Physio Progress Note

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name: physio-progress-note
description: "Write a physiotherapy progress note that shows clinical reasoning rather than attendance — what changed against the reassessment markers, what that means for the hypothesis, and what the plan does next. Use when asked to write a progress note, document a follow-up appointment, justify continued treatment to a funder, or when notes read as a list of what was done. Produces the reassessment against markers, the interpretation, the plan change with its reason, the objective-measure trend, and the discharge trajectory. A documentation framework for a licensed clinician; the clinical content remains theirs."
---

# Physiotherapy Progress Note

Most progress notes record what was done to the patient. A funder, a colleague, and your future self all need something different: what changed, what it means, and why the plan is what it is now. A note that says 'continued as before' across six visits is what triggers a funding review, and deserves to.

## What This Skill Produces

- **Reassessment against the markers** — the same measures from the initial assessment, so change is visible rather than asserted
- **The interpretation** — what the change, or its absence, means for the working hypothesis
- **The plan change with its reason** — including the deliberate decision to continue unchanged
- **The objective-measure trend** — numbers across visits rather than one snapshot
- **Adherence, recorded factually** — what the patient actually did, without blame
- **The discharge trajectory** — where this is heading and roughly when, which is what a funder is looking for

## Required Inputs

Ask for these if not provided:
- **The initial assessment markers** — what was chosen to re-test, and the baseline values
- **Today's findings** — the same measures, plus anything new
- **What the patient reports** — function, symptoms, and what has changed in their week
- **Adherence** — what they actually did between visits
- **The treatment given today** — and, more importantly, the reason for it

## Framework: Re-measure, Interpret, Then Change or Justify Not Changing

1. **Re-test the markers you chose.** The same measures, in the same way. Progress asserted without re-measurement is opinion.
2. **Lead with function.** What the patient can now do that they could not is the outcome; range of motion is a proxy for it.
3. **Interpret, do not just record.** Improvement consistent with the hypothesis strengthens it; no change after an adequate trial should challenge it. Say which.
4. **Record adherence factually and without blame.** 'Completed two of five sessions; work travel' is clinical information that explains the result.
5. **State what the plan does next, and why.** If it is unchanged, say why that is the right call — this is the sentence that answers a funding review.
6. **Trend the numbers.** A single value tells a reader nothing; three visits of the same measure tell them everything.
7. **Name the discharge trajectory.** Expected number of further visits and what discharge will look like. Treatment with no stated endpoint is what funders challenge.

## Output Format

### Progress note: [patient] · visit [n] · [date] · [clinician]

**Subjective:** [what the patient reports — function first, then symptoms] · **Since last visit:** [change, and anything new]

**Adherence:** [what was actually completed, and any reason given — recorded factually]

**Reassessment against markers**
| Marker | Baseline | Last visit | Today | Direction |
|---|---|---|---|---|

**New findings:** [anything not previously present]

**Interpretation:** [what the change or lack of it means for the working hypothesis — does it support, challenge, or require revision?]

**Treatment today:** [what was done] · **Reason:** [why this, now]

**Plan:** ☐ Continue unchanged — [why that is correct] ☐ Progress to [what] ☐ Regress to [what] ☐ Revise hypothesis — [to what, and what will test it] ☐ Onward referral — [to whom, why]

**Discharge trajectory:** [expected further visits] · **Discharge will look like:** [the criteria]

> A documentation framework for a licensed clinician. It does not diagnose, interpret findings, or determine appropriate treatment for any individual. Clinical reasoning and all decisions remain the treating clinician's, and record-keeping requirements follow your regulator's standards.

## Quality Checks
- [ ] The same markers from the initial assessment were re-tested
- [ ] Function is reported before impairment measures
- [ ] The findings are interpreted against the working hypothesis, not just listed
- [ ] Adherence is recorded factually
- [ ] The plan states what changes and why, including a reasoned decision to continue
- [ ] Objective measures are shown as a trend across visits
- [ ] A discharge trajectory is stated

## Anti-Patterns
- **'Continued as before.'** The phrase most likely to trigger a funding review, and fairly.
- **Recording treatment without reassessment.** Documents attendance, not care.
- **Listing findings without interpreting them.** The reasoning is the note's only real content.
- **Blaming the patient for adherence.** Record the fact; it explains the result without judging.
- **No change after six visits and no revised hypothesis.** The plan should have changed, or the reasoning should say why not.
- **Single-point measures.** A reader cannot see a trajectory in one number.
- **Never naming an endpoint.** Open-ended treatment is what gets challenged.

## Example Trigger Phrases
- "Write a progress note for a follow-up appointment"
- "The insurer is questioning continued treatment — what should my notes show?"
- "How do I document clinical reasoning in a progress note?"
- "My notes just list what I did — how do I improve them?"
- "Write a note where the patient has not improved"