Physical Therapy Home Evaluation

Physical therapy is the branch of medical science that concerns with the remediation of physical impairments, disability treatments and promotional treatments aimed to improve functional ability, mobility and the quality of life. Physical therapy home evaluation aims to probe into the efficacy of physical therapy in a way that one is able to judge the merit of the treatment in concern within the four walls of one’s home.

Sample Physical Therapy Home Evaluation

Physical therapy home evaluation


Goodlife Medical Association

The respondents are requested to fill the evaluation form in the most earnest way possible. The instructions for filling the form are provided alongside the questions.

Name of the patient: Beth Rutherford

Age: 42 years.

Diagnosis: spondylitis

Medical History: [Please tick]

  • Cardiac problems
  • Respiratory problems
  • Osteoporosis
  • Fractures
  • Cancer

Mobility: Can move on her own/ requires assistive device/ needs walker/ wheelchair patient. [Please Tick]

Functional Ability: self-sufficient / needs assistance at times/ failed eyesight/ hearing or speech impairment/ paralysis/ temporary paralysis [Please Tick]

Mental status: absolutely healthy/ forgetful/ comatose/ disoriented/ other. [Please Tick]

Previous sessions:

  1. Has the pain decreased after the last session? Yes/ No.
  2. Did the symptoms stop after the last session? Yes/ No.
  3. How does the patient feel after the last session in terms of health? 1,2,3,4,5
  4. What is the pain intensity during the physical therapy sessions? 1,2,3,4,5.
  5. Does the patient feel comfortable with the instruments used during the therapy? Yes/ No.
  6. How much does the patient feel his fitness owes to the previous therapy sessions?
  7. Did the patient experience any sort of harmful side effect after the physical therapy sessions? Yes/ No.
  8. What is the comfort level the patient shares with his or her therapist? 1,2,3,4,5.
  9. Does the patient find the sessions helpful? Yes/ No.
  10. Did the sessions help the patient to accept and overcome his problem? Yes/ No.

Category: Home Evaluation

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