ICRC Physiotherapy Standards Rehab Cycle

Welcome to The ICRC Physiotherapy Standards Content Development Project. This space was created by Physiopedia for the creation of content relating to the ICRC Physiotherapy Standards Workshop. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Add your name/s here if you are the original editor/s of this page.  User Name

Top Contributors - Kim Jackson      

Related Pages[edit | edit source]

  1. Professional Standards in (ICRC) Physiotherapy
  2. ICRC Physiotherapy Standards Project Cycle
  3. ICRC Physiotherapy Standards Rehab Cycle

Introduction[edit | edit source]

A number of PT standards are related to the rehab cycle of an individual patient or service user. It is advised to apply the ICF-Model for rehab cycle and for any intervention with a rehabilitation user. Click HERE for more information and for an e-learning module on ICF visit this LINK.

ICRC Health Conditions - Contextual Factors.png

See the tools and documents accompanying different steps of the rehab cycle.

Assess and Analyse[edit | edit source]

The assessment process is an important step in the rehab cycle. Information collected during an assessment can guide clinical reasoning and, by evaluating a person's individual needs, enhance the the rehabilitation experience as well as identifying gaps in service provision that can aid the improvement of physiotherapy services.

Assessment is a continuous process, where information is gathered through various sources. It is important to perform a good quality assessment, as the quality of care given is based on the assessment. The information once gathered is interpreted and the main aim is to identify key problems and then formulate a treatment plan which is relevant to the individual. This assessment should identify any additional factors that may contribute to the service users/patients presenting problems. The assessment process will also assist the physiotherapist to recognize his/her own expertise and limitations, and where necessary refer to other disciplines as indicated.

The key elements of the assessment process require the gathering information from relevant sources, medical notes, investigations. If there is no structured assessment process or form, then this gap would need to be addressed and is an example of identifying service needs. At this stage the development of an assessment process would become a project and part of the project cycle.

As part of the assessment process information needs to be gathered from important sources - this helps to develop a deep understanding of the person and situation. These courses should include:

  • Demographics - After taking the demographic information (which could also be retrieved by the general file), it is important to ask for the service user/patient informed consent. Oral consent should be received by every service user/patient prior to assessment/treatment and can be written in certain contexts.
  • Assessment - It is not always feasible to gather information required at one time, assessments may be ongoing, depending on the complexity of the problem. The purpose is to establish the service user/patient’s physical, psychological and social needs and perceptions of their needs through the interview. It is also desirable to get an insight into the person’s expectations of their assessment and subsequent treatment.


It is important to keep a clear, structured format of the assessment, for example using the SOAP note format. SOAP is an acronym for:

  • Subjective - What the patient says about the problem / intervention.
  • Objective - The therapists objective observations and treatment interventions (e.g. ROM, Outcome Measures)
  • Analysis - The therapists analysis of the various components of the assessment.
  • Plan - How the treatment will be developed to the reach the goals or objectives.

Subjective Assessment[edit | edit source]

It is not always possible to gather all the necessary information required at one time, assessments may be ongoing, depending on the complexity of the problem. The purpose is to establish the service user/patient’s physical, psychological and social needs and perceptions of their needs through the interview. It is also desirable to get an insight into the person’s expectations of their assessment and subsequent treatment. The important elements of the subjective assessment are:

