Musculoskeletal & Physical Performance Assessment

1. Patient & Assessment Details

Accurate information ensures safe, evidence-based evaluation and tailored intervention planning.


Full name

Patient identifier (initials/code)

Assessment date

Primary reason for assessment




Referring clinician/department

Relevant medical history (fractures, dislocations, systemic illness)

2. Pain & Symptom Profile

Pain characteristics guide tissue irritability grading and load management decisions.


Are you experiencing pain today?


Body chart: mark location(s) and quality (ache, sharp, burn, throb)

Pain behaviour

Does pain interrupt sleep?


Do you experience numbness, tingling or weakness?

3. Functional Impairment & Psychosocial Flags

Rate difficulty in the following activities (0 = unable, 4 = no difficulty)

0 Unable

1 Severe

2 Moderate

3 Mild

4 No difficulty

Walking on flat ground

Climbing stairs

Squatting or kneeling

Lifting/carrying 5 kg

Running

Sleeping

Working usual job/school tasks

Do you feel your symptoms are worsening despite previous care?

Are you worried you might never recover?


I have stopped most social/recreational activities because of pain

Support system for recovery

4. Posture & Alignment Screening

Observational findings guide corrective exercise prescription.


Static posture observations

View

Finding (e.g., forward head, scapular winging)

Severity (1 = subtle, 5 = marked)

Correctable with cueing?

Anterior
 
Yes
Lateral
 
 
Posterior
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Asymmetry noted in shoulder or pelvic height?

Leg length discrepancy (cm) if measured

5. Cervical Spine & Thoracic Function

Cervical active range of motion (0 = no movement, 4 = full pain-free)

0 Blocked

1 Severe limitation

2 Moderate limitation

3 Mild limitation

4 Full

Flexion

Extension

Right rotation

Left rotation

Right side bend

Left side bend

Reproduction of symptoms with cervical movement?


Dizziness or visual disturbances with neck motion?

Deep neck flexor endurance (seconds held before quality loss)

Thoracic rotation observations (symmetry, pain, range)

6. Shoulder Complex Integrity

Include both active and passive findings; note end-feel and symptom response.


Shoulder range of motion (degrees)

Movement

Active ROM

Passive ROM

Pain during movement?

End-feel (capsular, springy, empty)

Flexion
160
170
 
capsular
External rotation @ 90° abd
90
95
Yes
capsular
Internal rotation @ 90° abd
60
65
 
capsular
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Apprehension with load or movement?

Positive impingement signs (Hawkins, Neer)

Scapulohumeral rhythm observation (winging, early scapula, dyskinesis)

Rotator cuff strength grades or handheld dynamometer reading (kg)

7. Elbow, Wrist & Hand

Rate elbow pain provocation tests (0 = no pain, 3 = severe pain)

0 None

1 Mild

2 Moderate

3 Severe

Resisted wrist extension

Resisted wrist flexion

Resisted supination

Resisted pronation

Ulnar nerve subluxation?

Grip strength right hand (kg)

Grip strength left hand (kg)

Finger-to-floor distance > 10 cm on forward bend?

8. Lumbar Spine & Pelvis

Critical for load-transfer capacity and lower-quarter kinetic chain.


Repeated movement testing result

Pain on lumbar extension/rotation?

Prone instability test score (0 = unstable, 5 = stable)

Sacroiliac pain provocation positive?

Hip-lumbar dissociation observation

9. Hip Joint & Musculature

Hip range of motion

Movement

Right (°)

Left (°)

Pain?

Flexion supine
110
115
 
Internal rotation @ 90° flex
35
40
 
External rotation @ 90° flex
40
42
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

FAI (femoroacetabular impingement) signs?

Trendelenburg test positive?

Adductor squeeze test force (kg) & pain (yes/no)

10. Knee & Lower-Leg

Assess ligamentous, meniscal and patellofemoral components.


Effusion present (stroke test)?

Lachman test

Pivot shift positive?

Patellar grind test painful?

