Making the Invisible Visible: Theory and Treatment Specification in Occupational Therapy

In my final editorial as the Editor-in-Chief of the American Journal of Occupational Therapy, I reflect on the evolving role of theory in advancing treatment specification and interdisciplinary rehabilitation practice. Drawing on the Rehabilitation Treatment Specification System (RTSS) and recently published reporting guidelines, I distinguish between treatment theories, which explain how intervention ingredients are expected to change proximal targets, and enablement theories, which clarify how multiple targets collectively support distal participation outcomes. Using occupational therapy-specific and interdisciplinary examples, I illustrate how enablement theory complements treatment specification by connecting what occupational therapy practitioners do in intervention to what matters most to clients. While acknowledging the inherent complexity of rehabilitation interventions and the likelihood that early applications may be imperfect, I argue that progress requires deliberate use, reflection, and revision. Ultimately, this editorial invites occupational therapists to engage with theory as a practical tool for making intervention logic visible, communicable, and open to refinement.