OET Writing for Physiotherapists: The Complete Referral Letter Guide (2026)

OET Writing for physiotherapists presents a specific set of challenges that differ meaningfully from nursing or medical OET tasks. Physiotherapy letters are usually functional in focus — they centre on mobility, strength, pain behaviour, and rehabilitation progress — and they require careful attention to scope of practice when interpreting imaging or clinical findings.

This guide covers the complete referral letter structure for physiotherapy OET tasks, the most common errors physios make, registration score requirements by country, and a full annotated sample letter.

OET Writing Score Requirements for Physiotherapists

Before diving into technique, know your target. Here are the Grade B requirements for physiotherapy registration bodies:

Grade B is the universal standard. There is no C+ exception for physiotherapy as there is for NMC nursing in the UK. You need 350+ in Writing.

The OET Writing Criteria — What Physiotherapists Are Scored On

OET Writing is marked across 6 criteria:

Total: /40, converted to 0–500 scale.

For physiotherapy tasks, the Content and Organisation criteria are where most marks are lost — not Language. Most physios writing in English as a second language have sufficient grammar for Grade B. The harder challenge is selecting the right clinical content and organising it by priority rather than chronology.

What Physiotherapy OET Letters Usually Look Like

OET Writing tasks for physiotherapy professionals most often involve:

• Referral to an orthopaedic surgeon — for a patient with suspected structural injury or condition requiring surgical review
• Referral to a pain specialist or rheumatologist — for complex chronic pain or inflammatory conditions
• Referral back to the treating GP — with a rehabilitation update and return-to-work or discharge recommendation
• Discharge summary — summarising rehabilitation progress, goals achieved, and home exercise programme

Each letter type has a slightly different required content set, and the reader determines what you include. Referring to an orthopaedic surgeon requires different emphasis than referring to a GP — the surgeon needs imaging and functional assessment; the GP needs a full clinical update and clear management plan.

Structure of a Physiotherapy Referral Letter

OET letters must be organised thematically by clinical priority — not chronologically. This is one of the most common Organisation criterion errors.

Correct Thematic Structure

1. Purpose — Why are you writing? Who are you referring to and why?
2. Current status / functional presentation — What is the patient’s current functional ability, pain level, and mobility?
3. Relevant clinical findings — What did your assessment reveal? (ROM, strength, gait, special tests)
4. Imaging / investigation results — What do relevant investigations show?
5. Treatment to date and response — What physiotherapy has been provided and how has the patient responded?
6. Relevant past medical history — Include only what is relevant to the referral
7. Social context (if clinically relevant) — Occupation, home environment, support
8. Closing request — What specifically do you want the recipient to do?

Scope of Practice: The Diagnosis Rule for Physiotherapists

This is critical. Unless a doctor has explicitly confirmed a diagnosis in the case notes, you must not state it as a confirmed fact.

Physiotherapy case notes frequently contain MRI findings, clinical test results, and GP referral letters describing suspected diagnoses. These are clinical findings — not confirmed diagnoses by you.

Accepted hedging phrases: “is suggestive of”, “is consistent with”, “is in keeping with”, “is concerning for”, “raises concern for”, “findings indicate”, “presentation is highly indicative of”

Scope of practice errors cost marks across Genre & Style (clinical register) and can also affect Content if they suggest misunderstanding of the clinical situation.

Content Criterion: What to Include (and What to Leave Out)

The Content criterion (/7) is the most commonly misunderstood. It asks: Did you select the right information from the case notes for this specific reader?

For a physiotherapy referral to an orthopaedic surgeon, required items typically include:

• Current functional limitations (what the patient cannot do)
• Relevant clinical assessment findings (ROM measurements, strength grades, special test results)
• Imaging results (if available and relevant)
• Duration and nature of symptoms
• Treatment provided and response
• The specific clinical question you want answered

Distractor items that cost marks (for an orthopaedic referral):

• Unrelated medical history (e.g., a hypertension diagnosis when referring for a shoulder problem, unless it affects surgical candidacy)
• Detailed social history not relevant to surgical planning
• Medication details unless directly relevant (e.g., blood thinners would be relevant; antidepressants generally would not)

The key principle: Would the orthopaedic surgeon need this information to make their clinical decision? If not, it’s a distractor.