Single-leg hop for distance right (cm)

Single-leg hop for distance left (cm)

Compartment syndrome tightness with activity?

11. Ankle & Foot Mechanics

Rate ankle dorsiflexion (knee flexed) in subtalar neutral

0 < 5°

1 5–10°

2 11–15°

3 > 15°

Right

Left

Anterior drawer laxity?

Positive Windlass test (plantar fascia)?

Medial longitudinal arch height

Footwear type, wear patterns & orthosis use

12. Neurological & Vascular Integrity

Dermatome light-touch screen

Key point

Sensation

Pain referral?

C5 (lateral elbow)
Normal
 
L5 (1st web space)
Normal
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Deep tendon reflexes grades

Clonus present?

Capillary refill > 2 s in digits/toes?

13. Functional Movement & Performance Tests

Quantify movement capacity and asymmetry.


Y-Balance anterior reach right (cm)

Y-Balance anterior reach left (cm)

Pain or loss of balance during test?

Number of squats to 60° in 30 s

Prone plank hold time (s)

Running gait cadence & stride length (treadmill or track)

14. Assistive Devices & Environmental Factors

Currently using

Workstation ergonomic assessment completed?

Home exercise equipment available (bands, weights, pool access)

15. Outcome Measures & Goal Setting

General health status today (0 = worst, 10 = best)

Patient's top three functional goals (SMART format encouraged)

Confidence in achieving goals

Target review date

16. Clinician Summary & Plan

Integrate findings; prioritise impairments and justify interventions.


Primary impairments limiting function

Tissue irritability grade

Recommended interventions

Precautions & contraindications

Clinician signature


Analysis for Comprehensive Musculoskeletal & Physical Performance Assessment

Important Note: This analysis provides strategic insights to help you get the most from your form's submission data for powerful follow-up actions and better outcomes. Please remove this content before publishing the form to the public.


Overall Form Strengths & Purpose Alignment

The Comprehensive Musculoskeletal & Physical Performance Assessment is a meticulously engineered tool that directly supports its stated clinical purpose: evaluating structural integrity, joint mobility, and physical strain in rehabilitative or sports-medicine settings. By integrating pain profiling, functional rating scales, region-specific range-of-motion tables, and validated performance tests (Y-Balance, single-leg hop, Repeated Movement Testing), the form captures both qualitative and quantitative data streams required for evidence-based classification of tissue irritability, movement capacity, and impairment severity. Its modular sectioning (cervical, shoulder, lumbar, hip, knee, ankle, neurovascular) mirrors a clinician’s systematic top-to-toe scan, ensuring no kinetic-chain element is overlooked while still allowing rapid navigation during busy caseloads.


From a user-experience lens, the form balances comprehensiveness with conditional logic: only two core identifiers are mandatory, minimising front-end friction, while follow-up questions dynamically surface when pain, specific assessment reasons, or positive tests are reported. This keeps the interface uncluttered for asymptomatic cases yet richly informative for complex multi-region complaints. Embedded clinical prompts (e.g., end-feel descriptions, irritability grading, dermatome maps) act as just-in-time education for junior therapists, raising documentation quality without lengthening onboarding. Finally, the inclusion of patient-centred outcome sections (SMART goals, confidence rating, review date) nudges the clinician toward shared decision-making, which has been shown to improve adherence and satisfaction scores.


Data Quality & Privacy Considerations

The form’s mixture of numeric entry, ordinal scales, and standardised tables yields high-resolution, export-ready datasets perfect for audit, research, and machine-learning applications. Mandatory date stamping and unique patient codes create an auditable timeline while avoiding overt personal identifiers, thereby mitigating GDPR/HIPAA exposure. Optional free-text fields (medical history, footwear, workstation ergonomics) accept nuanced narrative yet remain parsable through keyword extraction, preserving richness without sacrificing structure. Clinicians should nevertheless be trained to avoid entering full names or birthdates in free text; a brief reminder banner could be added to reinforce this.


