Screening Tool FREE ONLINE SCREENING Could Physical Therapy Help You Move More Confidently? Select every statement that applies to you or your loved one. Your result will appear at the bottom of the screening. 1 Post-Procedure & Recovery Status Select any statements that apply to you or your loved one. Recent Surgery I have recently had a joint replacement (hip, knee, or shoulder) or another surgical procedure and need expert help regaining strength, range of motion, and flexibility. Incomplete Recovery I had surgery or a medical procedure months ago, but I still do not feel that I have fully recovered my normal mobility or walking stability. Graduation from Home Health I am transitioning out of home health physical therapy and need to continue my recovery in a private, one-on-one clinic setting. 2 Daily Mobility & Balance Select any statements that describe your current daily habits. Furniture Walking I find myself holding onto walls, tables, or countertops for support while moving around the house. Activity Avoidance I am skipping activities I enjoy, such as gardening, neighborhood walks, or shopping, because I feel unsteady or tire too quickly. Stair Difficulty Using stairs has become difficult or stressful, or I rely heavily on the handrail. Recent Slips I have had a minor slip, trip, stumble, or fall within the last year. 3 The At-Home Strength Test Sit in a standard, sturdy dining chair with your arms crossed over your chest. Try to stand completely and sit back down. Do not attempt this test without assistance if you feel unsafe. Hand Assistance I cannot stand from a standard chair without pushing off with my hands or arms. Slow or Unsteady It takes significant effort to stand, or I feel off-balance immediately after standing. The 30-Second Count I complete fewer than 10 stand-and-sit repetitions in 30 seconds, or I feel too fatigued or unsafe to finish. 4 Confidence & Safety Assessment Select any statements that match your current peace of mind. I worry about falling when I am home alone or out in public. My family members or friends have expressed concern about my balance or safety. My balance and independence have noticeably declined compared with last year. ✓ Complete the screening above. Select any statement that applies to see your screening result. Contact Our Team Call (262) 321-7164 Clear My Answers This screening is for general informational purposes only and is not a diagnosis or a substitute for medical advice. If you are experiencing a medical emergency, call 911.
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