Sample Letter: Physiotherapy Referral to Orthopaedic Surgeon

Scenario: James Carey, 48M, has been under your care for 10 weeks for right shoulder pain following a sports injury. MRI shows findings consistent with a full-thickness supraspinatus tear. He has not responded to conservative physiotherapy (ultrasound, manual therapy, strengthening programme). Active range of motion: flexion 90°, abduction 70°. Pain 7/10 at rest. Occupation: builder. You are referring him to an orthopaedic surgeon for surgical opinion.

Dear Dr. O’Sullivan,

Re: James Carey, DOB 14/07/1977

I am writing to refer Mr. Carey, a 48-year-old builder, for orthopaedic review of his right shoulder, which has failed to respond to a 10-week course of physiotherapy. His MRI findings are consistent with a full-thickness supraspinatus tear, and I would appreciate your surgical opinion. [Purpose — clearly states reason for referral, reader, clinical concern, and specific request in opening paragraph]

Mr. Carey currently presents with significant functional limitation. His active range of motion is restricted to 90° flexion and 70° abduction, with pain rated 7/10 at rest and 9/10 on overhead activity. He is unable to perform the overhead and lifting tasks essential to his occupation as a builder, and has been on modified duties for the past six weeks. [Current status — functional limitations and occupational impact, clinically prioritised]

MRI of the right shoulder (performed 3 weeks ago) demonstrated findings consistent with a full-thickness supraspinatus tear with minimal retraction. There is no evidence of significant biceps tendon pathology or acromioclavicular joint degeneration. [Imaging — presented as findings, not diagnosed; relevant detail only]

Over the course of 10 weeks, Mr. Carey received ultrasound therapy, manual therapy, and a progressive rotator cuff strengthening programme. He has shown no meaningful improvement in pain levels or functional range, and I do not believe further conservative management is appropriate at this stage. [Treatment and response — clear basis for the referral]

He has no relevant past medical history. He is a non-smoker with no known drug allergies. [Background — brief, relevant only]

I would be grateful for your assessment and surgical recommendation. Mr. Carey is keen to return to full duties as soon as clinically appropriate.

Yours sincerely, Emma Walsh, Physiotherapist City Physiotherapy Clinic

Word count: 278 words. (For OET, aim for 180–200 words — this sample is annotated for teaching purposes. In your actual exam, trim to 180–200 by condensing each paragraph to its essential information only.)

What this letter demonstrates:

• Purpose is stated in sentence one with clinical specificity
• Current functional status leads the body, not the history
• MRI findings are presented as “consistent with” — scope of practice maintained
• Treatment response is given as the clinical rationale for referral
• Social context (occupation) is included because it is directly relevant to surgical decision-making and rehabilitation planning
• No distractors included

Before and After: Organisation Error

Here is the same referral, organised incorrectly (chronologically), and the consequences for the Organisation criterion:

Chronological (incorrect) opening:

Mr. Carey first presented to our clinic 10 weeks ago following a shoulder injury sustained while playing rugby. At initial assessment, he reported pain and restricted movement. He was commenced on a physiotherapy programme…

This loses Organisation marks because the examiner has to read three sentences before understanding why you are writing and what the current clinical situation is. Clinical priority — the MRI finding and functional failure to respond — should lead.

Thematic (correct) opening:

I am writing to refer Mr. Carey for orthopaedic review of his right shoulder, which has failed to respond to a 10-week physiotherapy programme. MRI findings are consistent with a full-thickness supraspinatus tear…

The reader knows the purpose, the current status, and the clinical question within two sentences.

Common OET Writing Errors for Physiotherapists

Practice With Criterion-Specific Feedback

The fastest way to improve your OET Writing score is repeated practice with feedback that tells you which criterion failed and exactly where in your letter. For physiotherapy tasks specifically, this means feedback that checks:

• Whether your Content selection is appropriate for the specific reader
• Whether your hedging language is correct for the clinical findings in the case notes
• Whether your Organisation follows thematic priority or chronological order

Start with a free scored practice letter at /blog/oet-writing-practice-test-free.