Occupational Therapy Handwriting Practice in South Korea

Abstract

Background. Internationally, handwriting difficulty is a common issue among children. Occupational therapists are involved in helping children to improve their handwriting. Previous studies have summarised occupational therapy research and practice in handwriting, but these have not included information about occupational therapy practice for children’s handwriting in South Korea. To understand the nature of practice and identify the scope of evidence relating to South Korean occupational therapy for children with handwriting difficulties, a review of published literature on this topic is required. Methods. A scoping review was conducted to identify and summarize published literature on occupational therapy paediatric handwriting practice in South Korea. A detailed context of the review was provided in a background chapter (Chapter 1 “Introduction”). The introduction provided comprehensive information about the hand, handwriting, South Korea and the occupational therapy profession in South Korea to define terms and to help provide an understanding of occupational therapy practice conducted in Korea.  Chapter 2 “A scoping review of occupational therapy handwriting literature” is presented in the form of a manuscript for submission to a peer-reviewed journal (Occupational Therapy International). This background, the gap in evidence and research design used is presented. This study used a scoping review methodological framework suggested by Arksey and O’Malley (2005). This five-step framework was followed. First, the research question was identified; second, a search strategy was designed in Korean and English, and implemented in three databases which published or may have published Korean occupational therapy research. Third, after inspection a total of 22 articles were selected for inclusion from 151 sources. Fourth, a data-extraction form in Excel™ was created and this recorded the characteristics of each of these studies. At the last stage, a descriptive analysis of numerical data and thematic analysis were used to collate, summarise and synthesise the data from the 22 included papers. Results. Key findings of the scoping review demonstrate that hospitals and school-based settings were the most commonly studied service sites. Most studies were with Korean children with cerebral palsy. Standardized assessments were predominantly used, and these measured various performance components, rather than the “task” or “activity” of handwriting. Author-designed handwriting assessments which were reported to be based on previous studies were frequently used for measurement of handwriting quality. These did not ⅳ go through standardisation or validation processes. A sensory integration approach was the most popular approach to intervention, and the most targeted performance component of handwriting was fine-motor skills. Most study designs were of low research rigour in the evidence-based hierarchy. This study highlights that there is a diverse approach to assessments and intervention in Korean occupational therapy handwriting research, indicating that there is no consensus on the best handwriting approach in Korean occupational therapy literature. Conclusion. Most of the found evidence was focussed on clinical samples and used a sensory integrative approach. This is different to international occupational therapy research literature (which used standardised instruments) which focused mostly on typically developing children and used a wide number of conceptual approaches. Korean research was similar in the low level of research evidence generated. In the future, Korean occupational therapy handwriting research should use rigorous designs and should use assessments to accommodate the cultural and linguistic uniqueness of Korea. This will provide more opportunities to enhance the diversity of evidence on handwriting research.