Assessing transfers: why physiotherapy matters (and what actually helps)

Transfers — getting safely from bed ↔ chair, chair ↔ toilet, or in and out of a car are an everyday part of life for many people with disability. They’re also a common cause of pain, injury and loss of independence when they aren’t matched to a person’s current ability or environment. That’s why a careful, clinically-led physiotherapy assessment matters: the right combination of technique, therapy and assistive technology (AT) can dramatically improve safety, dignity and independence.

1) Start with the assessment — objective, repeatable, person-centred

Good transfer practice begins with a structured assessment that looks at how a person transfers (setup, movement, landing), their strength/balance/coordination, cognition, pain, and the environment (furniture heights, floor surfaces, clutter). There are validated clinical tools designed for this purpose — for example the Transfer Assessment Instrument (TAI), which breaks transfers into objective domains clinicians can score and track over time. Shirley Ryan AbilityLab

Assessing transfer type isn’t just “what we think will work”, it’s a clinical measurement that identifies risk, training needs and whether AT is required. That assessment also determines whether a transfer can safely be taught/rehabilitated, or whether a mechanical aid is a safer long-term solution.

2) Evidence: physiotherapy + exercise improves the building blocks of safe transfers

Transfers rely on strength, postural control, sit-to-stand ability and coordination. A strong and consistent body of research shows that targeted exercise and physiotherapy interventions improve muscle strength, postural control and balance, all of which translate into safer, more reliable transfers. Systematic reviews and meta-analyses demonstrate that structured strength and balance programmes improve these capacities across adults, and should be a core part of any transfer improvement plan. SpringerOpen

That means physiotherapy isn’t just about “telling people how to move” — it’s about progressively training the physical systems that make safer transfers possible (progressive resistance, balance training, motor learning and task-specific practice).

3) Assistive Technology (AT): match the device to the transfer style and person

When therapy + technique alone aren’t enough (or where safety demands it), AT is an essential part of the solution. Below are common transfer types and examples of assistive options that physiotherapists often prescribe and tune:

• Independent sit-to-stand (person can stand with or without contact):

  • Interventions: progressive strength training, cueing for technique, environmental changes (seat height).

  • AT: raised seats, foot positioning devices, grab rails.

• Standing-assist / impaired sit-to-stand (partial standing ability):

  • AT: sit-to-stand aids (e.g., Sara Stedy’s, standing frames, chair-mounted devices) that support the transition while encouraging weight-bearing through the legs. Evaluations show these devices support rehabilitation and reduce carer load. documents.arjo.com

• Sliding / repositioning transfers (bed ↔ chair using slide sheets or boards):

  • AT: slide sheets, slide boards, reduced-friction surfaces and training in reduced-contact techniques. Proper use reduces shear and manual handling risk and makes lateral transfers quicker and safer. Training and risk assessments are key.

• Hoist / sling transfers (where standing is unsafe or impossible):

  • AT: ceiling or mobile hoists with correctly-prescribed slings. The NDIS Commission emphasises the need for risk assessment, training and correct equipment selection when hoists are used; clinicians must document fit, sling type and staff competency. NDIS Quality and Safeguards Commission

• Sit-to-sit / single-caregiver transfer aids (no standing required):

  • Newer devices: products such as the Kera Sit2Sit and similar sit-to-sit transfer aids are designed to allow a single carer to transfer someone between seated surfaces without standing or heavy lifting. These innovations can reduce transfers, clothing removal, and carer strain while improving dignity and comfort for some users, but they require a clinical assessment and trial to confirm suitability. htsystems.co.nz+1

Key point: no single device is right for everyone. A physiotherapist’s job is to match the transfer style to the device design, the person’s capacity, the care team’s skills, and the environment.

4) Why combined care is best: therapy + AT + training

Research and clinical guidance consistently show the biggest reductions in injury risk and the best outcomes when training (staff/participant education) is combined with system changes (equipment, environment, process). In other words, giving carers a hoist without a proper equipment check, sling fit and competency training leaves risk in place; similarly, prescribing a sit-to-stand device without progressive strength training wastes rehabilitation opportunity. Integrated plans get the best results: improved safety, restored function where possible, and greater independence. documents.arjo.com+1

5) Practical assessment & prescription steps (how Function2Freedom approaches it)

1. Initial transfer assessment: functional observation (bed/chair/toilet/car), outcome measures, strength & balance screen, pain and cognition screen. Document baseline and goals. Shirley Ryan AbilityLab

2. Environmental review: bed & chair heights, clearances for hoists, floor surfaces, footwear. Simple changes (seat risers, decluttering) often give immediate improvements.

3. Therapy plan: individualised strength, balance and coordination programme (progressive, measurable), plus task-specific practice of the target transfer. We set objective markers so progress is visible. SpringerOpen

4. AT trial & prescription: trial appropriate devices (slide sheets, sit-to-stand aids, hoists, sit-to-sit devices). When prescribing slings or hoists we verify sizing, perform practice lifts, and liaise with suppliers for custom sling options. NDIS Quality and Safeguards Commission+1

5. Staff & carer training: hands-on competency checks for hoists, slide-sheet technique, safe sit-to-stand prompts and transfer sequencing. Document competency and include in the house file. (NDIS guidance emphasises documented competency for hoist use.) NDIS Quality and Safeguards Commission

6. 12-monthly (or sooner) review: people change - weight, mobility, cognition, so transfer plans should be date-stamped and reviewed regularly to keep equipment appropriate and safe.

6) Real outcomes — why this matters

When the right transfer technique, AT and ongoing therapy come together, providers report fewer staff injuries, safer and more dignified transfers for participants, and better day-to-day independence. For many participants, a well-matched AT solution plus ongoing strength and balance training means fewer painful transfers, fewer staffing changes, and improved participation in daily life.

Final thought — make it individual, measurable, and reviewed

Transfers touch every day. Treat them as a clinical intervention: assess objectively, prescribe what fits the person and the team, train staff, and review regularly. The right combination of physiotherapy and assistive technology doesn’t just reduce risk — it improves independence and dignity in day-to-day life.