The Role of Enablement Theory in Rehabilitation Practice, Education, and Research

Enablement theory refers to the theoretical framework that describes the interrelationships among different areas of functioning, such as those illustrated by the International Classification of Functioning, Disability, and Health (ICF). Enablement theory is necessary to explain causal relationships and predictions of how changes in one aspect of function impact distal outcomes. This is in contrast with treatment theory, which describes how the active ingredient(s) of an intervention directly impact a measurable target. Enablement theory helps clinicians articulate their rehabilitation treatment plans by identifying the underlying targets necessary to achieve a patient's desired outcomes and monitor the response to treatment. In this manner, enablement theory can also support the education of novice and experienced clinicians and/or trainees in their clinical reasoning process. Enablement theory helps researchers articulate the relationships they hypothesize between the aspects of function they seek to change with an intervention and the immediate and distal outcomes of that intervention. Researchers can then design the rehabilitation intervention and identify key outcome measures to rigorously test their conceptual framework, including the important mediators of the intervention's effects, and aid in the interpretation of study results. The use of enablement models has not been well-described in the rehabilitation literature, and formal research focused on understanding the nature and strength of the relationships within these enablement models is necessary to advance the field of rehabilitation. We discuss how enablement theory contributes to our understanding of rehabilitation interventions in the context of clinical practice, health professions education, and rehabilitation research.