Non-Response as a Diagnostic Signal: A Decision-Theoretic Framework for Continuation and Exit in Musculoskeletal Physiotherapy

Decisions to continue or discontinue physiotherapy are frequently driven by subjective report and clinician persistence rather than explicit criteria. This paper describes a clinical decision framework in which every intervention is a falsifiable hypothesis test and non-response functions as primary diagnostic information rather than failure. Each case terminates in one of six canonical outputs (DECLINE, DEFER, REFER, TRIAL, CONTINUE, DISCHARGE); continuation requires objective functional improvement within a bounded trial window. Companion framework: doi:10.5281/zenodo.20683788.