The task
Assume that today's date is 22 October 2026. Mrs Sethi had her initial physiotherapy assessment on 27 August 2026 and attended her eighth weekly treatment session today.
You are a physiotherapist at an outpatient physiotherapy clinic. Using the information in the case notes, write a letter to Mrs Sethi's GP, Dr Arun Juneja, updating him on her progress and asking him to consider further management. Address the letter to Dr Arun Juneja, General Practitioner, General Practice, 42 Park Road. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Update letter.
Case notes
Patient details
- Name: Mrs Jocelyn Sethi
- DOB: 14/03/1971 (55 yrs)
- Address: 15 Elm Street
- Referred by Dr Arun Juneja (GP) 08/26 with R frozen shoulder; initial physio assessment 27/08/26
Social background
- Office administrator, full time; mainly computer work; R-handed
- Married; husband currently doing most household tasks
- Enjoys gardening and swimming; unable to swim since onset
- Husband remarked at 3rd appt that she 'has always made a fuss about pain'
Medical history
- Type 2 diabetes (6 yrs): metformin 1 g BD; HbA1c 7.1% (06/26)
- Hypothyroidism: levothyroxine daily
- Appendicectomy aged 19
- Allergies: nil known
Initial assessment (27/08/26)
- Insidious onset R shoulder pain approx. 5/12 ago; no trauma
- R shoulder X-ray (07/26, ordered by GP): no abnormality detected
- Global ↓ active and passive ROM R shoulder, esp. external rotation (ER); night pain 7/10
- No neck-related symptoms; no red flags (no fever, wt loss, trauma or neurological signs)
Treatment
- Weekly physio × 8/52 (03/09/26–22/10/26): education, gentle ROM exercises within pain tolerance, home exercise program (HEP)
- Adherent to HEP: exercises 2×/day
- Analgesia: paracetamol 1 g QID, limited relief; ibuprofen ceased 09/26 due to indigestion
- Complained that clinic receptionist was rude to her on 2 occasions
Progress (22/10/26)
- Wks 1–4: small ↑ ROM (passive ER 10° → 20°)
- Wks 5–8: no further ↑ ROM. Current passive R: flexion 100° (L 170°), abduction 80° (L 165°), ER 20° (L 70°)
- Night pain persists 7/10; wakes 3–4×/night; unable to lie on R side
- Tired at work; ↓ concentration due to poor sleep
- Difficulty dressing (bra, jacket) and reaching overhead shelves
- Anxious condition will 'never get better'; keen to try further treatment options
- Asked about acupuncture, which a friend found helpful for back pain
Plan
- Ask GP to consider intra-articular corticosteroid injection for pain relief; pt willing
- Alternatively / if no improvement: referral to orthopaedic shoulder clinic for further options
- Corticosteroid inj may temporarily ↑ BGL: pt to monitor BGL closely after any injection
- Continue physio fortnightly meanwhile; reassess ROM 4/52 after any injection
- Next physio appt 05/11/26
Who is reading, and what do they need?
Dr Juneja is the GP who referred Mrs Sethi and ordered her July shoulder X-ray. He needs a concise clinical update he can act on: whether treatment has helped, what still limits her, and what you ask him to consider. Keep treatment description brief and give the figures and diabetes-related point that support the request.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Referred 08/26; assessment 27/08/26; R frozen shoulder, insidious onset, no trauma | Orients the GP to the referral and assessment date, so the update has a clear starting point. |
| X-ray 07/26 no abnormality detected; no fever, weight loss, trauma or neurological signs | Records what was found at assessment for the GP who ordered the X-ray. One brief mention is enough; it does not need interpreting. |
| Weekly physio ×8: education, gentle ROM exercises, HEP; exercises done 2×/day | States what has been provided and her adherence, so the GP knows what has already been tried before the request. |
| Wks 1–4 small ↑ ROM (ER 10°→20°); wks 5–8 none; current figures vs L | This is the objective basis for the request. The plateau and the side-to-side comparison need to be accurate. |
| Night pain 7/10; wakes 3–4×/night; cannot lie on R side; tired at work | Pain is what the injection is requested for, and the sleep disruption and effect at work show how much it limits her. |
| Difficulty dressing (bra, jacket) and reaching overhead shelves | Gives the functional impact in two concrete examples, supporting the need for further management without listing every limitation. |
| Paracetamol 1 g QID, limited relief; ibuprofen ceased 09/26 due to indigestion | Shows what pain relief she is taking and why one option stopped, which is relevant to a GP considering other pain treatment. |
| Ask GP to consider injection (pt willing); alternatively or if no improvement, orthopaedic referral | This is the purpose of the letter. Both options, her willingness, and the diabetes and glucose-monitoring point must be clear, with the physio plan and next appointment after them. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Husband said she 'has always made a fuss about pain' | A third party's judgement, not a clinical finding. It does not belong in a professional letter and could bias the reader. |
| Complaint that the receptionist was rude on 2 occasions | An administrative matter for the clinic, not relevant to her shoulder management or to what the GP is asked to do. |
| Asked about acupuncture; friend found it helpful for back pain | Trap: it looks like treatment interest, but acupuncture is not in the plan and the friend's experience concerned back pain. |
| Hypothyroidism on levothyroxine; appendicectomy aged 19 | The notes link neither to the shoulder or to the requests made, so they add words without helping the GP decide. |
| Enjoys gardening and swimming; husband doing most household tasks | Social detail that can be left out or reduced to a passing mention. The dressing and reaching difficulties and sleep effects show the impact more usefully. |
| Anxious it will 'never get better' | Compress or omit. Her wish to try further options already supports the request, and the letter should centre on clinical findings. |
A paragraph plan for this case
Open with the purpose, the referral and assessment date, and the brief initial findings. Use the middle paragraph for treatment and adherence, the plateau with current figures, pain, sleep, function and analgesia. Close with the request (injection, or orthopaedic referral), the diabetes and glucose point, and the continuing physio plan.
Where candidates slip on this task
- Keep dates exact: assessment 27/08/26, eight weekly sessions 03/09/26 to 22/10/26, next appointment 05/11/26. Do not confuse the fortnightly physio schedule with reassessment of range four weeks after any injection.
- Show the plateau exactly as recorded: small gains in weeks 1–4 (passive external rotation 10° to 20°), none in weeks 5–8. Do not add words like worsening, and do not claim the treatment failed.
- Word the request as asking the GP to consider an injection for pain relief, with orthopaedic referral as the alternative or if there is no improvement. State that she is willing.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Physiotherapy letter tasks
- Update to the orthopaedic surgeon: suspected re-tear after rotator cuff repair update letter
- ACL reconstruction rehab - patient relocating referral letter
- Discharge to pulmonary rehabilitation after COPD exacerbation referral letter
Your profession's guide: OET Physiotherapy. Layout and structure: OET letter format.
Questions about this task
How many range-of-movement figures should I include?
The notes give three passive movements with left-side comparisons, but only external rotation has a recorded earlier value (10° to 20°). Using it shows the early gain and plateau; add other figures only if the word limit allows.
Should the blood sugar note be included?
Yes, briefly. The notes say a corticosteroid injection may temporarily raise blood glucose and she has type 2 diabetes on metformin, so it bears directly on the injection request. Say she will monitor closely; do not predict her result.
Sources
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