A Systematic Review of International Evidence to Inform Occupational Therapy Practice Guidelines for Total Knee Replacement in the Korean Health System.
Junghun Aj Kim, Seong-Kyu Ha, Min-Ye Jung
OT after knee replacement is most strongly linked to shorter hospital stays, with weaker evidence for better daily function, mood, and community reintegration.
Most of the 51 studies reviewed were observational and low quality, so no single OT activity can be credited with these gains.
Key findings
1The strongest evidence (Grades A–B, from systematic reviews and randomised trials) links OT involvement within multidisciplinary enhanced-recovery pathways to shorter hospital stays after TKR, with reported reductions of approximately 1 to 6 days across different healthcare systems.
2Evidence for OT contributions to ADL improvement, reduced anxiety and depressive symptoms, patient satisfaction, and community reintegration is predominantly low quality: 31 of the 51 included studies were Grade C, and the community-reintegration and satisfaction findings rest mainly on case studies and observational designs.
3OT-led components most consistently identified across studies were ADL assessment and retraining, assistive device prescription and training, home environment modification, and discharge-readiness assessment. These were delivered as part of multidisciplinary teams that also included physiotherapy, nursing, and surgical protocols, so the contribution of OT alone cannot be separated from the other disciplines.
Still to come
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The review was designed to map OT interventions for guideline development in Korea, not to compare the effectiveness of different OT approaches or to isolate OT's contribution from other disciplines in a multidisciplinary team. 31 of the 51 included studies were Grade C (low quality), and 5 were Grade D (very low), meaning most of the evidence comes from observational designs, case reports, or small samples rather than controlled trials. Only English-language publications were included, which may exclude relevant evidence published in other languages. The search window (2000 to November 2021) excludes both earlier foundational work and the most recent 4 years of research. No quantitative synthesis or meta-analysis was performed; findings are a narrative mapping, so effect sizes cannot be pooled or compared across studies. The review's focus on the Korean healthcare context (where average post-TKR hospital stay is 19.4 days) may limit direct applicability to systems where stays are already 1–3 days.
Declared interests
No funding was received for this manuscript. The authors declare no conflicts of interest.
The easy way to misread this
Do not read the length-of-stay reductions as evidence that OT alone shortens hospitalization. Every study reporting a LOS benefit delivered OT as one component of a multidisciplinary enhanced-recovery pathway that also included physiotherapy, nursing, surgical protocols, and patient education. The review explicitly states it was not designed to compare intervention effects or to isolate OT's contribution from the other disciplines in the team.
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