Although rehabilitation professions have existed for many decades, the body of knowledge establishing the theoretical underpinnings of treatment methodology remains surprisingly limited. The Rehabilitation Treatment Specification System (RTSS) emerged to address this gap (Zanca et al., 2019). RTSS provides a way to describe rehabilitation interventions with clarity and precision—something our field has needed for decades. It clarifies what we do, why it works, and how it produces change.

Many therapists default to vague descriptions—“gait training,” “cognitive training,” “strengthening”—but these phrases reveal nothing about the active ingredients that actually drive change (Hart et al., 2014). RTSS challenges this superficial language by requiring practitioners to articulate mechanisms. It pushes us to move beyond tradition, habit, and inherited routines.

RTSS organizes treatment targets into four groups, each tied to distinct mechanisms of action (Zanca et al., 2019):

1. Structural Tissue Properties – Change driven by tissue remodeling.

2. Organ Functions – Modifying physiological output through regulation, substitution, or nonvolitional learning.

3. Skilled Performances – Change created by implicit and explicit motor learning.

4. Cognitive & Affective Representations – Change via semantic processing, emotional regulation, and internal representations.

These “targets” represent treatment theory—what we are trying to directly influence.
In contrast, RTSS describes aims as the functional outcomes that shift indirectly because the identified targets change (Hart et al., 2014). Aims live within enablement theory, closer to activity and occupation.

When clinicians, educators, and researchers use RTSS, four things happen:

1. Clinical practice sharpens. Practitioners become explicit about the change they intend to create.

2. Clinical education gains a common language. Reasoning becomes transparent and measurable.

3. Documentation and reimbursement strengthen. We articulate the elements that matter, not just the minutes.

4. Research advances. Data become mergeable and meaningful, accelerating knowledge translation.

In my view, RTSS—if used rigorously and partnered with real clinicians—could finally bridge the decades-long gap between research and practice. It could give occupational therapy the scientific backbone it has always deserved.

OTD Students — Read This Twice

If you are in an OTD program right now, this is the moment to raise your expectations—not lower them. RTSS represents what rehabilitation science should be moving toward: precision, mechanism-based logic, and testable theory. If your program is not teaching you to think this way, it’s not because you’re asking too much — it’s because the profession has historically asked too little of itself.

Science in OT is shifting.
Payers are demanding rigor.
Clinicians are demanding clarity.
Patients deserve mechanism-driven care.

Your generation could be the one that stops relying on inherited models and starts building real, reproducible rehabilitation science. Use RTSS as a blueprint, not a ceiling. Ask your faculty the hard questions:

• What is the mechanism behind this intervention?

• Where is the treatment theory?

• How do we know this approach produces meaningful change?

• How would we test it?

If your professors aren’t equipped to answer, that is not your failure. It is your signal that the profession needs stronger scientific leadership — and you may be the one who steps into that gap.

OT has waited long enough for rigor.
Your generation doesn’t have to.

References

Hart, T., Tsaousides, T., Zanca, J. M., Whyte, J., Packel, A., Ferraro, M., & Dijkers, M. P. (2014). Toward a theory-driven classification of rehabilitation treatments. Arch Phys Med Rehabil, 95(1 Suppl), S33–44.e32. doi:10.1016/j.apmr.2013.05.032

Zanca, J. M., Turkstra, L. S., Chen, C., Packel, A., Ferraro, M., Hart, T., . . . Dijkers, M. P. (2019). Advancing Rehabilitation Practice Through Improved Specification of Interventions. Arch Phys Med Rehabil, 100(1), 164–171. doi:10.1016/j.apmr.2018.09.110