Jan 17 / Kimberly Breeden, MS, OTR/L

Distinguishing Occupational Therapy's Role in Transfer Training: Addressing Duplication of Services

photo of back of woman with potty tail sitting in wheelchair holding to grab bars in front of toilet
Lately a lot of my formal and informal conversations at work are focused on minimizing duplication of services between occupational therapy (OT) and physical therapy (PT). The topic of transfers comes up very often. I hear a lot of folks say that if physical therapy is addressing transfers then OT should not. I think it is worth exploring how we could have come to this point and how we address it. 

First, let’s look at it from a reimbursement stand point. When a reviewer reads my OT documentation and then the physical therapy documentation, does it look like it is the same service? Am I documenting the same type of performance and using the same type of language?  

From an organization stand point, does it seem like the company is paying for 2 different disciplines to work on the same thing with the same client? Is occupational therapy and physical therapy actually providing the same training?

What do the scopes of practice say? The AOTA Occupational Therapy Scope of Practice States that the domain of OT includes the occupation of ADLs, which also includes toilet, tub, shower or chair transfers required to complete the task. The APTA Physical Therapist’s Scope of Practice states the PT scope of practice consists of “patient and client management… to optimize physical function, movement, performance…”. So both scopes of practice would include addressing transfer training.  

So who should be addressing transfers? In my opinion, OT and PT should address transfers at the same time. It is not the same service, even if it is the same goal and provided within the same episode of care. Let me explain.

Recently I had a client that I was seeing for a discharge assessment; I had never seen the client before. Physical therapy had discharged the client the day before and documented “Independent with ambulation, independent with toilet and shower transfers”. Upon initial assessment the client was independent with the toilet and shower transfer with their clothes on and not completing the transfer during the actual ADL task, in other words you could call it a simulated transfer. We then moved into the ADL assessment; the client completed toileting and required contact guard assist with the toilet transfer during the actual task of toileting as their pants were not pulled up and were under their feet. The client demonstrated some unsteadiness when they tried to transfer with one hand holding onto their pants. It was totally different than the simulated transfer.

We then progressed to showering. The client had a mild cognitive impairment. Once the shower was set up the client required contact guard assistance to transfer into the shower potentially because once their clothes were off and shoes were off they did not feel as steady. It may have been that they were distracted with the added demands or the additional sensory stimulation of the actual task versus the simulated task. The client completed the shower with assistance for safety. The client then required minimal assist to complete the same transfer out of the shower as the floor was wet, they were focused on where the towel was, and they were fatigued.

Hopefully this example illustrates how both disciplines addressing the same transfer goal are not providing the same training. We would be providing the same service if both OT and PT are only providing simulated transfer training.

Unfortunately, the burden typically falls on occupational therapy to show how our services are different than physical therapy for transfer training. I also feel the OT practitioner has the opportunity to demonstrate the vast areas that occupational therapy is assessing and considering during adl transfer training. 
 - Occupational therapy services extend beyond just the physical performance of strength, range of motion, balance, energy and coordination. 
 - OT extends beyond the adaptive equipment and durable medical equipment needed or used during the task, as we also consider how the environment supports or impairs performance based on the client’s physical and cognitive abilities.  
 - OT considers the client’s beliefs regarding bathing, their toileting and showering as well as habits and routines and how they are currently supporting or impairing performance.   
 - Occupational therapy considers how the sensory demands and the client’s sensory processing abilities impact their performance in the task.  
 - OT assesses how one’s psychosocial factors such as anxiety, depression, mania and behaviors may be impacting their performance with self care.  
 - Occupational therapy assesses cognition and determines the specific cognitive functions that may be impacting self care performance.   
And not only does occupational therapy assess these areas, but we have real solutions! I truly feel that it is so ingrained in our training that we often do not realize we are even assessing and addressing all of these areas. 

For me, I realize that I have not been documenting and explaining my services specifically enough. I, like everyone else, have limited time to document; however I realize that it is imperative that I document and explain to my colleagues, organization and payors exactly what I am assessing and addressing during the provision of my services. My profession depends on it; your profession depends on it. 

I hope this blog helps you as an OT practitioner recognize the unique value you bring to self care transfers as well as to all of your treatments. But most of all, I hope you soon have an opportunity to explain the value of your services!  

American Occupational Therapy Association (2021). Occupational therapy scope of practice. American Journal of Occupational Therapy, 75(Suppl. 3), 7513410030. https://www.aota.org/-/media/Corporate/Files/Practice/Manage/official%20docs%20prepublication/ajot-75S3005-OT-Scope-of-Practice-aota.pdf

American Physical Therapy Association (2017). Physical therapist’s scope of practice. APTA.org https://www.apta.org/contentassets/a400d547ca63438db1349c4a69bf7ead/position-pt-scope-practice.pdf

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