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Lower-extremity (LE) musculoskeletal disorders (MSDs) can have a major impact on the ability to carry out daily activities. The effectiveness of interventions must be examined to enable occupational therapy practitioners to deliver the most appropriate services. This systematic review examined the literature published between 1995 and July 2014 that investigated the effectiveness of occupational therapy interventions for LE MSDs. Forty-three articles met the criteria and were reviewed. Occupational therapy interventions varied on the basis of population subgroup: hip fracture, LE joint replacement, LE amputation or limb loss, and nonsurgical osteoarthritis and pain. The results indicate an overall strong role for occupational therapy in treating clients with LE MSDs. Activity pacing is an effective intervention for nonsurgical LE MSDs, and multidisciplinary rehabilitation is effective for LE joint replacement and amputation. Further research on specific occupational therapy interventions in this important area is needed.
Lower-extremity (LE) musculoskeletal disorders (MSDs), such as major joint replacement, hip fracture, amputation or limb loss, and osteoarthritis (OA), are common conditions that require people to seek medical and rehabilitation services. In the United States, the incidence of hip and knee OA is 88 per 100,000 person-years and 100 per 100,000 person-years, respectively (Oliveria, Felson, Reed, Cirillo, & Walker, 1995). Demand for major LE joint replacements is growing (Ravi et al., 2012; Weinstein et al., 2013), and in 2014 more than 400,000 procedures were performed that cost in excess of $7 billion just for hospitalizations (Centers for Medicare and Medicaid Services [CMS], 2016). In the United States, an estimated 300,000 older adults are hospitalized each year for hip fracture (National Center for Health Statistics, 2010), and the prevalence of LE amputation or limb loss is increasing (Ziegler-Graham, MacKenzie, Ephraim, Travison, & Brookmeyer, 2008).
The potential impact of LE MSDs on participation in meaningful life roles is immense. For example, approximately 80% of patients with OA have some movement limitation, with 25% unable to perform activities of daily living (ADLs; Centers for Disease Control and Prevention, 2015). LE MSDs can cause activity limitations and participation restrictions that require rehabilitation intervention (Gillen et al., 2007).
People recovering from or living with LE MSD may be referred to and receive occupational therapy services because these conditions regularly hamper participation in meaningful occupations (American Occupational Therapy...