How do I use this worksheet?
Print it or copy the boxes into a notebook. Work through the four steps with a pen, and take your time with step one, because the rest follows from it.
A physiotherapist will help you fine-tune the goals at your first visit. You do not need to get them perfect in advance.
Step 1: What do I want to be able to do again?
Write the activity in your own words, not a medical term. Be specific about the place and the person.
| Instead of | Write |
|---|---|
| “Better knee” | “Climb the stairs of my terrace house to my bedroom without holding the rail” |
| “Less back pain” | “Sit through a kopitiam breakfast, then drive to my daughter’s home in Taman Cempaka” |
| “Walk well after stroke” | “Walk to the corner shop and back with my stick, without a helper” |
| “Return to sport” | “Play two sets of badminton at the club hall on Saturday” |
My goal: ______________________________________
Step 2: Where am I starting from today?
Measure it, so you can see change. Choose a simple measure for each goal.
- How far I can walk before I need to stop, in steps or in minutes.
- The number of stairs I can climb before I rest.
- How long I can sit or stand before the pain rises.
- Pain from 0 (none) to 10 (worst) at its worst and at its best.
- How long it takes to get up from a chair five times.
Starting point today: ______________________________________
Step 3: What is the target, and by when?
A good target has a number or a clear picture, and a review date. Choose a short target, for about four weeks, and a longer one.
| Short target | Longer target | |
|---|---|---|
| What I will do | ||
| How I will know | ||
| Review date |
Agree the dates with your physiotherapist, because recovery after surgery, stroke or a long illness runs at a different speed for each person.
Step 4: What small steps will I take each week?
Break the goal into steps you can tick off. These steps are the exercises and habits that your physiotherapist will suggest.
- Do my home exercises on the days we agree.
- Walk a set route in the cooler part of the day.
- Practise the stairs with a helper nearby.
- Note any pain, tiredness or fear that gets in the way.
- Bring this sheet to each visit.
How do I review and update the goals?
At each review date, write down the new measure next to the starting point. If you reached the target, set a bigger one. If you did not, ask what got in the way: pain, tiredness, time, fear or the plan itself.
Your physiotherapist will adjust exercises and targets with you. Our page on reassessment and discharge explains how that works, and the guide on older adult function goals has more examples.
If you are arranging care for a parent, pair this with the family care planner. If something on our when to seek medical care page applies, see a doctor first.