Physiotherapy Progress Survey
Between-session tracking: pain, function, and home-exercise adherence.
5 questions · 1 page · about 2 minutes to answer · fully editable after you start
Physio outcomes are made between appointments, in whether the home programme actually happens. This between-session check-in tracks pain, day-to-day function, and exercise adherence – with the reasons when the programme slips, because pain during exercise and no time need very different responses from the therapist.
Have patients complete it the day before each session. A few minutes of triage before the appointment turns the session itself into treatment time rather than interview time.
Replace [local emergency number, e.g. 000] and [local crisis line, e.g. Lifeline on 13 11 14] in its opening note with the services where your respondents live, before you share it: the numbers shown are Australia's. The Collect tab lists both until they are changed.
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Page 1
Since your last session
This survey asks how your recovery is going between sessions. Your answers help your physiotherapist adjust your treatment. It takes about 2 minutes.
This form is not an emergency service. If you need urgent medical help or are in immediate danger, call [local emergency number, e.g. 000]. For crisis support, call [local crisis line, e.g. Lifeline on 13 11 14].
Q1.Average pain level this week?*
Q2.How many days did you complete your home exercises?*
- Every day
- Most days
- A few days
- Not this week
Q3.What got in the way of doing them every day?
Asked only if the answer to Q2 is “Most days”, “A few days” or “Not this week”.
- Pain during exercises
- No time
- Forgot
- Unsure I was doing them right
Q4.Compared to last week, how are these?
| Worse | Same | Better | |
|---|---|---|---|
| Everyday movements | |||
| Sleep comfort | |||
| Confidence in the injured area |
Q5.Anything to flag before your next session?
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