Detailed Question-by-Question Insights

Patient identifier (initials/code)

This minimalist identifier respects privacy yet maintains longitudinal traceability across sessions—crucial for tracking rehab trajectories and outcome metrics. The open-line format flexibly accommodates site-specific coding schemes (e.g., centre ID + incremental number) without forcing a rigid pattern that might fail in multi-centre trials. Mandatory status ensures every record is linkable to subsequent re-tests, preventing orphaned data rows that would otherwise compromise statistical power or clinical continuity.


Because full names are not collected, clinicians must ensure their local master index securely maps codes to identities. A future enhancement could be a duplicate-code warning to avoid inadvertent collisions when multiple therapists work concurrently.


Assessment date

Time-stamping is foundational for calculating recovery velocity, monitoring episode-of-care duration, and benchmarking against published prognosis data (e.g., rotator-cuff healing time-frames). Capturing the date separately (rather than relying on server metadata) safeguards integrity when paper printouts are later scanned or when offline completion occurs in mobile clinics. The date also drives automated report templates that graph progress over weeks or months, a feature highly valued by both insurers and patients.


Clinicians exporting data for research should ensure date formatting is ISO-8601 compliant to prevent regional ambiguity; a calendar picker already enforces this in most EHR integrations.


Primary reason for assessment

This branching question funnels the responder into condition-specific pathways, populating tailored follow-ups such as surgery details or sport-specific training loads. By forcing a single primary reason, the form prioritises the main driver of impairment, aligning with International Classification of Functioning (ICF) principles that emphasise primary health condition. The "Other" option with conditional free-text guards against forced misclassification when presentations do not fit predefined categories.


Data analytics benefit because the discrete categories map cleanly to ICD-10 codes and enable caseload benchmarking (e.g., percentage of post-surgical vs chronic pain cases). Clinicians should review the "Other" narratives periodically to decide if new categories need promotion into the single-choice list.


Pain level right now (0–10)

Numeric Pain Rating Scale (NPRS) at rest provides a baseline for irritability grading and dose-response tracking of analgesic or manual-therapy interventions. Because it only appears when pain is affirmed, the form avoids desensitising asymptomatic athletes with redundant scales. Pairing this with the body-chart location field enables spatial pain mapping, useful for identifying centralized vs peripheralised patterns consistent with serious pathology or neuropathic drivers.


Research shows that even a 2-point change in NPRS is clinically meaningful; storing the value as an integer permits straightforward minimal-clinical-important-difference calculations in registry reports.


Walking on flat ground difficulty

This matrix sub-question is part of the validated Modified Lower-Extremity Functional Scale (LEFS) proxy. Capturing perceived difficulty (rather than yes/no independence) aligns with WHO disability gradients and supports goal-setting that is specific to the patient’s desired activity level. Because the scale is 0–4, it can be summed for a total score that correlates well with objective performance tests like the 6-minute walk.


Clinicians should remind patients that ratings reflect their typical day, not their worst or best, to reduce recall bias. The matrix layout minimises screen estate yet remains fully accessible on tablets commonly used at bedside.


Cervical flexion range of motion

Cervical flexion is a key indicator of deep-neck-flexor endurance deficits commonly seen in whiplash-associated disorders and tech-neck syndromes. Rating movement as 0–4 rather than requesting goniometer degrees speeds assessment in high-volume clinics while still providing ordinal data suitable for irritability classification. When combined with the subsequent deep-neck-flexor endurance field, clinicians can quickly decide whether motor-control retraining should be prioritised over passive mobilisations.


Because the scale anchors are standardised (0 = blocked, 4 = full), inter-rater reliability improves compared with purely subjective descriptors. Sites wishing greater precision can layer a goniometry field without altering the existing schema.


Shoulder flexion active ROM

Active flexion is a prime indicator of overall glenohumeral and scapulothoracic mechanics; documenting both active and passive values in the table highlights potential strength or capsular limitations. The additional columns for pain and end-feel guide safe progression of mobilisation grades: a springy end-feel with pain may suggest internal-derangement precautions, whereas a hard capsular end-feel without pain supports more aggressive stretching.


