Occupation-based intervention in therapy for upper limb musculoskeletal conditions: A systematic review.

Introduction: Using meaningful activities as a treatment modality is characteristic of occupation-based intervention (OBI). The benefits of OBI have been described, but not the effectiveness thereof. The aim of this review was to assess the effectiveness of OBI in relation to the type, commencement, duration and outcomes as reported in literature.

Methods: A comprehensive search of electronic databases was conducted, including EBSCOHost, PubMed, Cochrane Register for Controlled Trials, Web of Science, OTSeeker, PEDro and Google Scholar. Search terms included 'occupation-based', 'occupation-centered', 'intervention', 'upper limb' and 'outcome measures'. Studies including OBI for neurological or paediatric cases were excluded.

Results: Twelve studies met the inclusion criteria. Using the PEDro scale, three of the studies, all randomised controlled trials (RCTs), were viewed as high quality, one of fair and one of poor quality. Due to the heterogeneity of the studies, a meta-analysis was not possible, and a narrative synthesis is presented. Five studies used interviewing together with the Canadian Occupational Performance Measure (COPM) to determine the client's occupational profile when choosing meaningful activities. The commencement and duration of OBI varied amongst the studies, and a variety of outcome measures were used to determine the effectiveness of OBI.

Discussion: OBI used together with biomechanical approaches shows promising effectiveness. Outcome measures such as the COPM and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) that measure activity and participation, should be employed in client-centered practice. More robust scientific evidence regarding the effectiveness of OBI is needed.