What it is built on
- Rehabilitation after knee replacement. NICE guideline NG157, Joint replacement (primary): hip, knee and shoulder (2020)
- Function. Timed Up and Go and 30-second chair stand
How to use it: Free Evidence-Based Physiotherapy Note Templates
Check first
- Warning signsAny of these: contact the surgeon or emergency the same day.
- Calf pain, swelling or warmth (possible clot) Tick box
- Shortness of breath or chest pain Tick box
- Wound redness spreading, discharge, or fever (possible infection) Tick box
- None of the above Tick box
Progress
- Weeks since surgery Short answer
- Pain today (0–10) Scale 0 to 10
- Knee flexion (degrees) Number
- Knee extension lag (degrees) Number
- Swelling and wound Written answer
- Walking and aids Written answer
- Timed Up and Go (seconds) Number
- 30-second chair stand (repetitions) Number
Treatment and plan
- Treatment and exercises today Written answer
- Home program changes Written answer
- Plan and next review Written answer
A starting point, not clinical advice. Check that it fits your patients, your practice and the rules where you work before you use it.