How Physical Therapists Can Advocate For Occupational Therapy
By Donna Cifuni, PT, DPT
Physical Therapist
Physical therapists often receive referrals for patients without occupational therapy referrals. While not everyone will benefit from both disciplines, occupational therapy is a diverse field that can treat more impairments and conditions than some may realize.
As physical therapists, it is our responsibility to review the occupational therapy scope of practice so we know what to look out for when performing our PT evaluations and treatments with patients. It is also important to realize that many of our PT goals can be linked to functional activities and can therefore be correlated with occupational therapy goals.
To ensure patients are getting the best possible treatment, physical therapists should look at the entire picture and refer to occupational therapy when appropriate. This will ensure that patients are able to achieve any goals they may have in their daily lives. With a combination of PT and OT services, we can facilitate aging in place and improve the quality of life of our patients.
What’s the Difference Between Physical and Occupational Therapy?
Physical therapists traditionally receive referrals for patients with lower extremity pathologies such as knee or hip arthritis, low back pain, difficulty with balance, and difficulty with ambulation. A physical therapist’s plan of care will typically involve gait training and an emphasis on a reduced falls risk. Frequently, the physical therapist will also address strength and range of motion impairments.
Many times, patients think occupational therapy only focuses on the upper extremities, but it does so much more! The goal of occupational therapy is to “make daily life easier“. In addition to upper extremity strengthening and range of motion, occupational therapy concerns dressing, bathing, grooming, meal preparation, household activities, environmental modifications, ordering of durable medical equipment, and much more.
Does My Patient Need Occupational Therapy?
A patient referred for strength and balance deficits will most likely also have difficulty performing some of their activities of daily living (ADLs), which can also be addressed by occupational therapy.
It is sometimes the responsibility of a physical therapist to dig deep and ask patients questions regarding their daily life. Adding in some questions to an evaluation regarding what activities the patient has difficulty with can help point toward an occupational therapy referral.
Some simple questions that can be incorporated into an evaluation to indicate the need for an occupational therapy referral could include:
- Does the patient have difficulty getting in or out of the bathtub?
- Does the patient have difficulty with overhead tasks?
- Does the patient complain of upper extremity pain or weakness?
- Does the patient have trouble getting dressed in the morning?
- Does the patient exhibit difficulty holding a utensil?
- Does the patient present with decreased functional activity tolerance when performing daily tasks around the house?
- Does the patient require any adaptive equipment for dressing, bathing, eating, writing, etc.?
It is also important to note if you feel there may be a need for any environmental modifications. Occupational therapists will be able to suggest modifications for safety and can perform a home safety assessment in order to educate caregivers on safety measures that can be taken to reduce the risk for falls.
How To Identify Potential Occupational Therapy Goals Based On Current Physical Therapy Interventions
Many physical therapy goals can be correlated to occupational therapy goals. Here are some simple examples:
| Physical Therapy Goal | Related Occupational Therapy Goal |
| Improve lower extremity strength | Improve functional transfers |
| Decrease need for assistance for sit-to-stand transfers from couch/soft chair | Improve patient’s ability to perform transfers on/off commode/toilet |
| Improve safety with ambulation around the house | Improve patient’s ability to walk while carrying laundry to and from the laundry room |
| Improve static/dynamic balance to reduce fall risk | Improve balance in order to perform tooth brushing while standing, standing without upper extremity support to reach into cabinets |
| Ability to walk more than 1000 feet without rest breaks | Increased endurance when performing morning routine with decreased shortness of breath |
| Increased balance when navigating obstacles and stepping over objects | Improve patient’s ability to maintain balance while stepping in and out of the shower or tub |
| Improved UE/LE ROM | Decreased need for assistance when performing dressing activities |
Educating Patients and Caregivers On The Role of Occupational Therapy
As physical therapists, it is imperative that we educate patients and caregivers on the need for additional services based on our assessment, especially when there is no original OT referral in place from the physician.
Based on our quick assessment of the questions listed above, physical therapists can educate patients and caregivers on why they think occupational therapy is appropriate. Linking our tasks to functional goals will give patients a better understanding of exactly how OT can benefit them in their daily lives.
Some patients may not want to utilize PT and OT concurrently. CDC guidelines actually indicate that a patient should perform at least 2 days of strengthening and 150 minutes of aerobic activity in a week. The CDC also indicates that for increased health benefits, an older adult should perform more than 300 minutes of moderate-intensity exercise a week (60 minutes per day, 5 days a week) or 150 minutes of vigorous-intensity activity (30 minutes, 5 days a week). If a PT and OT come 3 times per week and other services occur 2 times per week, this will add up to the appropriate amount of moderate-intensity exercises for optimal health benefits.
These articles are a great resource for more information on how PT and OT can prevent functional decline associated with aging: