Physical Performance Test/Functional Testing Report

Patient: [Patient name]  |  DOB: [DOB]  |  MRN: [MRN]
Sport/Position: [Sport/position]  |  Dominance: [Hand/foot dominance]
Date of Testing: [Date]  |  Location: [Facility/setting]
Episode Context: [Episode context, e.g., post-op month X, pre-return-to-sport, baseline/preseason]
Primary Condition/Region Under Test: [Primary condition/region]
Referring Clinician: [Referrer name and referral question]
Rendering Clinician: [Clinician name, credentials]

(This is a measurement report format. Include only domains that were tested. If a domain would reasonably be expected given the referral but was not performed, document as "Not tested" with reason rather than omitting.)

Reason for Testing

[Chief testing objective and clinical decision this report informs] (State why testing was performed in one sentence. List specific decisions supported: return to participation vs sport vs performance, discharge readiness, equipment/bracing needs, activity restrictions. Note key stakeholders receiving this report. End with: "Final return-to-play clearance remains with the designated medical decision-maker.")

Pre-Test Screening

• Consent: [Informed consent status]
• Contraindications: [Presence/absence of acute swelling, wound issues, unstable symptoms, unsafe pain levels] (If present, document adjustments or deferral.)
• Baseline Symptoms: Pain at rest [0-10], pain with movement [0-10], effusion [none / trace / mild / moderate / severe], recent instability episodes [description if any]
• Functional Prerequisites: [ROM status], [single-leg squat tolerance], [hop-in-place tolerance], [other prerequisites relevant to protocol]
• Psychological Readiness: [Fear/apprehension rating or validated measure and score] (Include for return-to-sport evaluations.)
• Elements Not Assessed: [Element and reason] (Include only if screening elements were deferred; do not omit silently.)

Test Session Protocol

• Environment & Equipment: [Surface], [footwear], [bracing/taping], [measurement devices]
• Warm-up: [Duration and activities]
• Testing Order & Rest: [Order of tests], [rest intervals between tests/trials]
• Standardization: [Instructions provided], [allowed compensations], [depth/form standards]
• Practice Trials: [Number per test]
• Validity & Effort: Patient-reported effort [0-10 or descriptor], clinician-observed effort [maximal / submaximal / guarding noted], invalidated trials [description and reason if any]

Test Battery

(List tests performed by domain. Include only domains tested. If a domain would reasonably be expected but was not performed, list as "Not tested" with reason.)

• Strength: [Tests and muscle groups] / [Not tested: reason]
• Power: [Tests, e.g., jump height, reactive strength] / [Not tested: reason]
• Hop/Unilateral Function: [Single hop / triple hop / crossover hop / timed hop] / [Not tested: reason]
• Dynamic Balance: [Variant used, e.g., Y-Balance, SEBT] / [Not tested: reason]
• Agility/Change of Direction: [Test names; closed-skill / reactive] / [Not tested: reason]
• Movement Quality: [Scoring system and tasks] / [Not tested: reason]
• Conditioning: [Endurance test] / [Not tested: reason]

Results

(Use consistent rounding within each domain. Include units, trials, normalization, symmetry metrics, thresholds, pass/fail, and notes on form/pain/apprehension/invalid trials. If a test could not be completed, mark "Not tested" with reason. Include only domains that were tested.)

Strength

Setup: [Modality: isometric / isokinetic / handheld dynamometry], [muscle group(s)], [joint angle], [dynamometer position], [speed for isokinetic], [stabilization method]

Test	Side	Value (best/avg)	Units	Normalized	LSI or Δ	Threshold	Result	Notes
[Test name]	[L / R]	[Value, # trials]	[Units]	[Nm/kg or N/kg]	[LSI % or Δ]	[Threshold]	[Pass / Fail]	[Form, pain, invalid trials]

Power

Setup: [Test apparatus], [arm swing: allowed / restricted], [countermovement / squat jump], [scoring: best / average]

Test	Side	Value (best/avg)	Units	Normalized	LSI or Δ	Threshold	Result	Notes
[Test name]	[L / R / Bilateral]	[Value, # trials]	[cm / RSI]	[Normalized value]	[LSI % or Δ]	[Threshold]	[Pass / Fail]	[Notes]

Hop/Unilateral Function

Standards: [Distance / timed], [landing criteria], [arm swing: allowed / restricted], [scoring: best / average], [invalid trial criteria]

Test	Side	Value (best/avg)	Units	LSI or Δ	Threshold	Result	Notes
[Hop test name]	[L / R]	[Value, # trials]	[cm / sec]	[LSI % or Δ]	[Threshold]	[Pass / Fail]	[Form, pain, invalid trials]

Dynamic Balance

Variant & Scoring: [Exact test variant], [reach directions], [scoring method], [limb length normalization: yes / no] (Do not compare scores across different test variants.)

