A rehabilitation progress self-assessment: twenty-six statements score six dimensions — functional mobility, pain interference, activities of daily living, psychological resilience, social participation and recovery self-efficacy — into a personal AI PDF report physiotherapists and patients can review together.
Quick answer
A rehabilitation progress self-assessment rates mobility, pain interference, daily-living activities, psychological resilience, social participation and self-efficacy on 1–5 statements, producing a six-dimension profile that shows what is recovering well and what needs the next focus in therapy.
Disclaimer: this page and its AI report are for self-reflection and process reference only. They do not constitute medical, psychological, financial, legal or safety advice. Consult a qualified clinician before making care decisions.
Methodology: items are a structural adaptation of widely used clinical frameworks, not an official validated instrument; scores are indicative, not diagnostic.
Recovery moves on six clocks at once: walking and balance, pain getting in the way, everyday tasks, mental stamina, rejoining people and activities, and belief in one's own recovery. Scoring each separately shows where progress is real and where it has stalled — giving therapists and patients one shared, printable picture to steer the next phase of rehab.
Sample form, AI PDF report and AI consultant — fill the form to unlock all three.
Everything you need to run this template.
From copy to deliverable in four steps.
Copy the form and its scoring, report and branding settings into your FormLM workspace — free.
Adjust fields, options and consent language to match your clinic workflow.
Send the link or QR; every response is captured automatically.
Open the personalized AI PDF report and share it with the patient or the chart.
Pick your role — see how it fits your clinic workflow.
Objective self-reported progress between sessions.
Spot stalled recovery before the next appointment.
A record of improvement you can actually see.
What makes this template work as a professional clinical deliverable.
A preview of real statements patients rate — the full version scores each answer 1–5 across six dimensions and generates a personalized, printable AI PDF report per patient.
