Patient Information and Clinical Reasoning A 72-year-old man is asked what aggravates his back and bilateral leg pains. His response is: ‘Walking. I'm afraid to even try anymore. Even short walks make the back and legs worse, and then I have to sit down to ease it off. Sitting is good, but I can't sit all day! I can't even help out around the house anymore or get over to see the grandchildren. I'm really worried it might be something serious’. The following preliminary interpretations (hypotheses) can be made: ▪ Activity restriction: walking
▪ Activity capability: sitting
▪ Participation restrictions: helping around house and seeing grandchildren
▪ Patient perspectives: afraid to try walking, worried it may be serious
▪ Pain type: consistent mechanical pattern – nociceptive? neuropathic?
▪ Sources of symptoms: lumbar joints and neural (peripheral? central?) implicated
▪ Pathology/syndrome: vascular claudication, stenosis (neuropathic claudication)?
▪ Contributing factors: age
▪ Precautions: age, easily aggravated, bilateral leg pain, patient's fears/worry
▪ Prognosis: (negatives) age, extent of symptoms and disability, neuropathic features, potential for patient's perspectives to be a barrier; (positives) specific easing factor