Occupational therapy and vocational rehabilitation are increasingly available for people with musculoskeletal diseases. Occupational therapy aims to improve or maintain function in work, leisure, self-care and domestic activities, social roles, and psychological status. A wide range of interventions is provided, including joint protection, assistive devices and splints. Vocational rehabilitation aims to improve ability to stay in or return to work. Comprehensive occupational therapy and some interventions (joint protection, assistive devices and splints), as well as vocational rehabilitation, are reviewed. There is moderate to good evidence for effectiveness of comprehensive occupational therapy in rheumatoid arthritis, and for joint protection and splints in rheumatoid arthritis and osteoarthritis. However, evidence for other aspects of occupational therapy is still scarce, and better-quality trials are needed. Vocational rehabilitation to prevent job losses in rheumatic diseases is effective, but once people are unemployed, return-to-work interventions are less successful. Evidence is moderate to good for work conditioning programmes using a cognitive behavioural approach in chronic low-back pain, and also for early return-to-work interventions in subacute low-back pain.