE was by coin-tossing. A self-report questionnaire (measuring objective knowledge and subjective attitudes) and audit checklist (measuring objective behaviour) were completed at baseline and 12 weeks. The primary outcome was EBP knowledge at 12 weeks while secondary outcomes were attitudes and behaviour at 12 weeks. Data collection occurred at participants' places of employment. Audit raters were blinded, but participants and the provider could not be blinded. RESULTS: Twenty-one of 28 pairs reported outcomes, but due to incomplete data for two participants, 19 pairs were included in the analysis. There was a median increase of 1.0 points (95% CI = -4.0, 1.0) in the IE for the primary outcome (knowledge) compared with the DE, but this difference was not significant (P = 0.098). There were no significant differences on any of the attitude subscale scores. The median 12-week audit score was 8.6 points higher in the IE (95% CI = -7.7, 27.0) but this was not significant (P = 0.196). Within-group analyses showed significant increases in knowledge in both groups (IE: T = 4.0, P <0.001; DE: T = 12.0, P = 0.002) but no significant differences in attitudes or behaviour. CONCLUSIONS: The results suggest that the interventions had similar outcomes at 12 weeks and that the interactive component had little additional effect. TRIAL REGISTRATION: Pan African Controlled Trials Register PACTR201201000346141, registered 31 January 2012. Clinical Trials NCT01512823, registered 1 February 2012. South African National Clinical Trial Register DOH2710093067, registered 27 October 2009. The first participants were randomly assigned on 16 July 2008.