ORTHOPEDIC AND MUSCULOSKELETAL REHABILITATION: AN OCCUPATIONAL THERAPY PERSPECTIVE

Abstract

Musculoskeletal diseases (MSDs) are the main cause of disability in the world, and it includes diseases of bones, joints, muscles, tendons, ligaments, and cartilage. In India, the prevalence of MSDs is estimated to range between 15 and 30 percent of the population where the increasing prevalence is due to an ageing population, work-related risks in agriculture and construction and road traffic injuries. The chapter will provide a conceptual summary of the orthopedic and musculoskeletal rehabilitation using an occupational therapy (OT) approach, with an orientation towards occupation-driven practice, rather than impairment-based approaches. The OT role in musculoskeletal rehabilitation is found in fractures of the upper extremities, lower extremities, arthroplasties, spinal, inflammatory arthropathies, and hand disorders. Clinical reasoning is guided by theoretical frameworks such as the Model of Human Occupation (MOHO), Canadian Model of Occupational Performance and Engagement (CMOP-E) and Biomechanical Frame of Reference. The International Classification of Functioning, Disability and Health (ICF) offers a biopsychosocial framework of assessment and goal setting that is consistent with activities, participation and contextual elements. Some of the OT interventions covered are orthotic fabrication, joint protection and energy conservation, therapeutic exercise, physical agent modality, environmental modification, assistive technology, psychosocial interventions, and vocational rehabilitation. Throughout, cultural adaptation is highlighted, with special focus on Indian living conditions, including floor-level living, squat toilets, and occupations that are culturally important. The two case studies, one of fracture rehabilitation in post-Colles, Mumbai, and the other, total knee arthroplasty rehabilitation in rural Rajasthan, show how the occupation-based and client-centered principles are applied in practice.