Knee Condition Progress Tracking Sheet

Patient Information

Name: ___________________ Date Started: //___ Diagnosis: ________________ Provider: _______________

Daily Symptom Tracker

Pain Level (0-10)

Swelling Assessment

• Location: ☐ Above knee ☐ Below knee ☐ Behind knee
• Severity: ☐ Mild ☐ Moderate ☐ Severe

Activity Log

Exercise Compliance

• Prescribed exercises completed: /
• Duration: ___ minutes
• Difficulty level: ☐ Easy ☐ Moderate ☐ Challenging

Daily Activities Impact

• Walking tolerance: ___ minutes/blocks
• Stairs managed: ☐ With rail ☐ Without rail ☐ Unable
• Activities limited by knee: _____________________

Treatment Response

Medications

• Type: ________________
• Dosage: ______________
• Effectiveness: ☐ Poor ☐ Fair ☐ Good ☐ Excellent

Physical Therapy

• Sessions completed this week: ___
• New exercises added: ________________
• Progress notes: _____________________

Goals and Milestones

1. Short-term goal: _____________________
2. Progress toward goal: ________________
3. Barriers identified: __________________

Bring this tracking sheet to all follow-up appointments