The Effect of Occupational Engagement on Lifestyle in Adults Living with Chronic Pain: A Systematic Review and Meta-analysis.

Occupational engagement was always one of several treatment components, so its individual contribution cannot be separated from the rest of the multidisciplinary package. Most trials (6 of 11) had uncertain risk of bias and 4 had high risk of bias; only 1 had low risk. No trial blinded participants or providers, and 10 of 11 relied on self-reported outcomes, increasing the chance of overestimating benefit. Three trials used as-treated analysis rather than intention-to-treat, which can inflate effect sizes. Only primary chronic pain diagnoses were included; people with osteoarthritis, neuropathic pain, and other secondary pain conditions were excluded. The number of trials per outcome was very small (1-6), limiting the reliability of the pooled estimates. No trial attempted pain phenotyping, making it hard to know which pain subtypes benefit most.

Do not read the short-term physical activity gain as proof that occupational engagement works for chronic pain. The long-term effect was not statistically significant, the evidence was rated low certainty, and occupational engagement was one of several treatment components in every trial, so its individual contribution cannot be separated from the rest of the package.