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Physio Review
Patient Assessment - Page 1 (Edit)
Date *
Patient Name *
PR No
Age / Gender *
F
M
T
Contact No
Reference
Address
55, Karpagam colony, Paravai
Occupation Type *
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Government
Non-Government
Senior Citizen
Others
Designation
Nature of Work
Select
Active
Desktop
Field
Travel
House Holder
others
Vitals
HEIGHT
WEIGHT
BP
PR
TEMP
SPO2
Other Health Issues & Treatment History
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History of Present Complaints
8+ yrs Left knee residual pain after ACL injury - Non surgical management 2+months Right knee started to pain due to increased loading in this knee
Onset
Sudden
Insidious
Gradual
Treatment Taken
Multiple treatments - Vadamalayan hospitals - Dr Ravichandran, Jayam hospital for Left knee Right knee - Ayurvedha medication in Paravai
Investigation Details
Not Taken
Done , Not Produced
Attached with Case Sheet
Current Physiotherapy Episode
1
2
>3
Previous Session Details
Nil
Update
Present Complaints
Pain in BL knee in ADL Left knee constant pain even at zero activity 8+ years Low back pain on left side - on/off - Increased during Physical exertion
Symptoms
Constant
Intermittent
Worsening Factors
Relieving Factors
Pain Chart Notes
19-20-37
Pain Scale
Worst
Same
Better
VAS
At Worst
At Best
Pain Type
Nociceptive
Neuropathic
Nociplastic
Skin Colour
Scar
Adherent
Non-Adherent
No Scar
Swelling
Soft Fluctuating
Leathery
Tough
Dry
Tened
Hard
Boggy
Spongy
Thick
8 to 24 Hours of Injury
Tenderness
Grade I
Grade II
Grade III
Grade IV
Remarks
Left Inferomedial Knee
Update
Edit - Page 3
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Patient Management
Edit - Page 3
ROM
AROM
Movement
Side
Part
Plane
Available Range
Pain Starts
Action
Select
Left
Right
Select
Neck
Wrist
Shoulder
Elbow
Spine
Hip
Knee
Ankle
Select
Sagittal
Frontal
Transverse
-
+ Add AROM
PROM
Movement
Side
Part
Plane
Available Range
Pain Starts
Action
Select
Left
Right
Select
Neck
Wrist
Shoulder
Elbow
Spine
Hip
Knee
Ankle
Select
Sagittal
Frontal
Transverse
-
+ Add PROM
End Feel
Soft
Firm
Hard
Empty
MMT
-
+ Add MMT
Special Tests
Special Test 1
Special Test 2
Remarks
FOCUS: Lower limbs Open chain exercises - Include Leg machine and Recumbent bike Lower back - LPHC strength - Spinal mobility and strength
Diagnosis
Patient Goals & Concerns
Physiotherapy Goals
Short Term Goals
Long Term Goals
Action
-
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Further Referral (if needed)
Physiotherapist Details
Assessed Physio Name
IAP Membership No.
Treatment In-Charge Name
IAP Membership No.
Update
Electrotherapy
Modality
Site
Details
Date
Remarks
Action
-
-
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Supportive Techniques
Technique
Details
Date
Remarks
Action
-
-
-
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Corrective Exercises
S.No
Exercise
Sets
Reps
Time
Date
Remarks
Action
1
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2
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3
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4
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5
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6
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7
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8
Start focusing on low back as knee pain starts to decrease
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+ Add Row
Date
Remarks
rPMS 3sessions per wk X 2 wks - Rs.1500 Total treatment course 3sessions per wk x 4 wks - Rs.800
Update
