Wheelchair Order Referral Process
Send the wheelchair order to a physical therapist (PT) or occupational therapist (OT) for formal assessment and prescription, as wheelchair prescriptions must be based on careful evaluation of the patient's functional needs, physical capabilities, and the environment in which the wheelchair will be used. 1
Why Therapy Referral is Essential
The wheelchair prescription process requires specialized assessment that goes beyond a simple order:
Wheelchair prescriptions must be specific to the patient's needs, environment, and preferences rather than generic orders, as designs vary greatly and improper fitting can lead to skin breakdown, functional limitations, and safety issues 1
Physical and occupational therapists are the appropriate professionals to conduct the multidisciplinary assessment required for wheelchair prescription, including evaluation of positioning needs, mobility capabilities, transfer ability, and pressure ulcer risk 1, 2
Proper sizing and component selection require measurements and functional testing that therapists are trained to perform, including assessment of seat width, depth, back height, footplate positioning, and cushion requirements 3, 4, 2
What the Therapist Will Assess
The therapy evaluation will determine:
Ambulatory status and safety: Whether the patient is nonambulatory, has severely limited walking ability, or cannot accomplish mobility-related activities of daily living (toileting, feeding, dressing, grooming, bathing) 1, 5, 6
Manual versus power wheelchair needs: Manual wheelchairs require sufficient upper body strength and coordination for self-propulsion, while power wheelchairs are indicated for patients lacking these capabilities 1, 5, 3
Seating and positioning requirements: Assessment for pressure ulcer risk, existing skin breakdown, need for specialized cushions, trunk support, and power positioning features (tilt, recline, seat elevation) 1, 5, 6, 7
Transfer ability and upper body function: Whether the patient can independently transfer in/out of the wheelchair and operate controls safely 5, 3
Environmental factors: Home layout, doorway widths, flooring surfaces, outdoor use requirements, and transportation needs 1, 2
Common Pitfalls to Avoid
Do not write a generic "wheelchair" order without therapy evaluation, as this leads to inappropriate equipment that may worsen function, cause skin breakdown, or create safety hazards 1, 4, 8
Do not assume a scooter is equivalent to a power wheelchair – scooters require preserved upper body strength, balance, and independent transfer ability, while power wheelchairs serve patients who lack these capabilities 5
Do not delay wheelchair provision while waiting for pressure ulcers to heal – proper seating is required for healing, and specialized positioning equipment is medically necessary for patients with existing ulcers 7
Documentation Requirements
Your referral should include:
Diagnosis and medical justification for why the patient cannot ambulate safely or accomplish mobility-related ADLs without a wheelchair 6, 7
Specific functional limitations documented in clinical terms (e.g., "cannot walk >10 feet without rest," "requires maximum assist for all transfers," "stage 4 pressure ulcer present") 6, 7
Statement that less costly alternatives are insufficient (e.g., "cane and walker inadequate due to bilateral lower extremity weakness") 5, 7