Effectiveness of Occupational Therapy Interventions for Adults With Osteoarthritis: A Systematic Review

PURPOSE: Osteoarthritis (OA), the most common form of arthritis, involves degeneration of articular cartilage and underlying bone (Hunter, Schofield, & Callander, 2014). Common sites for OA include the hands, knees, and hips. OA causes activity limitations, decreased quality of life, and excessive utilization of health care services. Splints, assistive devices, activity pacing, adaptations for activities of daily living and work, and exercises are recommended for people with OA (Deshaies, 2013; Hammond, 2014). However, persons with OA often are not referred to occupational therapy (OT) except for referrals post joint surgery. An understanding of the effectiveness of interventions targeted at improving these outcomes can help OT practitioners select and use evidence-based interventions for people with OA. The purpose of this review is to summarize evidence for the effectiveness of interventions within the scope of occupational therapy practice to address occupational performance, pain, fatigue, and depression in persons with OA.

DESIGN AND METHOD: This systematic review was part of the American Occupational Therapy Association (AOTA) Evidence-Based Practice Project. Databases and sites searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and Ergonomics Abstracts. Also included were consolidated evidence-based medicine reviews such as the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, and the Database of Abstracts of Reviews of Effectiveness. In addition, bibliographies from articles included in the databases and relevant journals were hand searched as needed to confirm that all appropriate articles were included. Examples of key words included osteoarthritis, exercise, cognitive behavior therapy, energy conservation, self-management, education, and rehabilitation.

Inclusion criteria required an intervention approach within the scope of OT practice, peer-reviewed scientific literature (Levels I–III) published in English between January 2000 and July 2014, and adult participants with OA. Studies were excluded if interventions focused specifically on the hand and upper or lower extremities as these topics were included in the AOTA systematic review on musculoskeletal disorders. Studies were also excluded if people with different types of arthritis were included but there were no separate analyses by type of arthritis.

RESULTS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to summarize the articles. The initial search yielded 450 studies; 45 were included in the final review. Articles were reviewed and compiled into evidence and bias tables, and interventions were grouped into two subthemes: physical activity and psychoeducational interventions. In general, physical activity interventions, which included land- and water-based exercises, Tai Chi, and yoga, generally resulted in reduction of pain and depression and improvements in mobility and occupational performance. The psychoeducational interventions, which included education, self-management, stress management, cognitive–behavioral approaches, and occupational therapy, resulted in improvements in pain and occupational performance.

CONCLUSION: This systematic review found evidence to support the use of physical activity and psychoeducational interventions to improve occupational performance, pain, mobility, and depressive symptoms in persons with OA. These interventions could be incorporated into OT practice for persons with OA.

IMPACT STATEMENT: The prevalence of OA and impact of OA on occupational performance are expected to increase with the increase in the population of people age 65 and older. Occupational therapists are best suited to design and provide occupation-based interventions to improve mobility and independence and reduce symptoms such as pain and fatigue. Further research is needed to show the benefits of occupation-based interventions for this population.

References

Deshaies, L. (2013). Arthritis. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Occupational therapy: Practice skills for physical dysfunction (7th ed., pp. 1003–1036). St. Louis, MO: Mosby Elsevier.

Hammond, A. (2014). Rheumatoid arthritis, osteoarthritis, and fibromyalgia. In M. V. Radomski & C. A. Trombly Latham (Eds.), Occupational therapy for physical dysfunction (7th ed., pp. 1215–1243). Philadelphia: Lippincott Williams & Wilkins.

Hunter, D. J., Schofield, D., & Callander, E. (2014). The individual and socioeconomic impact of osteoarthritis. Nature Reviews Rheumatology, 10, 437–441. https://doi.org/10.1038/nrrheum.2014.44