  • History of presenting condition (HPC)- Using open-ended questions, to explore the issue, for example “what is your main problem?” When exploring symptoms, use the following questions to guide -
    • Duration. How long have you had these symptoms? This present episode - how long?
    • Severity. Is each episode of the same severity? Or are things getting worse, with each episode? Is there a pattern- seasonal, symptoms change as the day progresses?
    • Other factors, what aggravates/ relieves your problem?
    • Are there any other symptoms? For example- fatigue, fever, headache, weakness present?
  • Past medical history (PMS) - Consists of a brief summary of past medical/surgical problems.
  • Medical/clinical investigations
    • What medication are they presently prescribed, and what dose.
    • Will medication have any adverse effects- in relation to treatment and rehabilitation?
    • Are there any history of allergic reactions to medication?
  • Investigations - Are there any investigations or test results? These might include
    • X Rays
    • CT or MRI scan
    • Blood tests
    • Blood gas analysis
    • Sputum analysis
  • Social history- It is important to build a picture of their home environment and if they have any available support.
    • Do they have family, friends or support services that can assist in the short/long term?
    • Record a general outline of home environment, for example, are there stairs? if so, how many handrails?
    • How are they managing at present? Looking for any functional limitation.
    • How are they managing with activities of daily living (ADLs)? Consider location of toilets, washing facilities, where they sleep.
    • What is the level of mobility? Do they use walking aids, had they any falls or dizziness, any recent changes to mobility- indoors/ outdoors?
    • Consider occupation and hobbies - are there any impact on these from presenting problem?
    • Look at lifestyle factors, for example - do they smoke? how many cigarettes a day? any alcohol consumption?

Objective Assessment[edit | edit source]

Once you have gathered information from the patient (subjective assessment) it is important to record what the therapist observes as well as baseline observations that can be obtained from outcome measures and a physical examination.The information gathered during this stage will help to reassess after treatment and monitor the functional progress that the patient is making and the effectiveness of the treatment interventions. It can be helpful to use a body chart to clearly record and summarise information. During this stage it is important to:

  • Record initial observations - general first impressions can be made quite quickly
    • How does the patient look? Are there any signs of distress or indicators of pain and/or fatigue, is there medical equipment in-situ?
    • Patient vital signs: temperature, heart rate, blood pressure (if indicated)
  • Physical examination - this is information that can be recorded and used to monitor progress, for example
    • Range of movement (ROM)
    • Flexibility
    • Power/Strength
    • Tone
    • Sensation
    • Gait
  • Outcome Measures - chosen specifically for the individual depending on their health conditions and goals. See Outcome Measure section below.

Outcome Measures[edit | edit source]

Outcomes measures for an individual user must be chosen according to their health condition and rehabilitation goals. There are generic outcome measures that should be performed with each user. When measuring health and disability we advise using the Manual for WHO Disability Assessment Schedule (WHODAS 2.0) for this purpose.

For more consistency we also advise a few simple outcomes measures for the following health conditions and clinical pictures :

  • Lower limb conditions (due to amputation, fracture, stroke, incomplete SCI, Polio, old age, etc.)
  • Upper limb conditions (due to amputation, fracture, stroke etc.)

Note - You are encouraged to individually select and use additional outcome measures for and with each user. Remember: measuring outcome is not a goal in itself (it's the outcome that counts, not the measuring) – keep it short and simple!

Formulate and Plan[edit | edit source]

By using the clinical decision-making process (theoretical knowledge and clinical experience), findings from the assessment are analyzed and interpreted, formulating the problem list. A wide range of factors may be taken into account, service user/patient’ age, diagnosis and comorbidity. The treatment plan and problem list are based on the individuals needs at the time of assessment.

Assessment/Analysis[edit | edit source]

By using the clinical decision-making process (theoretical knowledge and clinical experience), findings from the assessment are analyzed and interpreted, formulating the problem list. A wide range of factors may be taken into account, service user/patient’ age, diagnosis and comorbidity. The treatment plan and problem list are based on the individuals needs at the time of assessment.

The development of long and short term goals are beneficial to enhance service user/patient performance, motivation. Always involve the service user/patient/and or carer from the start. Short term goals will be met, according to treatment plan, these are small steps leading to the fulfilment of the Long term goals. Ensure the goals are SMART goals and are objective and measurable:

  • Specific - define what you want to achieve
  • Measurable - how will you measure your success
  • Achievable - include some quick wins and a goal you need to reach/stretch for
  • Realistic/Relevant - the goal reflects your interests
  • Time-related - establish a realist timeframe to achieve the goals set

Long term goals are around level of function and independence. Be aware of what can reduce level of compliance/ achievement. Goals should also respect the opinion from other team members such as occupational therapists, nurses or orthotists and/or prosthetists.