Numeric entry (degrees) rather than ordinal scales permits calculation of side-to-side deficits expressed as percentages—critical for return-to-sport clearance where < 10% asymmetry is often required. Exporting these data to Excel or R allows generation of radar plots that visually communicate progress to patients and coaches.


Repeated movement testing result

Derived from the McKenzie method, this single-choice item is pivotal for classifying derangement, dysfunction, or postural syndromes, thereby directing exercise prescription (e.g., repeated extension in centralisation). Capturing "Unable to test due to pain" flags high irritability cases that may require pharmacological or modality-based pain modulation before mechanical evaluation. Because the response is categorical, it can be used in large-database prognostic models predicting surgery avoidance.


Clinicians should ensure standardised loading (e.g., 10–15 repetitions) before selecting a result; embedding the protocol in a hover-over tooltip would reduce inter-rater variability.


Primary impairments limiting function

This open-text synthesis field obliges the clinician to distil assessment findings into a concise problem list, aligning with SOAP note best-practice and facilitating communication with multidisciplinary teams. Because it is free-text, it accommodates any region or combination of impairments without artificially fragmenting inter-related issues. The field also serves as a natural language processing opportunity for automated coding of impairment types in quality-improvement projects.


Clinicians should avoid vague terms like "weakness" and instead adopt measurable descriptors (e.g., "3/5 resisted external rotation, right shoulder") to maximise utility for subsequent visits and billing justification.


Mandatory Question Analysis for Musculoskeletal & Physical Performance Assessment

Important Note: This analysis provides strategic insights to help you get the most from your form's submission data for powerful follow-up actions and better outcomes. Please remove this content before publishing the form to the public.


Mandatory Field Justifications


Question: Patient identifier (initials/code)
Justification: Maintaining a unique yet de-identified code for every assessment is non-negotiable for longitudinal tracking across rehabilitation episodes. Without this mandatory field, data rows cannot be reliably linked to prior visits, undermining outcome analytics, insurance reporting, and clinical audit trails. The minimalistic approach (initials or site code) balances privacy obligations with operational traceability, ensuring compliance with data-protection statutes while preserving the clinical narrative.


Question: Assessment date
Justification: Capturing the assessment date is fundamental for calculating recovery velocity, episode-of-care duration, and benchmarking against evidence-based prognosis time-lines. It enables automated graphing of progress, supports billing cycle alignment, and ensures medico-legal validity of documentation. A missing date would render comparative analysis impossible and breach standardised record-keeping requirements set by most regulatory bodies.


Overall Mandatory Field Strategy Recommendation

The form adopts a minimalist mandatory stance: only two administrative fields are required, dramatically lowering respondent burden and maximising form-completion rates in busy clinical environments. This strategy is evidence-based—studies show that each additional mandatory field can reduce submission rates by 5–10%. By relegating rich clinical data (pain scores, ROM, neurovascular findings) to optional status, the design respects clinician autonomy and patient flow while still encouraging thorough documentation through contextual prompts and structured tables.


Going forward, consider introducing conditionally mandatory logic: for example, if "Injury follow-up" is selected, the injury-mechanism description could become required; similarly, affirming pain could trigger a mandatory pain-behaviour field. Such adaptive rules preserve the low-entry barrier yet elevate data completeness where clinically critical. Always provide visual cues (asterisks, micro-copy) to distinguish optional versus required items, and periodically audit missingness rates to determine if high-value fields should be promoted to mandatory without compromising throughput.


This template is your game board—strategize, customize, and WIN BIG! 🏆🎯 Edit this Musculoskeletal & Physical Performance Assessment
Like the layout of this form? You can create your own with powerful tables and spreadsheet calculations using Zapof!
This form is protected by Google reCAPTCHA. Privacy - Terms.
 
Built using Zapof