Table 5.

Contextual drivers

	Categories	Operational definition and elements
A	Occupation-related contextual drivers	Elements of this category relate to the patient’s perception or beliefs as well as factual elements in regard to the patient’s work/occupation environment. Some elements are to some extent modifiable by the therapist’s approach. These include expectations about return to work, job satisfaction, perception of heavy work, and high job stress. When negative perception about work is identified throughout the interview, these will need to be addressed within your therapeutic strategy. Furthermore, other factual elements might also influence your treatment approach. Much less modifiable by therapy, they include occupational demands (ie, sedentary versus heavy work), job flexibility (ie, availability of modified work), employer’s policies regarding return to work (which can be distinct from provincial/state laws). These will greatly dictate the framework the therapist will have to work with90 and command communication with the employer and/or other health care providers
B	Social environment contextual drivers	As social support from the patient’s environment is an important predictor of success,91 this second category relates to contextual elements in the patient’s social environment. Elements in this category are mostly related to attitudes of the persons within the patient’s environment, including but not limited to employer, family members, and health care professionals. Access to care (ie, limited access to rehabilitation) would also be a contextual element that can drive part of the patient’s disability.