Test	Side	Composite/Reach Score	Units	Normalized	LSI or Δ	Threshold	Result	Notes
[Balance test name]	[L / R]	[Score, # trials]	[cm / %LL]	[Normalized value]	[LSI % or Δ]	[Threshold]	[Pass / Fail]	[Notes]

Agility/Change of Direction

Course & Timing: [Course layout], [timing method], [turn directions tested], [closed-skill / reactive], [sport-specific constraints]

Test	Direction	Value (best/avg)	Units	Δ (L vs R)	Threshold	Result	Notes
[Agility test name]	[Left-turn / Right-turn / Bilateral]	[Value, # trials]	[sec]	[Δ time or %]	[Threshold]	[Pass / Fail]	[Notes]

Movement Quality

Scoring System: [System name], [tasks assessed], [scoring rules]

Task	Score	Key Faults	Fatigue Effect	Threshold	Result	Notes
[Task name]	[Score]	[Valgus / trunk lean / stiff landing / asymmetry / other]	[Worsened / No change / Improved]	[Threshold]	[Pass / Fail]	[Notes]

Conditioning

Protocol: [Test name], [stage progression/speed], [termination criteria], [environmental conditions]

Test	Primary Metric	Units	Secondary Metrics	Threshold	Result	Notes
[Conditioning test name]	[Value]	[Units]	[HR response, RPE, symptoms]	[Threshold]	[Pass / Fail]	[Notes]

Summary Dashboard

(Optional single-glance summary. Mark domains not performed as "Not Tested" rather than omitting.)

Domain	Status	Key Metric	Notes
Strength	[Pass / Borderline / Fail / Not Tested]	[Key metric]	[Brief note]
Power	[Pass / Borderline / Fail / Not Tested]	[Key metric]	[Brief note]
Hop/Unilateral Function	[Pass / Borderline / Fail / Not Tested]	[Key metric]	[Brief note]
Dynamic Balance	[Pass / Borderline / Fail / Not Tested]	[Key metric]	[Brief note]
Agility/Change of Direction	[Pass / Borderline / Fail / Not Tested]	[Key metric]	[Brief note]
Movement Quality	[Pass / Borderline / Fail / Not Tested]	[Key metric]	[Brief note]
Conditioning	[Pass / Borderline / Fail / Not Tested]	[Key metric]	[Brief note]

Interpretation

[Narrative summary of current functional capacity and primary limiting factors] (State what the data indicate. Document whether tested criteria were met or unmet. Do not diagnose new pathology or state clearance beyond scope.)

• Key Deficits: [Prioritized list: asymmetry, absolute performance gaps, movement quality concerns, pain-limited performance, fatigue intolerance]
• Clinical Significance: [Whether deficits are performance-limiting, reinjury-risk relevant, or both]
• Comparisons: [Baseline or normative comparisons if available; note if not available]
• Limitations: [Missing tests, pain-limited effort, learning effects, non-standard conditions and effect on interpretation]

Readiness Recommendation

(Include when return-to-sport or return-to-activity decision is in scope.)

Readiness Level: [Not ready for return to participation / Ready for return to participation (modified training) / Ready for return to sport (full practice) / Ready for return to performance (unrestricted competition) / Deferred pending medical clearance]

• Criteria Met: [List met criteria]
• Criteria Unmet: [List unmet criteria]
• Restrictions/Allowances: [Contact status], [cutting/pivoting], [minutes limits], [bracing requirements], [surface/footwear constraints]
• Final Clearance Decision-Maker: [Name/role if not rendering clinician]

Plan

• Training Priorities: [Strength], [power/reactivity], [neuromuscular control], [conditioning]
• Sport/Activity Progression: [Stepwise progression with criteria to advance]
• Risk Mitigation: [Technique coaching], [workload monitoring], [bracing/taping], [environmental considerations]
• Follow-up: [Retest timing], [tests to repeat], [stakeholder communication]
• Referrals: [Referrals if needed]

Billing Metadata

• Total Face-to-Face Testing Time: [Minutes]
• Written Report: Generated and provided to stakeholders

Signature

Clinician Signature: [Name, credentials]  |  Date: [Date]

Distribution: [Patient, surgeon, referring provider, athletic trainer, other recipients]