rehab-programme-design

Rehabilitation Programme Design

The best-designed programme in the notes is worthless if the patient does two of the six exercises twice. Adherence is a design property, not a patient characteristic: how many exercises, how long it takes, whether it fits the actual week, and whether the patient understands what each one is for. This designs for that first, then dose and progression — with the criteria to advance written down rather than left to feel.

What This Skill Produces

• The programme by phase — what each phase is for, and the criteria to enter and leave it
• Dosage — sets, repetitions, load, frequency, and the intended difficulty, stated rather than implied
• Progression criteria — the specific conditions to advance, so progression does not depend on recall
• Adherence design — the number of exercises, the time it takes, and where it fits in the patient's week
• The regression plan — what to do on a bad day, which prevents abandonment
• The patient-facing version — plain language, with what each exercise is for and what it should feel like

Required Inputs

Ask for these if not provided:

• The assessment findings — the impairments, the irritability, and the stage of healing or condition
• The goal — what the patient needs to return to, and by when
• Their week — realistically, how much time and what equipment or space they have
• What they have tried — previous programmes, what they did and did not do, and why
• Constraints — other conditions, pain behaviour, load tolerance, and anything contraindicated by the referring clinician

Framework: Design for Adherence, Dose Deliberately, Progress on Criteria

1. Decide the number of exercises by the patient's week, not the impairment list. Three done consistently beats eight done twice. This is the single most consequential design decision.
2. State the intended difficulty. Not just sets and reps — how hard the last repetition should feel, and what a correct effort looks like. Under-dosed rehab is the most common form of failure.
3. Write the progression criteria down. 'Progress when 3×12 is completed with good control and symptoms settle within 24 hours' is a rule. 'Progress when ready' is not.
4. Give a regression, not just a progression. A patient with no plan for a bad day stops entirely.
5. Tell them what each exercise is for. Adherence rises sharply when the purpose is understood, and drops when the programme feels arbitrary.
6. Anchor it to something in their day. After breakfast, before the shower. Unanchored programmes drift and stop.
7. Set the reassessment date at the start. Both to check progress and to signal that the programme is expected to change.

Output Format

Rehabilitation programme: [patient] · [condition] · [date] · [clinician]

Goal: [what they are returning to, by when] · Stage: [phase] · Irritability: [high/moderate/low]

Phase [n] — [purpose]

| Exercise | Sets × reps | Load/level | Frequency | Intended difficulty | What it is for |

|---|---|---|---|---|---|

Time per session: [minutes] · Sessions per week: [n] · Anchored to: [the daily event it follows]

Progression criteria — advance when ALL are met

• [criterion, e.g. completes 3×12 with control]
• [criterion, e.g. symptoms settle within 24 hours]
• [criterion, e.g. no compensation observed]

Regression — on a bad day, do [what] instead. Do not stop entirely.

Stop and contact the clinic if: [the specific signals — not a long list]

Reassessment: [date] · Markers re-tested: [from the initial assessment]

---

Patient version

> [Exercise] — [what it is for, in plain language]. [Sets and reps]. It should feel [description]. It should not [description]. Do this [when].

> A structuring framework for a licensed clinician. It does not prescribe exercise, dosage, or progression for any individual, and it does not assess appropriateness, contraindications, or safety for a specific patient. All clinical decisions, load tolerance and progression judgements remain the treating clinician's.

Quality Checks

• [ ] The number of exercises reflects the patient's real week
• [ ] Intended difficulty is stated, not just sets and repetitions
• [ ] Progression criteria are written as conditions that can be checked
• [ ] A regression exists for bad days
• [ ] Each exercise has a stated purpose in the patient version
• [ ] The programme is anchored to an existing daily event
• [ ] Reassessment is scheduled at the point of prescription
• [ ] Clinical determinations are left to the treating clinician

Anti-Patterns

• Eight exercises at the first visit. Guarantees partial adherence and uninterpretable results.
• Sets and reps with no intended effort. The most common cause of under-dosed, ineffective rehab.
• 'Progress when ready'. Not a criterion; progression then happens by accident or not at all.
• No plan for a flare. The patient stops altogether and returns having done nothing.
• Exercises with no stated purpose. Feels arbitrary and is abandoned first.
• Designing for an ideal week. The programme fails on contact with a real one.
• No reassessment date. The programme ossifies and stops being appropriate.

Example Trigger Phrases

• "Design a rehab programme for a post-op knee"
• "My patient is not doing their exercises — how should I change the programme?"
• "How do I write progression criteria?"
• "Structure a return-to-running programme"
• "How many exercises should I give at the first appointment?"