Impairments, Contributing Factors, Safety and Red Flags

Impairments can be anatomical, physiological, cognitive, physical or psychological. Mark stresses reasoning about why a problem developed or persists, sorting contributing factors into intrinsic or extrinsic and modifiable or not, since recurrence follows if they are not addressed. Safety judgments decide whether to examine, how limited the examination should be, which tests to add, and whether and how strongly to treat. Caution increases with neuropathic or nociplastic pain, anxious or fearful patients, high severity and irritability, active systemic inflammation, osteoporosis and rapidly worsening conditions. Conditions that can look musculoskeletal, such as gastrointestinal problems presenting as back pain, call for a watch and wait approach. Red flags are poor predictors on their own, so screening covers history of cancer, infection in the last six weeks and trauma, along with symptoms that are unexplained, unrelieved by rest, out of proportion or not helped by treatment, night pain, links to food or bowel and bladder, confusion and constitutional symptoms. Unplanned weight change of 10% over 10 to 21 days is one cited threshold.