Procedural Reasoning, Clinical Guidelines, Reassessment and Prognosis

Mark treats management as a hypothesis. Clinical guidelines reduce variability and bias, and Croskerry identified 30 types of cognitive error, but they still have to be applied to the individual. In nociceptive problems, treatment choice depends on stage, severity, irritability, inflammatory or mechanical behavior, the relevance of impairments, pain and resistance, and the patient's goals, tested through trial and mini treatments. Time- or load-dependent symptoms point to control or strength as contributing factors, while a consistently symptomatic movement supports treating the source directly. Treat the most significant impairment linked to the patient's restrictions, not everything at once. Reassessment uses key markers, called asterisks, after the examination, during and after each intervention, at the end of the session and at the next visit, examined over a 24 hour pattern. Improvement means progressing, no change means progressing before discarding, and getting worse means modifying the dose. Prognosis weighs the nature and modifiability of the problem, its status, contributing factors, comorbidities and the person's willingness and self-efficacy to change.