Physiotherapist GLA:D® assessment notes document a patient's joint function, pain levels, and movement patterns as part of the Good Life with osteoArthritis in Denmark program designed to improve hip and knee osteoarthritis symptoms through neuromuscular education and exercise therapy.
These specialized records establish baseline measurements for joint range of motion, functional capacity, and pain severity while providing objective data for tracking patient progress throughout the GLA:D® intervention protocol.
They facilitate evidence-based clinical decision-making by identifying specific movement compensations, strength deficits, and functional limitations that guide personalized modifications to the standardized GLA:D® exercise program.
Comprehensive GLA:D® assessment notes enhance communication between physiotherapists, orthopedic specialists, and other members of the arthritis care team.
Properly documented GLA:D® assessments ensure compliance with clinical practice guidelines and physical therapy regulatory standards.
Detailed GLA:D® notes contribute to improved functional outcomes for patients with hip and knee osteoarthritis by establishing clear baselines and treatment progressions.
Begin by documenting patient demographics, referral source, and specific osteoarthritis presentation in the initial assessment section.
Include standardized outcome measures such as the 40m walk test, 30-second chair stand test, and patient-reported outcome measures specific to the GLA:D® protocol.
Maintain objective language while clearly documenting functional limitations, pain levels, and movement patterns observed during the GLA:D® assessment process.
A comprehensive subjective history should include pain characteristics, functional limitations, prior interventions, and patient goals specific to osteoarthritis management.
The objective examination section documents range of motion, strength assessments, and functional testing results that will serve as baseline measures for the GLA:D® program.
The assessment and plan sections should avoid vague language and instead clearly connect clinical findings to specific GLA:D® exercise interventions and education components.
Focus documentation on functional limitations and goals rather than exclusively on pain descriptions to maintain a client-centered approach aligned with GLA:D® principles.
Ensure patient privacy by following HIPAA and regional health information protection regulations when documenting and sharing GLA:D® assessment information.
Utilize digital GLA:D® templates that include drop-down menus for standard tests and measurements to streamline documentation while maintaining comprehensive records.
Implementing automated GLA:D® assessment templates can reduce documentation time by 40% while ensuring all required program elements are consistently captured.
Transition gradually by starting with hybrid documentation, where standardized GLA:D® outcome measures are automated while maintaining personalized narrative for individual patient presentations.
Initial GLA:D® assessments should comprehensively document baseline functional status using program-specific outcome measures, pain patterns, and activity limitations to effectively track progress throughout the program's duration.
Use a side-by-side comparison format that clearly highlights changes in standardized outcome measures, functional status, and self-reported improvements to efficiently document progress through the GLA:D® program.
While individual GLA:D® assessments require detailed patient-specific documentation, group session notes should focus on exercise progression, participant adherence, and any modifications made for specific participants within the standardized program.
Well-documented GLA:D® assessment notes are essential for program fidelity, effective communication with referral sources, and demonstrating the evidence-based outcomes of this specialized osteoarthritis intervention.
Leveraging digital templates specific to the GLA:D® program can enhance documentation efficiency while ensuring all required elements are captured for program evaluation and patient progression.
Patient Information
Presenting Complaint
History of Presenting Condition
Aggravating Factors (Agg):
Easing Factors (Ease):
Red Flags:
None identified during assessment.
Medications:
Radiology and Pathology Results:
24-Hour Symptom Behavior:
Patient Concerns:
Pain Levels:
Baseline Functional Assessment:
Objective Measures Specific to OA:
Initial Examination:
Clinical Impression:
Moderate knee osteoarthritis (right), impacting daily activities and quality of life.
Education Session Details:
Provided an overview of OA, emphasizing the importance of physical activity, weight management, and pacing activities to manage symptoms. Discussed the role of neuromuscular exercises in reducing pain and improving function.
Treatment:
Exercise Program Specifics:
Reassessment:
Plan to reassess in 6 weeks for progress in pain levels and functional outcomes.
Home Exercise Program:
Goals:
Next Appointment:
Quality of Life Measures:
Patient Education on Self-Management Strategies:
Follow-Up and Outcomes Assessment:
Additional Notes or Patient Concerns:
Patient expressed interest in group exercise sessions for OA management; will explore options for participation in the GLA
® program group classes.
Sincerely,
Jane Wilson, PT
Certified GLA
® Practitioner[Your Clinic's Name][Your Contact Information]