Occupational therapy (OT) is widely provided for people with chronic musculoskeletal conditions. The aims are to improve their ability to perform daily occupations (i.e. activities and valued life roles at work, in the home, at leisure and socially), facilitate successful adaptations to disruptions in lifestyle, prevent losses of function and improve or maintain psychological status. This chapter reviews the evidence for the effectiveness of OT interventions, suggests who is relevant for referral and indicates the appropriate timing for referral. The main emphasis is on OT for people with rheumatoid arthritis-primarily because most evidence to date is for this condition. Comprehensive OT is effective in improving function in people with moderate-severe arthritis. Some interventions (e.g. joint protection and hand exercises) are effective. People are increasingly being referred sooner after diagnosis for interventions to help prevent progression of functional, physical and psychological problems. Little is known of the effectiveness of therapy at this early stage.