Treatment Plan[edit | edit source]

Once findings are analysed and a problem list has been formulated, it is discussed and clarified with the service user/patient and eventually with the carer. This will take into account the service user/patient’s expectations and perceptions of their needs. Successful rehabilitation depends on the discussion of findings between the therapist, the multi-disciplinary team (MDT) and service user/patient.

Assessment and Treatment Guidance [Word doc]

Check out the Goal Setting in Rehabilitation (Physiopedia)

Make sure your goals are SMART

PTS Assessment and Treatment Guidance .docx [Document missing https://icrc.scenari.eu/public/Health/Health_Wiki/PTS/PTS%20Assessment%20and%20Treatment%20Guidance%20.docx]

For further reading

Bovend Eerdt SMART guide.pdf [Document missing https://icrc.scenari.eu/public/Health/Health_Wiki/PTS/Bovend%20Eerdt%20SMART%20guide.pdf]

Evidence based practice WCPT keynote.pdf

Herbert Evidence based physiotherapy.pdf [Document missing https://icrc.scenari.eu/public/Health/Health_Wiki/PTS/Herbert%20Evidence%20based%[email protected]]

How to make SMART goals [Powerpoint Presentation]

Physio network - Infographics

Physio network - Free resources

Implement and Monitor[edit | edit source]

Once a treatment plan has been designed and agreed the next step is to implement an intervention programme. The programme should empower clients to be involved in all stages of their care from exercise programmes to keeping a daily record of their progress. Effective monitoring has many benefits such as:

  • Keep track of project/ patient progress
  • Keep project staff/ patients motivated
  • Empower patients: self-monitoring ‘manage your progress’
  • Correct action/treatment plan if necessary
  • Prepare for evaluation, eg. with outcome measure

www.physiotherapyexercises.com

For further reading

Rehabilitation exercise diary.pdf

Personal exercise diary.pdf


Throughout the rehabilitation cycle it is important to record and monitor, this is done effectively by keeping records and documentation of each stage of the patient's journey. When recording patient's progress it is important that documentation of the changing condition should be clear, accurate and logical, highlighting any changes. According to the rehabilitation development, it should be documented daily, bi weekly or less frequently if there are no changes. It should be placed in the main patient/service user file, especially in the hospital contexts so that the prescriber and the multidisciplinary team is informed of physiotherapy outcomes at any time.

Discharge[edit | edit source]

The purpose of rehab is to help patients achieve a level of independence that leads to discharge from care/service. The discharge should include a summary of intervention (including main steps and eventual complications) and effectiveness (e.g. independence level achieved) to referring agent or as a conclusion of treatment. This is essential when referring to other professions or services; it could/should also include a home programme or any follow up instructional or educational points.

Documentation of the changing condition should be clear, accurate and logical, highlighting any changes. According to the rehabilitation development, it should be documented daily, bi weekly or less frequently if there are no changes. It should be placed in the main patient/service user file, especially in the hospital contexts so that the prescriber and the multidisciplinary team is informed of physiotherapy outcomes at any time.

Evaluate and Learn[edit | edit source]

Check out the documents from the Assess and Analyse 

There are many ways to collect information to evaluate services and user experience. By collecting this information a lot can be learnt that can highlight efficiency, obstacles and problems which can guide service delivery, and improve practice standards. There are many tools that can assist at this stage, for example using a Service User Feedback Tool [Word Doc]


Summary[edit | edit source]

There are many tools and documents that can help guide the rehab cycle and the choice of tools and documents depends on what’s in the centre of the cycle. Missing elements of the rehab cycle could become part of a project: eg. a training on outcome measures

Every cycle to be successful is part of a bigger project: eg. gaps in a patient rehab cycle often reflect gaps in service organisation and should be addressed on both levels.

Types of cycle.jpg


Resources[edit | edit source]

International Classification of Functioning, Disability and Health - Beginners' Guide

International Classification of Functioning, Disability and Health - Practical Manual

References[edit | edit source]