What is the difference between occupational therapy (OT) and physiotherapy (physical therapy, PT) for limb rehabilitation?

Differences Between Occupational Therapy and Physiotherapy for Limb Rehabilitation

Occupational therapy (OT) focuses on enabling participation in meaningful daily activities and roles, while physiotherapy (PT) focuses on restoring physical function and movement patterns through exercise and physical modalities.

Core Differences in Focus and Approach

Occupational Therapy Approach

• Primary Focus: Enabling participation in daily "roles, habits, and routines in the home, school, workplace, community and other settings" 1
• Assessment: Evaluates how physical limitations impact activities of daily living (ADLs) and identifies factors influencing performance (visual, physical, cognitive, psychosocial, environmental) 1
• Intervention Goals: Improve functional independence in self-care, productivity, and leisure activities
• Key Components:
  • Environmental and task modifications to enhance safety and enable completion of daily activities
  • Adaptive equipment and assistive device training
  • Joint protection techniques and activity pacing
  • Training in strategies for medication management and use of medical devices 1

Physiotherapy Approach

• Primary Focus: Restoring physical function, movement patterns, and mobility
• Assessment: Evaluates physical impairments, movement patterns, strength, range of motion, and mobility
• Intervention Goals: Improve physical function, strength, range of motion, and mobility
• Key Components:
  • Exercise prescription (aerobic, strengthening, neuromuscular)
  • Manual therapy techniques
  • Gait training and mobility exercises
  • Pain management including thermal therapy 1

Specific Differences in Limb Rehabilitation

Hand/Upper Extremity Rehabilitation

Occupational Therapy:

• Focuses on functional use of the hand/arm in daily activities
• Provides training in adaptive techniques and equipment for self-care tasks
• Addresses environmental modifications to support independence 1
• Emphasizes naturalistic occupations as context for therapeutic exercise 2
• Implements visual-skills training to enhance ability to compensate for vision loss 1

Physiotherapy:

• Focuses on restoring range of motion, strength, and movement patterns
• Implements specific exercise protocols (e.g., CIMT, bilateral training)
• Utilizes physical modalities for pain management
• May incorporate robotic therapy and NMES for motor recovery 1

Lower Extremity Rehabilitation

Occupational Therapy:

• Focuses on how lower extremity function impacts daily activities
• Addresses mobility in context of home management, work, and leisure
• Provides training in adaptive techniques and equipment for ADLs
• Implements activity pacing strategies for lower extremity MSDs 3

Physiotherapy:

• Focuses on gait training, balance, and lower extremity strengthening
• Implements specific exercise protocols for joint-specific rehabilitation
• Addresses biomechanical aspects of movement
• Provides training in use of mobility aids 1

Overlapping Areas and Collaboration

Both disciplines:

• Provide exercise interventions, though with different focuses
• Address pain management strategies
• Work on improving function and quality of life
• May be involved in prosthetic training for amputees 1, 4
• Participate in multidisciplinary rehabilitation programs 1

Clinical Applications and Examples

Case Example: Stroke Rehabilitation

• OT: Focuses on retraining in self-care activities, environmental modifications, and compensatory strategies for daily tasks 5
• PT: Focuses on gait training, balance exercises, and neuromuscular reeducation 1

Case Example: Hand Injury

• OT: Focuses on functional use of the hand in daily activities, adaptive equipment, and environmental modifications 6
• PT: Focuses on range of motion exercises, strengthening, and manual therapy techniques 6

Practical Implications

1. Referral Decision-Making:

   • Refer to PT when the primary goal is to improve physical function, movement patterns, and mobility
   • Refer to OT when the primary goal is to improve participation in daily activities and roles

2. Timing of Interventions:

   • PT often begins earlier in acute rehabilitation to address basic movement patterns
   • OT may be introduced as functional goals become more prominent

3. Collaborative Approach:

   • Most effective rehabilitation programs include both OT and PT working together
   • "We recommend that patients sustaining HELET (high-energy lower extremity trauma) participate in a multidisciplinary rehabilitation program including physical and occupational therapy" 1

Both occupational therapy and physiotherapy are essential components of comprehensive rehabilitation, with distinct yet complementary approaches to improving function and quality of life for individuals with limb impairments.