Developing policy-informed principles for rehabilitation using a model of care framework: a hand therapy example in a Global South context*

A call for contextually responsive rehabilitation practice necessitates services being shaped by policy. This imperative extends to the field of hand therapy, required to respond to a substantial and increasing burden of hand injuries in South Africa. To inform a strategic response to this need, this study sought to develop policy-based principles for hand therapy services delivered by occupational therapists in South Africa. A qualitative document synthesis was undertaken. Relevant local and international policies (n = 29) were identified by a review of the literature, stakeholder consultation and expert review. Ritchie and Spencer’s (1994) framework analysis was employed. Eighteen generic rehabilitation principles were generated under three categories namely the goal of rehabilitation (full participation and inclusion) the nature of rehabilitation (quality patient-centred care; equity and equality; accessible services; truly comprehensive care; an occupational focus; and work interventions); and enablers of rehabilitation (empowered clients and communities; intersectoral action for vital communities; a vital workforce; seamless services; resources (including assistive devices and technology); infrastructure and equipment; leadership and governance; financing; data for service improvement; networks & partnerships; responsive and anticipatory). The generic nature of the principles allows versatile application of these policy principles to numerous fields of rehabilitation practice. Specific application of the principles is discussed for hand therapy services in South Africa. Hand therapy in South Africa must be shaped by policy in order to strategically pursue universal accessRehabilitation must focus on enabling full participation and inclusion of clients and communitiesRehabilitation services should be characterised by quality, person-centredness, equity and equality, comprehensive care, accessibility, and a focus on work participationInvesting in key enablers of rehabilitation should be a strategic and operational priority Hand therapy in South Africa must be shaped by policy in order to strategically pursue universal access Rehabilitation must focus on enabling full participation and inclusion of clients and communities Rehabilitation services should be characterised by quality, person-centredness, equity and equality, comprehensive care, accessibility, and a focus on work participation Investing in key enablers of rehabilitation should be a strategic and operational priority