Physio Initial Assessment

Physiotherapy Initial Assessment

A weak subjective produces an objective examination that tests everything and localises nothing. The assessment that works spends its time in the history — what the patient can no longer do, what changes the symptoms, and what they are afraid of — and then examines to confirm or refute a hypothesis rather than to fill in a form. This structures that sequence, and makes the flag screening deliberate rather than incidental.

What This Skill Produces

• A structured subjective — history, behaviour of symptoms, aggravating and easing factors, and the 24-hour pattern
• A deliberate flag screen — red flags checked and recorded as checked, and yellow flags identified rather than noticed in passing
• A targeted objective plan — the tests that would confirm or refute the working hypothesis, rather than a standard battery
• The working hypothesis, with competitors — what you think it is, and what else would explain the same picture
• Patient-centred goals — in the patient's own functional terms, measurable, with a timeframe
• The reassessment markers — the specific findings that will tell you whether treatment is working

Required Inputs

Ask for these if not provided:

• The presenting problem — what happened, when, how it has behaved since, and what the patient can no longer do
• Symptom behaviour — location, quality, aggravating and easing factors, 24-hour pattern, and any change over time
• Screening information — general health, medications, weight change, previous episodes, and relevant medical history
• The patient's beliefs and concerns — what they think is wrong, what they are afraid of, and what they have been told already
• Context — occupation, activities, sport, home demands, and what recovery needs to allow them to do

Framework: Subjective Localises, Objective Confirms, Goals Come From the Patient

1. Start with function lost, not pain location. 'I cannot lift my daughter' orients the whole assessment better than a point on a body chart.
2. Establish symptom behaviour precisely. What makes it worse, what eases it, and the 24-hour pattern. This is what separates plausible hypotheses more efficiently than any test.
3. Screen red flags deliberately and record that you did. Not as a background impression. An unrecorded screen is indistinguishable from no screen.
4. Identify yellow flags in the subjective. Fear of movement, catastrophising, low recovery expectation, and work dissatisfaction predict outcome strongly and change the plan.
5. Form a hypothesis before examining. Then choose tests that could refute it. An examination with no hypothesis produces findings with no meaning.
6. List the competing explanations. What else fits this presentation, and what would distinguish them.
7. Set goals in the patient's words, and make them measurable. 'Return to running 5 km without symptoms by week eight' can be reassessed; 'improve function' cannot.

Output Format

Initial assessment: [patient] · [date] · [clinician]

Presenting problem: [in the patient's words] · Onset: [when, mechanism, gradual or sudden] · Course since: [better/worse/unchanged]

Function lost: [what they can no longer do — specific activities]

Symptom behaviour: location [body chart reference] · quality [description] · severity [scale, at best and worst] · aggravating [what, how long to onset, how long to settle] · easing [what] · 24-hour pattern [night, morning, through day]

Red flag screen — checked and recorded [relevant screening questions for this presentation] · Findings: [none identified / detail] · Action: [none required / onward referral, to whom, urgency]

Yellow flags: fear of movement [ ] · catastrophising [ ] · low recovery expectation [ ] · work/activity dissatisfaction [ ] · Detail: [what was said]

History: general health · medications · previous episodes and response to treatment · relevant medical history · investigations already done

Patient's beliefs: what they think is wrong [ ] · what they fear [ ] · what they have been told [ ]

Working hypothesis: [the leading explanation] · Competing explanations: [alternatives and what would distinguish them]

Objective examination plan: [the specific tests chosen, and what each would confirm or refute]

Findings: [observation · movement · strength · special tests · palpation — recorded against the plan]

Goals (patient's terms)

Reassessment markers: [the specific findings that will be re-tested to judge progress]

A documentation and reasoning framework for a licensed clinician. It does not diagnose, does not determine the appropriateness of any assessment or treatment for an individual, and does not replace clinical judgement or your profession's standards. Red flag screening and onward referral thresholds must follow current guidance and local pathways.

Quality Checks

• The subjective establishes lost function, not just pain location
• Symptom behaviour includes aggravating, easing and the 24-hour pattern
• Red flag screening is recorded as having been performed, with findings
• Yellow flags are actively identified, not noted incidentally
• A hypothesis exists before the objective examination, and the tests target it
• Competing explanations are listed with what would distinguish them
• Goals are in the patient's words and measurable
• Reassessment markers are identified at the first visit

Anti-Patterns

• Examining without a hypothesis. Produces a page of findings and no reasoning.
• A body chart with no functional impact. You cannot set a goal against a diagram.
• Screening red flags silently. An unrecorded screen provides no protection and no information.
• Treating yellow flags as personality. They are prognostic factors and they change the plan.
• Goals written by the clinician. 'Improve ROM' motivates nobody and measures little.
• A standard test battery. Time spent on tests that could not change the plan.
• No reassessment markers. Progress then gets judged on how the patient says they feel today.

Example Trigger Phrases

• "Structure an initial physio assessment for low back pain"
• "Write an assessment template for a new patient"
• "How do I make my subjective examination more efficient?"
• "What should I document at a first appointment?"
• "How do I set goals with a patient?"